If you get struck by lightning or bitten by a pig, a physician can record that information with a code shorter than your phone number.
But if you can’t afford your bills, doctors and health plans have no consistent way to document that.
Now the biggest U.S. insurance company and the country’s most influential association of doctors want to create new ways to better capture information about patients’ social conditions. It’s part of a shift in the health care industry to address aspects of people’s lives that influence their well-being beyond medical care, so-called social determinants of health.
“Having a standardized diagnosis allows for everyone in the system to understand that there’s an unmet social need,” said Sheila Shapiro, a senior vice president at UnitedHealthcare. The company, a unit of Minnetonka, Minnesota-based UnitedHealth Group Inc., announced the plan Tuesday with the American Medical Association (AMA).
Medical care accounts for only about 20% of what determines a person’s health. The rest comprises behavior, social and economic factors, and environment. While the U.S. spends much more than peer countries on health care, it spends far less on a thinner social safety net.
Just as medical diagnoses trigger prescriptions or referrals to labs and specialists, the proposed codes are meant to help clinicians refer patients to assistance for food, housing, transportation or other needs.
Since 2017, UnitedHealthcare’s Medicare Advantage plans have made more than 700,000 referrals to outside social-service programs. The insurer’s Medicare plans cover about 4.9 million people.
Among the more than 20 new codes under consideration:
- Unable to pay for prescriptions.
- Unable to afford child care.
- Worried about losing housing.
- Unable to count on family and friends.
- Feeling unsafe in current environment.
Having standard designations for such conditions would let doctors, hospitals and health plans share the information through medical records and insurance claims forms.
“Everyone can start reading from the same sheet of music,” said Tom Gianulli, chief medical information officer at the AMA’s Integrated Health Model Initiative.
While the codes wouldn’t immediately lead to reimbursement changes, capturing data about patients’ social needs may be a step toward paying for interventions that address them.