It’s no secret that social factors influence our health. These may be as overt as not having access to clean water or sufficient food, or as subtle as an undiagnosed mental health condition being aggravated by environmental factors. It is estimated that half of healthcare costs in the United States—a country that spends more on healthcare than any other country—are attributable to about 5% of the population, and this group is often suffering from one or more deficiencies in the social determinants of health, which frequently contributes to complex conditions and chronic diseases. In an effort to lower costs, much has been made of healthcare providers addressing these nonmedical needs to improve this population’s health outcomes and thus lower their heavy use of healthcare resources.
Actually addressing these social determinants data, however, is a trial-fraught path. For patient intake, hospitals and health systems have been able to capture a number of social determinants data through ICD-10-CM codes in categories Z55–Z65, which cover a range of issues such as education, occupational hazards, housing security, and mental health. However, this data wasn’t regularly captured in most cases.
The chief reason was that, until recently, the ICD-10-CM Official Guidelines for Coding and Reporting prevented codes from being reported without physician documentation. Since physicians aren’t regularly performing this kind of documentation—except for certain social determinant issues that would fall more directly under a physician’s purview, such as alcoholism and substance abuse—this information is more often attested to by the work of case managers, social workers, and others who more regularly interact with the socio-economic situations of patients. Consequently, hospitals were not reporting much of this information, severely hampering any effort to form a strategy to address the social determinants of health within a continuum of care or health system.
In February, the American Hospital Association (AHA) modified the reporting requirements to permit the Z55–Z65 categories to be documented by non-physicians involved in caring for the individual—including case managers and social workers.
Because of this change, it is now significantly easier for vital social data to be reported and shared with those participating organizations who are better equipped and more directly responsible for addressing the social determinants of health. In working toward better outcomes from the communities served by hospitals and health systems, having better social data can also be used to inform risk scoring frameworks and as driving data for predictive analytics that can help formulate better strategies regarding which regions or populations to target with coordinated care. For instance, if the data reveal that a given geographic region is disproportionately suffering from food insecurity and lack of a transportation, it will be clear that this is a region requiring special attention by food pantries and transportation assistance.
By improving hospitals’ and health systems’ ability to capture and report social determinants data, it becomes far more feasible to employ a Whole Person Care perspective, focusing on treating whole individuals and the circumstances contributing to their poor health outcomes rather than treating the resulting conditions and symptoms as they arise. With better social determinants data available, hospitals and health systems can better coordinate care by communicating and sharing data with participating organizations and nonmedical services that are dedicated to addressing the social needs of the patient outside the walls of a hospital or primary care office.
One of the greatest obstacles to care coordination in a community is the lack of communication between medical and nonmedical providers. A strong care coordination solution, such as Eccovia Solutions’ ClientTrack platform, is essential to bridging this communication gulf and bringing healthcare providers and social services providers together. ClientTrack allows users to gather into a single place all patient data to which authorized users in all participating organizations have access. With the right data being captured and shared, healthcare providers can see what social needs their patients have that are not being addressed, and can refer their patients to the appropriate service providers directly within the platform, which by design facilitates compliance with federal, state, and local laws and regulations.
The AHA’s move to make the capture and reporting of social determinants data easier is an important step in empowering healthcare providers to collaborate with nonmedical partners and tackle social determinants issues extant in their communities. It is hoped that with these new guidelines, hospitals and health systems will be able to treat patients with a Whole Person Care paradigm and improve the health outcomes for the populations within their communities that most need help. Stay tuned here for further developments!