Health outcomes can be influenced by many factors other than the health care services received, including patient-related factors such as existing clinical conditions and sociodemographic status (SDS), which refers to a variety of socioeconomic (e.g., income, education, occupation) and demographic factors (e.g., age, race, ethnicity, primary language).  

While risk adjustment for clinical conditions is a common consideration for quality measures in certain situations (particularly outcome measures), consensus on the appropriateness of adjusting quality measures for SDS-related risk factors is still evolving. Careful evaluation of SDS risk adjustment reflects an important component of health equity by ensuring that organizations that care for disadvantaged populations are measured fairly.  

PQA has a new frequently asked questions (FAQ) document that addresses background and basics of SDS risk adjustment and PQA’s risk adjustment recommendations for the three adherence measures in Medicare Part D (PDC-Diabetes All Class, PDC-Renin Angiotensin System Antagonists, and PDC-Statins).

CMS recently finalized its plans to implement PQA’s risk adjustment model for the adherence measures that will be phased in over three years. CMS will first display the SDS risk adjusted medication adherence measures for the 2024 measurement year (2026 display page), while the legacy adherence measures remain in the Star Ratings. The SDS risk adjusted measures will replace the existing medication adherence measures beginning with the 2026 measurement year (2028 Star Ratings). CMS also intends to incorporate the SDS risk adjustment operationally to these measures reported by CMS to Part D sponsors in the last monthly patient safety report for the measurement year.

For more information, see CMS’ 2024 Medicare Advantage and Part D Rate Announcement, plus PQA’s summary of the announcement, as well as the CMS rule for Medicare Advantage and Part D (CMS-4201-F), and PQA’s summary of that rule.

In addition to the PQA SDS Risk Adjustment FAQ document, the March 16 PQA Quality Essentials Webinar detailed risk adjustment in quality measurement and provided an overview of the shifts in thinking related to risk adjustment. Subscribe to PQA’s YouTube channel to receive updates and notifications when new videos are added.

For more information, read about PQA Measure Use in CMS’ Part D Quality Programs and PQA’s adherence measures.