Utilization of Social Determinants of Health in Healthcare  

Social determinants of health (SDOH) refer to the non-genetic and non-medical conditions in the places people live, learn, work and play that affect health and quality-of-life risks and outcomes. Factors such as economic stability, education, food, housing, transportation, community, and social situations all feed into the social determinants of health. In recent years these have begun to be utilized in promoting health and health equity. It has been determined that a patient’s care journey is 80% dependent on non-clinical factors such as socioeconomic or environmental.   

Our current health system is moving toward a value-based model which incentivizes positive results rather than individualized treatments and procedures. With this shift, healthcare leaders increasingly regard social determinants of health as a critical part of overall healthcare efforts and indicators. By including these facets with standard medical care, providers are taking a holistic view of their patients and enhancing patient care, promoting better outcomes, and driving value.  

There are a growing number of initiatives to address SDOH within healthcare and outside of the healthcare system. Outside, these initiatives aim to shape policies and practices in non-health areas in ways that promote health and health equity. Within the healthcare system, collecting this data can help improve quality and care coordination by identifying social risks and unmet needs such as homelessness or lack of transportation. In addition, they can help to determine healthcare and services follow-up and to plan a patient’s discharge from a hospital situation. Understanding the external factors that can impact a patient’s overall health can also trigger needed referrals to social services that can help meet that individual’s needs.   

Recording Social Determinants of Health 

It has been established that any member of a patient’s care team can collect social determinants of health data during a visit. This includes providers, social workers, community health workers, case managers, and nurses. This data, once gathered, is then recorded in the patient’s health record.   

When ICD-10 codes were first released, they included codes that encompassed SDOH. Some of these “Z” codes are:  

• Z55 – Education  
• Z56 – Employment  
• Z59 – Housing and Economic  

• Z60 – Social Environment  
• Z61 – Live Events  
• Z62 – Upbringing  
• Z63 – Family and Social Support Issues  
• Z64 – Certain Psychosocial Circumstances  

• Z65 – Other Psychosocial Circumstances  

These codes were established to better understand what is happening outside of physical health that can contribute to a patient’s overall well-being. For example, access to public transportation affects a person’s ability to go to work, get healthy food, healthcare, and other important health and wellness factors.   

Z Codes Not Widely Utilized  

According to the American Hospital Association, the Z codes are being utilized infrequently. Reasons range from the codes not being part of reimbursement to not having time to ask the necessary questions during the encounter. As the landscape of healthcare shifts more and more toward value-based care, this information will become extremely important to ensure favorable outcomes in a patient’s overall health.   

Several national initiatives are gaining traction concerning SDOH, including Healthy People 2030 and The Gravity Project. Utilizing these codes can allow for trends to be identified and community-based programs to be started in areas that need social services and prevention programs. And according to the Kaiser Family Foundation’s 50-state Medicaid budget survey, several states require Medicaid MCOs to address social determinants of health as part of their contractual agreement. In addition, in 2018, the CHRONIC Care Act expanded coverage under Medicare Advantage plans to include non-medical interventions. These include transportation to medical appointments, meal delivery, and home improvements that add accessibility, such as installing a wheelchair ramp or handrails.   

Challenges  

It has been acknowledged that one of the most significant challenges related to social determinants of health is the lack of a consistent definition and agreement around what truly is a social determinant. Also cited was the lack of standardization and validated SDOH measures as a major barrier. The concern is around different entities utilizing different methodologies to measure SDOH making comparisons through populations and changes difficult. The thought is that states need to agree on standardizing the various data collection approaches and then incorporating the information into EHRs. Without a uniform reporting and collecting method, the ability of agencies, health plans, and providers to share data and use SDOH to guide their strategies, care planning and make referrals is very limited.   

The other challenge that must be overcome is the lack of interoperability between technology systems like third-party SDOH tools and electronic health records (EHRs).   

Social determinants of health codes can be very powerful tools to collectively measure and evaluate social determinants of health on a national scale. These external factors affecting patients’ health can justify risk adjustment payment methodologies, higher levels of evaluation and management services, prolonged services, extended monitoring, etc. Utilizing these codes can greatly impact public health issues if providers and coders embrace the importance of including these in their comprehensive clinical documentation.   

_________________________________________________________________________________  

Who is Billed Right?  

In 2006, two business partners envisioned creating holistic services that help improve medical billing operations. They started by listening to doctors and building a service model around what doctors need the most. As a result, Billed Right’s Revenue Cycle Management (RCM) model was born. The focus continues to be on solving the problem rather than selling a product. Hence, Billed Right’s advanced RCM model revolves around personalized service in today’s corporate world while still cutting costs and improving patient care and practice revenue. As a strategic partner, we look to streamline your revenue cycle and operational management, thus helping you to grow your healthcare practice.  

Contact Billed Right to learn more.