UnitedHealthcare, AMA ask ICD-10 for 23 new codes for SDoH

UnitedHealthcare and the American Medical Association have joined forces to enable healthcare organizations and payers to use ICD-10 codes for social determinants of health.

UnitedHealthcare and the American Medical Association have joined forces to enable healthcare organizations and payers to use ICD-10 codes for social determinants of health.

The two organizations say they are working together to standardize how data is collected, processed and integrated when it comes to the factors that contribute to a patient’s overall health. As part of that effort, last month they recommended 23 new codes to the ICD-10 Coordination and Maintenance Committee.

The codes cover problems related to education and literacy; psychological development disorders; employment and unemployment; occupational exposure to risk factors; housing and economic circumstances; the inability to pay for prescriptions, utilities, medical care and other needs; the inability to deal with stress; inadequate social interaction; and feeling unsafe.

According to Sheila Shapiro, senior vice president of National Strategic Partnerships at United, the ICD-10 committee welcomed the recommendations and held a “very engaging” dialogue with representatives from the AMA and United. For some of the codes, the committee even asked why the two groups hadn’t “gone deeper” with their suggestions, she says.

Shapiro expects to hear by late June or early July if the committee approves the recommendations. The earliest the codes would be available for use would be 2020, but she is not dismayed. “These things take time,” she says.

According to the AMA’s Integrated Health Model Initiative’s chief medical information officer Thomas Giannulli, MD, the AMA is dedicated to ensuring that data portability standards and semantic interoperability are openly achievable and keep pace with innovation. “As we looked at the codes themselves, they really are an excellent place to start,” he says. “ICD-10 codes describe patients’ conditions for reporting purposes; it made perfect sense.”

According Shapiro, United’s network includes 1.3 million doctors and 6500 hospital systems with a shared vision to address all aspects of life that contribute to a patient’s health. “Leveraging a code system that already exists is an easier way to get large-scale traction on this work,” she says.

Minnetonka, Minn.-based UnitedHealthcare, a division of United HealthGroup, has been coding for SDOH for some time and has developed a data model focused on standardizing the capture and processing of SDOH-related information, according to Shapiro. Using that model, United has made more than 700,000 social service referrals for people enrolled in its Medicare Advantage plans since 2017—at an estimated value of $250 million.

United has a chronic condition program that assists in making sure that patients are getting the care they need, Shapiro says. Adding more codes will only make things better for doctors and the payer as they continue this work. The SDOH needs are self-identified by the patients.

“By creating a common language to share this information, we have designed a model that allows us to share known information, so we can reuse those referrals that we’ve already made,” Shapiro says. “This occurs naturally with our clinical teams and other touch points within our organization. We leverage a standard code set.”

The latest recommendations “bring a voice to all that work that was really unknown to the healthcare system, but was already there in our existing workflow,” Shapiro says.

The AMA and UnitedHealthcare’s recommendation to expand the existing ICD-10 code set fulfills a hope that both organizations have of “getting the healthcare system thinking about social determinants as a part of health.”

Shapiro is optimistic about the increasing awareness in healthcare, in general, surrounding SDOH. “Good work is occurring everywhere,” she says.

United and the AMA decided to propose the ICD-10 codes “because we know how to scale the work, and healthcare organizations need a common language to be able to speak to each other,” she says.

“Our ambition at United is to redefine health, looking at the whole person,” Shapiro says. “We are looking at overall health and finding better ways to identify, address and improve patient outcomes, which is where we would like to see the industry move in the future.”

Giannulli says the codes will help with data analysis and will provide the “semantic consistency needed” to do apples-to-apples outcomes studies. “To move medicine forward, we need doctors to be able to use social determinants to make good clinical decisions and to drive outcomes,” he says.

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