News & Commentary

Insurer, AMA Put New Spin on SDOH


Frank Diamond

In what’s being hailed as the first organized effort to standardize how social determinants of health data are collected, processed, and used for patient care, nearly two dozen new ICD-10 codes related to SDOH have been created through a collaborative effort by UnitedHealthcare and the AMA.

The codes are designed to direct local and national social services to beneficiaries who could use some help when it comes to transportation, food, housing, and financial needs. They were created by combining traditional medical data with self-reported SDOH data, United and the AMA said in a joint statement.

HealthLeaders points out that more states are directing Medicaid managed care plans to address SDOH.

The quality of medical care and access to services explains only about 20% of a person’s health status, according to an oft-cited Robert Wood Johnson Foundation report. SDOH explains about half of the rest.

Michael Cantor, MD, the CMO of CareCentrix, a consulting company that helps providers and health plans better facilitate home care, told Managed Care via email that the codes would allow clinicians to document patients’ social barriers to care and refer them to community organizations that could meet those needs.

“The codes will also indicate if patients are unable to pay for transportation for medical appointments or prescriptions as well as if they have inadequate social interaction or fears about losing housing,” Cantor said.

Medicare Advantage plans could use the codes to shift the site of care.

“For example, if a dialysis patient is being treated in a dialysis center three times a week, and the patient has the code for transportation barriers, the health plan care management team could work with the patient’s clinicians to schedule dialysis treatments in the home to improve outcomes and lower the cost of care,” Cantor said.