AMA and UnitedHealthcare Create ICD-10 Codes To Document Social Determinants Of Health

Here at this blog, we’ve been talking about social determinants of health for quite some time, and I have little doubt that most of you have been doing so as well. After all, it’s hardly a secret that many factors outside of clinical care play a role in how well a patient is overall.

Given this reality, I was happy to see that the American Medical Association has come together with UnitedHealthcare to standardize how SDOH data is collected, processed and integrated. In short, it’s about time.

This week, the AMA and the health plan said that they supported the creation of almost 2 dozen new ICD-10 codes related to SDOH, with an ultimate goal of combining them with traditional medical data.

In their recent announcement, the two cited a 2014 study from the Robert Wood Johnson Foundation found that nearly 80% of what influences a person’s health relates to non-medical issues such as access to food, housing, transportation and the ability to pay for medications, utilities and other services.

The agreement follows a pilot conducted by UHC in which the health plan tested the use of non-traditional ICD-10 codes to address the needs of Medicare Advantage beneficiaries. The new codes embraced counseling, economic stability, education come on employment, personal care, respite care and social/community supports and involvement.

During the pilot, UHC captured the barriers to care reported by Medicare beneficiaries in a standardized file layout. They then matched the self-reported data to diagnosis codes and integrated it with their clinical data. Between January 2016 and May 2018, UHC collected more than 600,000 data points on social barriers to care.

UHC has since provided more than 560,000 referrals for nearly 100,000 individuals for social services. These referrals generated an estimated $250 million in supports and services for the beneficiaries, UHC said. Common problems cited by the patients included an inability to pay for prescriptions, inability to pay for utilities and a lack of transportation to services unrelated to healthcare.

Going forward, it looks like these codes will be adopted quickly. Research published last year concluded that 80% of healthcare organizations had begun to track and use data on social determinants of health in their population health management strategies. Twenty-one percent of respondents are training doctors to identify social determinants, and 21% have also rolled out point-of-care checklists help physicians identify potential social barriers to care.

Other strategies identified by the researchers to use SDOH info include integrating community programs and resources into population health management programs, integrated medical data with financial, census and geographic data, offering social assessment tools with health risk assessments, incorporating social determinants into the clinical workflow, and using third-party software, data and/or services.

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.