Doctor writing a medical prescription in hospital
The American Medical Association and UnitedHealth Group have developed billing codes for social determinants of health as insurers move toward paying for more than just medical treatment to improve health outcomes.
Health insurers are already paying for an array of services from food and nutrition to housing to make sure patients are getting the right care in the right place and at the right time.
But the AMA and UnitedHealth executives say new “ICD-10 codes” that are used to describe diseases and medical procedures in the insurance billing process need to be adopted to address social determinants of health. UnitedHealth's UnitedHealthcare insurance business has created — and the AMA said Tuesday it has endorsed — nearly two dozen new “ICD-10” diagnostic codes to track social determinants of health.
"By combining traditional medical data with self-reported (social determinants of health) data, the codes trigger referrals to social and government services to address an individual’s unique needs, connecting them directly to local and national resources in their communities," UnitedHealthcare and the AMA said in a joint statement.
As one example, a proposed new code would assist a dialysis patient in need of transportation. A patient in need of dialysis three times a week who misses an appointment could have a poor health outcome and wind up in the more expensive emergency room or end up in the hospital for a long-term stay.
“This paves the way for more creative solutions,” UnitedHealthcare senior vice president of national strategic partnerships Sheila Shapiro said in an interview. “If benefits do not exist, we are seeking to assist that (health plan) member with other types of services."
New codes are needed so doctors, social workers, care managers and others can document patients’ social history along with their medical history. The new codes would be an integral part of a patient’s electronic medical record and claims history just like what already exists from tens of thousands of other ICD-10 codes.
“In healthcare, the beauty of (ICD-10) is that you can leverage the existing claims processing to communicate these concepts,” Dr. Tom Giannulli, chief medical information officer for the AMA’s Integrated Health Model Initiative said in an interview. Giannulli said the data is not only in a physician’s chart but also “very portable data.”
By getting out in front of the issue, the AMA and UnitedHealth hope to prevent myriad sets of codes to be developed by multiple parties, adding to the already complex healthcare system. Doctors and other medical care providers already get frustrated when dealing with multiple commercial insurers on top of data sets and billing systems used by government insurers.
The new codes and system to address social determinants could be an industry standard by the end of next year. The proposal for ICD-10 codes for social determinants of health have been submitted to the ICD-10 Coordination and Maintenance Committee, a federal body that includes members from the Centers for Disease Control and the Centers for Medicare & Medicaid Services.
“UnitedHealthcare and the AMA share a common goal to redefine our nation’s health care system to consider the whole person – not just medical care – by placing as much emphasis on people’s social needs as we do on their clinical needs,” Bill Hagan, President, Clinical Services, UnitedHealthcare said in a statement accompanying Tuesday's announcement. “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.”
