May 13, 2019

Healthcare is building tools to address gaps in the safety net

The healthcare system is increasingly stepping into the shoes of social workers to stem avoidable healthcare costs and poor outcomes that arise from unaddressed social determinants of health (SDOH). The World Health Organization boosted the visibility of SDOH in 2008 with a major commission and report. The momentum in our nation’s healthcare system to address these factors has grown ever since. Industry responses have been innovative and many are promising.

The American Medical Association (AMA) and UnitedHealth Group announced in April 2019 that they have developed nearly two dozen new ICD-10 billing codes identifying SDOH risks. These codes are intended to trigger referrals based on standard medical and self-reported SDOH data. If adopted, they could give the industry a standard way to track the variables that make up SDOH. The AMA and United have submitted their recommendations to the federal agency that defines and regulates ICD codes.

Other strategies include the development of a Social Vulnerability Index (SVI) that drills down to the member or patient level. The Centers for Disease Control created an SVI to measure vulnerability at the community level. This is useful in preparing for natural disasters and other scenarios, but that’s only a piece of the puzzle. New York’s not-for-profit Northwell Health system is using the CDC SVI as a starting point, but will enhance it with individual patient data gleaned in part from intake interviews. Northwell is building its own SVI that will offer a more revealing, whole-person picture of the patient and their barriers to care.

Another large-scale opportunity is the expansion of Medicare Advantage rules to include SDOH supports. MA plans can design their benefits to curb avoidable emergency and healthcare utilization, better address chronic conditions and target members to receive additional supports based on medical conditions. More flexibility is coming in 2020, but since these changes require considerable thought and analysis by health plans, they may take longer to become a reality.

Doing something about social issues and poor health is not easy, but the industry is using creativity, technology and strong partnerships to make a difference for members. To learn more about how health plans are responding to challenges in social determinants of health, read our report.