Risk Adjustment Methods for Patient Experience to Advance Health Equity

Project Summary

The project team will leverage Massachusetts Health Quality Partners' (MHQP) existing annual patient experience survey to explore social risk factors in adjustment models. Their aim is to fairly compare racial and ethnic disparities in patient experiences across organizations with different patient populations and to better understand racial inequities in patient experiences. The team will engage national and local stakeholders to accomplish the goals of developing and implementing social risk adjustment and other provider comparison methods that fairly account for the intersection of race, ethnicity and social risk factors, and of deepening the understanding of the ways in which social risk explains and reinforces racial and ethnic disparities in patient experience. Through this work, the project team will shed light on structural disparities in healthcare for Black, Hispanic/Latino/a/x, Asian, and other patients of color.  The project ultimately aims to inform value-based payment reforms that promote fair comparisons and incentivize the reduction of disparities.

Research Question(s)

  1. What social risk factors contribute to racial and ethnic disparities in patient experiences?
  2. What are approaches for testing and developing fair and valid models that account for social risk in evaluating patient experiences?


  1. Informed knowledge regarding the underlying mechanisms of racial and ethnic disparities in patient experience can lead healthcare providers and other stakeholders to improve public health and clinical interventions. 
  2. Payers and regulators can use the newly developed approach to account for social risk in patient experience to inform the design of value-based payment reforms that achieve the dual goal of fairly comparing racial and ethnic disparities in patient experience and incentivizing providers to reduce disparities.
  3. Researchers can further investigate healthcare disparities using insights from this project.
  4. Advocacy groups can leverage findings to support equitable healthcare practices.

Racial Equity Implications

The MHQP's annual statewide Patient Experience Survey results showed that Black, Hispanic/Latino/a/x, and Asian patients reported worse experiences with primary care compared to white patients. These patient experience disparities translate to disparities in health outcomes, as patient experience is associated with care processes for prevention and disease management, adherence to medical advice and treatment plans, and technical quality of care. Patient experience measures play an invaluable role in revealing structural disparities in healthcare for patients of color, shedding light on unequal treatment, biased interactions, and the enduring impact of racism on patient care.


Health outcomes: Patient experience, quality of care


The project team will analyze the Massachusetts Health Quality Partners’ (MHQP) annual statewide Patient Experience Survey dataset to measure racial and ethnic disparities in patient experience and assess the underlying social risk factors that drive these disparities. To achieve this, the team has three phases: 1) defining principles for measuring racial and ethnic disparities in patient experiences with a workgroup of national experts and local stakeholders; 2) developing risk adjustment approaches to test new risk variables and possible adjustments; and 3) interpreting results by engaging with national experts and local stakeholders (e.g., MHQP’s Physician, Health Plan, and Consumer Health Councils).

Black doctor smiling and holding a clipboard to help an elderly patient
Grantee and Partner organizations

Massachusetts Health Quality Partners
Cambridge Health and Alliance Health Equity Research Lab

Grant status
In Progress
Principal investigators
Barbra G. Rabson, MPH
Ben Lê Cook, PhD, MHP
Marcela Horvitz-Lennon, MD
Start date
Award amount
18 months

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