When addressing issues of health equity, understanding Social Determinants of Health (SDOH) is fundamental for improving health outcomes, reducing healthcare costs, and mitigating health disparities. The World Health Organization defines SDOH as “the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels.” These determinants encompass a wide range of factors that influence individual and community health, including socioeconomic status, education, neighborhood and physical environment, employment, and social support networks.
Poor social determinants of health have been shown to negatively several quality measures that the Centers for Medicare & Medicaid Services (CMS) evaluates, such as hospital readmission rates, extended length of stay, and the use of post-acute care like home health, skilled nursing facilities, and long-term care. There is also growing concern that value-based payment programs could penalize healthcare organizations that disproportionately serve disadvantaged populations due to the resources required to achieve optimal health outcomes.
Standardizing the SDOH data within the health record enables health organizations and health systems to achieve four key goals:
- Improve health, lower cost, and advance health equity as the overarching goal
- Assess SDOH needs
- Link patients to community services
- Develop sustainable business models to fund access to community services
To meet these goals, health systems need an SDOH strategy that will leverage data for risk stratification as well as connect patients with appropriate community services.
Doing so requires data interoperability, common sets of values, and the capability to harness SDOH data for analytic purposes.
Importance of SDOH and ICD-10-CM reporting
SDOH data captures information at a level that traditional health data sources cannot. By integrating SDOH insights into care plans, healthcare stakeholders can recognize the need for and enable access to additional services or interventions for individuals, such as programs related to accessing healthy food, providing reliable housing, or helping patients manage isolation and loneliness, ultimately driving better health and wellness outcomes. ICD-10-CM Z codes are used to record this information.
Medical Coding for Social Determinants of Health
The official medical coding guidelines for SDOH should be assigned based on documented evidence. The documentation needed for coding SDOH can be obtained from various healthcare professionals, including social workers, community health workers, case managers, or nurses, who provide their input as part of the official medical record. Patient self-reported documentation is also valuable for SDOH coding, as long as it is incorporated into the medical record by a clinician or provider.
Embracing Data Insights and Technological Tools
By accurately documenting and coding for SDOH, healthcare organizations can gain insightful data about the health needs and challenges faced by different patient populations. Standardizing the collection of SDOH data within health records and committing to data-driven decision-making helps organizations better understand broader health patterns to help shape patient care strategies tailored to meet the needs of diverse patient groups. By integrating data analytics into healthcare processes, targeted interventions and policies can be developed to improve health outcomes, promote health equity, and ensure that all individuals have access to appropriate care and resources.
Contact us to discuss how we can help integrate RCM and medical coding practices and refine approaches to data collection, analysis and technology to better understand the factors affecting health access and outcomes to identify and address health disparities.
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