New ICD-10 Codes will help Physicians Tackle Social Barriers to Care

A new collaboration between the AMA and UnitedHealthcare will work to address the social and environmental factors that affect patients’ health by standardizing data collection on their social determinants of health (SDOH) to help address individuals’ unique needs that often go unmet.

The two organizations are supporting the creation of 23 new ICD-10 codes related to social determinants. ICD-10 codes are typically used to record diagnosis, symptoms and procedures. Social factors that the new codes would capture include:

  • Access to nutritious food.
  • Adequate and safe housing.
  • Available transportation.
  • Financial ability to pay for medications.
  • Financial ability to pay for utilities.
  • Caregiver needs.

“The AMA is excited to work with UnitedHealthcare through the continuing efforts of our Integrated Health Model Initiative™ [IHMI] to foster collaboration around innovative data and technology-driven processes for incorporating social determinants of health into routine medical care,” said Tom Giannulli, MD, IHMI chief medical information officer. “The collaboration reinforces the importance of social and environmental factors in patient care, and will shape IHMI’s efforts to support clinical decisions with useful and valid data to achieve broad improvements in health and greater health equity.”

The IHMI group is a collaborative effort across health care and technology stakeholders that seeks to improve patient health outcomes by empowering physicians with the clinically valid health care data needed to make informed clinical decisions. IHMI supports a market-informed, continuous learning environment to enable interoperable technology solutions and care models that evolve with real-world use and feedback.

The effort is a recognition that unmet social needs have a significant impact on a person’s health and well-being. It aims to collect the self-reported data in a manner that minimizes variation to solve problems caused by non-standardized data and data quality issues.

Because UnitedHealthcare, a UnitedHealth Group company, directly contracts with more than 1.3 million physicians and other health care professionals they have an existing network with the capacity to take this mission on.

“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,” said Bill Hagen, UnitedHealthcare clinical services president.

Providing Non-medical Services

The new codes will also trigger referrals to local and national social and government services to address the patient’s self-reported social barriers to better health.

Some 560,000 referrals were made in 2017 for individuals enrolled in UnitedHealthcare Medicare Advantage plans, the company reported. These referrals connected people to transportation, nutrition assistance and social programs that reduce isolation, UnitedHealthcare reported.

Nearly 80 percent of the factors that affect a person’s health are non-medical in nature, according to the Robert Wood Johnson Foundation. By capturing standardized data on such elements as employment, isolation, veteran status and other social determinants, the AMA-UnitedHealthcare collaboration is poised to address non-medical barriers to better health.

Privacy To Be Protected

The proposed codes were presented at a March 6 meeting of the Centers for Medicare & Medicaid Services’ (CMS) ICD-10 Steering and Maintenance Committee and are out for public comment. If CMS adopts the codes, they will apply to fiscal 2020, which runs from Oct. 1, 2020 through Sept. 30, 2021.

UnitedHealthcare said it does not seek to add to physicians’ administrative burdens and noted that the 23 new codes would not significantly grow the ICD-10 database of 68,000 codes. It also noted that physicians would not be reimbursed for adding the new codes on a claim for payment.

Some of the data collected qualifies as protected health information (PHI) as defined by the Health Insurance Portability and Accountability Act (HIPAA). UnitedHealthcare said it will follow HIPAA regulations and industry standards regarding sharing PHI.

The AMA plans to review the model in several areas, including compatibility with Fast Healthcare Interoperability Resources, the burden on physicians and other health professionals, and potential social bias.

AMA policy supports efforts to integrate training in social determinants of health in the medical school curriculum and support payment-reform policy proposals that encourage screening for social determinants of health and referral to community-support systems.

UnitedHealthcare stated that one of its long-term goals is to build support for reimbursement of nonclinical support by standardizing fair market value for these services.

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