As the health care industry turns its attention to models that address social barriers that prevent people’s access to better health, two big-name organizations have joined forces to push providers to use data for social determinants of health to improve and simplify how referrals are made to social services.
UnitedHealthcare and the American Medical Association (AMA) have announced plans to work together to standardize how data on critical social and environmental factors that contribute to patient well-being is collected, processed, and integrated into care plans.
The two organizations will push for the creation of 23 new ICD-10 codes to help incorporate social determinants of health into routine medical care. ICD-10 codes typically capture diagnosis, symptoms, and procedures, but if approved, these new codes will capture access to nutritious food, adequate and safe housing, available transportation, financial ability to pay for medications, financial ability to pay for utilities, and caregiver needs. UnitedHealthcare and the AMA also want the codes to trigger referrals to social and government services, connecting patients directly to local and national resources in their communities.
The collaboration is in response to growing recognition that unmet social needs have a significant impact on a person’s health and well-being. Indeed, research shows that nearly 80 percent of what influences a person’s health relates to non-medical issues. The current health care system doesn’t have a consistent, organized approach to capture and address those needs.
“UnitedHealthcare and the AMA share a common goal of expanding the health care system’s perspective to consider the whole person–not just medical care–by placing as much emphasis on people’s social needs as on their clinical needs,” said Bill Hagen, UnitedHealthcare clinical services president, in an announcement about the collaboration. “By working together to leverage data, technology and the incredible expertise of our network physicians, we can more effectively address the social factors that limit access to health care.”
UnitedHealthcare is in a good position to take on the mission because it directly contracts with more than 1.3 million physicians and other health care professionals. The organization has already developed a data model focused on standardizing the capture and processing of information related to social determinants. The model has led to more than 700,000 social-service referrals for members enrolled in its Medicare Advantage plans since 2017.
The company presented the proposed codes in March to the Centers for Medicare & Medicaid Services’ (CMS) ICD-10 Steering and Maintenance Committee. If the agency adopts the codes, they will take effect on October 1, 2020, according to the AMA.
The AMA said it supports efforts to integrate training in social determinants of health in the medical school curriculum and is in favor of payment-reform policy proposals that encourage screening for social determinants and referrals to community-support systems.
CMS has also made moves to pay for services related to social determinants. In its Final Call Letter released earlier this month, it allows Medicare Advantage plans to offer chronically ill patients a broader range of supplemental benefits, such as providing meals beyond a limited basis, and transportation for non-medical needs like grocery shopping.
RISE will take a deeper look at what Medicare Advantage health plans can do to address social determinants of health at The National Summit on Social Determinants of Health, June 23-25, in Washington, D.C. Click here to see the preliminary agenda.