How Social Determinants of Health Affect Your Practice and Patients

There has been a lot of talk through the provider community as of late about Social Determinants of Health (SDOH) and they affect people. Currently, SDOH are defined as conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of-life-risks and outcomes.

• 1979 – 2010: Promote Health/Preventing Disease Objectives
• Mission for Healthy People 2020
• Mission for Healthy People 2030 – Evolution of SDOH Based on a place-based framework that outlines five key areas of SDOH:
  • Healthcare Access and Quality
  • Education Access and Quality
  • Social and Community Context
  • Economic Stability
  • Neighborhood and Built Environment

Other organizations such as the World Health Organization also provide their own definition of social determinants of health. They state the SDOH conditions mostly responsible for health inequities – the unfair and avoidable differences in health status seen within and between countries.

How This Impacts Your Practice

We all know how much documentation is required for all services rendered and how valued this information is from a practice and plan perspective. Part of documentation that is beginning to become more crucial to our organization is the social determinants of health of our members. The question asked about a member’s social history during a visit are very important. We need your help with further understanding what issues are affecting our members. We recommend asking the patients the SDOH questions at least twice a year to ensure the conditions are valid and current.

The common SDOH Conditions that can be captured during a visit are:

• Tobacco Use
• Food Insecurity
• Physical Activity
• Social Connections (such as feelings of isolation, especially during a pandemic)
• Housing (such as cannot render care and needs assistance)
• Financial Resource Strain (such as an inability to afford the medications as prescribed)
• Transportation Needs (inability to keep appointments)
• Alcohol Screen
• Intimate Partner Violence (unsafe environment)
• Stress
• Depression

The most common way to communicate these conditions to us is by submitting a claim using the diagnosis codes ranged Z55-Z75.

We cannot stress enough the importance with communicating these conditions to the plan. Ultimately, it will help us better serve our membership. Please note, if a diagnosis code cannot fit onto your claim, please contact your provider concierge representative, so we can work with you on a way to send us supplemental data.

References

CMS. (2021, February). Using Z Codes: The Social Determinants of Health (SDOH) Data Journey to Better Outcomes. Retrieved from The Centers for Medicare and Medicaid: https://www.cms.gov/files/document/zcodes-infographic.pdf

U.S. Department of Health and Human Services. (n.d.). Healthy People 2030. Retrieved from Healthy People: https://health.gov/healthypeople