Social determinants of health (SDOH). You’ve probably been hearing that term a lot lately. Karen DeSalvo, MD, MPH, MSc, spoke on social determinants at HEALTHCON in Las Vegas (April 28 – May 1); and the American Medical Association and UnitedHealthcare recently announced a collaboration to standardize data collection on SDOH with new ICD-10-CM codes.
What are social determinants of health and how can you help healthcare providers code them?
The 411 on SDOH
Social determinants of health are factors that affect access to healthcare and health outcomes such as:
- Problems related to education and literacy
- Problems related to employment
- Problems related to housing and economic circumstances
- Problems related to social environment
The Centers for Medicare & Medicaid Services (CMS) is proposing that some data elements be collected on standardized patient assessment instruments in post-acute care provider settings beginning this year.
Organizations can measure these factors using existing tools, including:
- Z codes from ICD-10-CM
- Accountable Health Communities Health-Related Social Needs Screening Tool
- Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) Tool
- Health Leads Screening Toolkit
In detecting SDOH, providers may be able to help their patients connect with and/or navigate the appropriate community-based services. For example, a patient who isn’t taking his medication because he lacks transportation to the pharmacy would be referred to federal, state, or local assistance programs.
A Model of Accountability
The Accountable Health Communities Model is the first CMS payment model to include SDOH. The CMS Center for Medicare and Medicaid Innovation (CMMI) made the Accountable Health Communities (AHC) Health-Related Social Needs (HRSN) Screening Tool to use in the AHC Model.
The HRSN Screening Tool can help providers assess patients’ needs in five core domains:
- Housing instability
- Food insecurity
- Transportation problems
- Utility help needs
- Interpersonal safety
CMMI recently added eight supplemental domains:
- Financial strain
- Employment
- Family and community support
- Education
- Physical activity
- Substance use
- Mental health
- Disabilities
The questions in the AHC HRSN Screening Tool are meant to be answered by the patient or the patient’s legal guardian or caregiver. Clinicians and their staff are encouraged to use this tool as part of their clinical workflows.