Strives have been made to better integrate social care into the healthcare system, but data has been traditionally hard to collect, analyze, and act upon. We know social drivers are critical health factors, but having the most up-to-date, accurate data is necessary for payers and providers to address patient needs.
Thanks to the efforts of The Gravity Project and other leading healthcare organizations, new social determinants of health codes will now be added to ICD-10-CM on October 1, 2021, granting payers and providers the opportunity to identify the most pressing social needs of their patients and expand their SDoH efforts using a more targeted, personalized approach.
The benefits of ICD-10-CM codes
The well-known ICD-10-CM system has reached its tenth revision and contains more than 72,616 diagnosis codes, all of which are used by payers, providers, physicians, clinical staff, and care coordinators to track public health risks, measure the quality of care, process reimbursements, adjust health policy, and improve clinical, administrative, and financial performance.
In 2016, socioeconomic factors like extreme poverty (Z59.5), low income (Z59.6), and homelessness (Z59.0) were added to the coding system, solidifying the importance of SDoH in the healthcare system. The problem is that these codes have gone underutilized, even as updates have been made to improve SDoH screenings and reporting.
The benefits of a Z code expansion are immense, especially if payers and providers make intentional efforts to not only screen for SDoH but utilize the codes in a more frequent, consistent manner. Doing so will allow payers and providers to:
- Identify population needs
- Improve referral rates
- Enhance care coordination
- Build and implement data-driven SDoH interventions
- Monitor ROI and success of programs
- Improve patient care
With more screening efforts, clear guidelines, and incentives, one study found that SDoH code utilization rates can increase. Another study found that reported individual-level SDoH data could improve the predictive performance of various outcomes, such as service referrals and the risk of 30-day readmission.
We all know the pandemic has widened the health equity gap, making social determinants like housing, food, and employment ever more important. With expanded codes, we anticipate that payers and providers will have a better understanding of the socioeconomic barriers facing their patients and be able to make more informed decisions around care coordination, preventative measures, and personalized interventions.
Get to know The Gravity Project
Launched in May 2019 by the Social Interventions Research and Evaluation Network (SIREN) with funding from the Robert Wood Johnson Foundation, The Gravity Project has been the leading voice driving the SDoH code expansion. They have been tireless in developing structured data standards around SDoH, making it possible for us to track social risks and exchange data across various systems of care for the purpose of changing health outcomes in high-risk populations.
While The Gravity Project was instrumental in solidifying the October 1, 2021 implementation, one year ahead of plan, they are also proposing additional Z codes, which will be considered for a 2022 implementation.
Learn more about the SDoH code expansion
We cover the upcoming code expansion in our latest white paper Everything Payers Need to Know About the SDoH ICD-10-CM Code Expansion, which explores which codes are being added, how payers can benefit, and how to prepare for the early implementation.