Why UnitedHealthcare wants to expand diagnostic codes to the social determinants of health 

UnitedHealthcare
UnitedHealthcare wants to see nationwide use of diagnostic codes for social determinants of health. (jetcityimage/Getty)

UnitedHealthcare wants to see diagnostic codes for services targeting the social determinants of health—such as transportation or healthy meals—expand nationwide. 

In an interview with FierceHealthcare, Sheila Shapiro, senior vice president for national strategic partnerships in UHC's clinical services team, said that one of the key barriers to expanding access to nonmedical care for social needs is a lack of coding standardization. 

So the insurer has begun to roll out new ICD-10 codes that providers can use to document these needs. Adding new code options ensures that social services are tracked effectively and patients actually receive them, while also avoiding additional administrative work for physicians, Shapiro said. 

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“We wanted to look at a model that existed within the healthcare system that would allow us to capture the social determinants,” she said. 

RELATED: CMS planning to expand supplemental benefits in Medicare Advantage for members with chronic illness 

UnitedHealthcare rolled out the codes first in its Medicare population and is looking to expand into Medicaid next. And the results among Medicare Advantage members so far have been significant: Between January 2017 and the end of 2018, it made 560,000 referrals to social services, equivalent to about $250 million in social value. 

In tandem with building new codes for these services, UHC has conducted an extensive survey of its Medicare Advantage members to identify the most crucial social issues they face, Shapiro said. Over the past year, about 1 million MA beneficiaries have identified at least one socioeconomic barrier to care, she said. 

Having that data in combination with the new code options has allowed for large-scale solutions to some of the most pressing concerns flagged by the surveys. For example, in partnership with delivery service Mom’s Meals, UnitedHealthcare distributed more than 2.5 million meals to its members in 2018 and is looking to provide access to at least 1 million more. 

“Because of this standardized infrastructure and process, we’ve been able to start to think about it in clinical design,” Shapiro said. 

RELATED: Social determinants became mainstream in 2018, but it can’t be just a fad 

And UnitedHealthcare is taking that work outside of its membership this spring, Shapiro said. In March, the insurer and its partners on the project—which include the National Committee for Quality Assurance and the National Association of Community Health Centers—plan to formally push the Centers for Medicare & Medicaid Services and the Centers for Disease Control and Prevention to adopt a similar model across the country. 

Shapiro said that expanding standards can ensure that the data gathered is even more effective at targeting such services to certain populations or even individual patients. 

“We know that there is a business case to be made and it is setting the stage for the industry to standardize,” she said.

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