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AMA, UnitedHealthcare team up on billing codes that address social determinants of health

The two organizations are working together to standardize how data is collected, processed and integrated regarding SDoH.

Jeff Lagasse, Associate Editor

UnitedHealthcare and the American Medical Association have entered into a new collaboration that will better identify and address social determinants of health with the goal of improving access to care and patient outcomes, the groups announced on Tuesday.

Building on work initiated by UnitedHealthcare, the two organizations are working together to standardize how data is collected, processed and integrated regarding critical social and environmental factors that contribute to patient well-being -- also called social determinants of health.

IMPACT

Nearly 80 percent of what influences a person's health relates to non-medical issues, such as food, housing, transportation and the financial means to pay for medications, utilities and other services, according to a Robert Wood Johnson Foundation analysis. Yet the healthcare system doesn't have a consistent, organized way to capture those needs and then incorporate the data into a person's overall care plan.

Throughout the collaboration, UnitedHealthcare and the AMA are supporting the creation of nearly two dozen new ICD-10 codes related to SDoH. By combining traditional medical data with self-reported SDoH data, the codes trigger referrals to social and government services to address people's unique needs, connecting them directly to local and national resources in their communities.

The collaboration illustrates a growing recognition of the partnerships that are essential to the success of patient-centric healthcare, the groups said. With a consistent set of standardized data, healthcare organizations can tap into local and national resources to connect people to social and government services.

Typically, physicians and care providers use a system of ICD-10 codes to classify and record all diagnoses, symptoms, and medical treatments and procedures. UnitedHealthcare has developed a data model focused on standardizing the capture and processing of SDoH-related information.

WHAT ELSE YOU SHOULD KNOW

Essential to improving health and wellness are identifying and aggregating critical factors of patient well-being, such as employment, education, food, housing, access to transportation other factors.

UnitedHealthcare partners with national and local community-based organizations to expand access to critical social services. Using its data model, UnitedHealthcare has made more than 700,000 social-service referrals for people enrolled in its Medicare Advantage plans since 2017, providing an Imputed Market Price of more than $250 million.

The AMA's Integrated Health Model Initiative group, meanwhile, is dedicated to ensuring that data portability standards and semantic interoperability are openly achievable and keep pace with innovation. Its work continues to focus on market-driven needs in healthcare data interoperability through the development of common data portability standards that enhance information sharing and unlock potential improvements in patient outcomes.

ON THE RECORD

"The AMA is excited to work with UnitedHealthcare through the continuing efforts of our Integrated Health Model Initiative to foster collaboration around innovative data and technology-driven processes for incorporating social determinants of health into routine medical care," said Tom Giannulli, chief medical information officer of AMA's IHMI. "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 TREND

Automation, and technology that learns as it goes, is one way providers can make sense of the glut of SDoH data, and make informed decisions based on it.

These technologies aren't new, exactly, but they're still maturing. That doesn't mean it's too early to jump onboard. Embracing new approaches can be one way to ensure that SDoH are addressed in a timely and efficient manner.

Twitter: @JELagasse

Email the writer: jeff.lagasse@himssmedia.com

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