Quality over Quantity: Developing New Measures to Assess Patients’ Experiences of Social Care

I want to just tee up the presentation by offering a little context for this project.

It will come as no surprise to any of you that over the last decade, we've seen a lot of policymaking related to healthcare-based social care, including screening and referral efforts.

We've seen policymakers use every kind of lever, including guidelines, practices, standards, rules, regulations, name your healthcare policy lever, and you'll certainly find something related to social care.

But like many of the folks on

this webinar, I think I realized that social care had hit the big time around 2023 when NCQA, CMS, and several different value-based purchasing programs and the Joint Commission all began developing quality measures or other standards related to social care.

And at first I thought, this is amazing, healthcare is being held accountable for social care.

And then I thought, wait a second, healthcare is being held accountable for social care? Do we really know enough to say what the healthcare sector's role here should be or really what high quality

social care should look like?

And it turns out that I think everybody who's involved in that policymaking was actually struggling with those same questions.

Because I think that's the confusion that explains why the different policies that emerged in this space actually differed quite a bit from one another.

So they differed on things like what domains they included, what instruments they recommended, how frequently screening should be done, who the target population should be, whether the standard should include screening or screening and an intervention of some kind, and then what kind of intervention, and then how the information would be reported.

I just want to highlight those differences so that you can see concretely how that played out.

So again, in 2023 and into 2024, the NCQA, National Committee on Quality Assurance, the Joint Commission, CMS, all introduced measures intended to incentivize social risk screening, and in some cases, interventions.

Now, in

2025, admittedly, CMS actually rolled their measures back in the programs where they had been adopted.

But NCQA and the Joint Commission haven't changed either their HEDIS or their hospital accreditation guidelines as of yet.

And despite the CMS changes in 2025, it may well be that CMS is not entirely out of the game.

In fact, just last week, the Medicaid and CHIP Core Set Working Group just recommended that social needs screening and referral quality measures be included to evaluate Medicare and Medicaid services.

for children and adults nationally.

So we'll see if CMS actually adopts those recommendations or not, but I don't think CMS is out of the game.

What you'll see here is that all of the measures differ a little bit on all of those characteristics that I mentioned just a minute ago on the last slide.

But one of the most fascinating things about all of these measures is that they encourage healthcare organizations, whatever the level of healthcare organization, to increase screening without any accountability for the quality of the screening or subsequent interventions that are being done.

Again, this is just showing that CMS actually moved away from that measure, but it's still out there in some form.

So setting aside all the arguments for and against social risk screening generally, which actually has been the focus of some of our other webinars and papers and some of the other conversations that we've hosted.

And you can go and find those in the SIREN website if you're interested.