May 15, 2022
Social Determinants of Health – Why are they so important?
A 28-year-old single Mom of three children while working and going to nursing school was having a tough time making ends meet. Her primary care physician referred her to two community outreach resources. Because of the awareness of social determinants of health and the actions taken by the physician, the medical profession now has a new RN.
Social Determinants of Health (SDoH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality of life outcomes and risks (1). According to the Kaiser Family Foundation, 30% of direct medical costs for blacks, Hispanics and Asian-Americans are excess costs and related to health inequities (2).
SDoH can be grouped into 5 domains that impact people’s health and well-being (3):
- Economic stability – access to healthy foods, health care and housing.
- Education access – access to educational opportunities for children and adolescents.
- Health care access – increase insurance coverage and access to a primary care provider.
- Neighborhood – access to a safe environment including safe water and air.
- Social and Community Context – help develop social and community support relationships
SDoH-related Z codes ranging from Z55 – Z65 are the ICD-10 encounter codes used to document SDoH data. In the McLaren Physician Partners 2022 Top Ten Quality Metrics Quick Reference, on page 20 and 21, there is information on the Social Determinants of Health ICD 10 codes, a QR code for a complete list of the SDoH codes and a patient survey for screening. SDoH codes may not raise the risk score, but they do have the ability to raise the level of complexity of care in medical decision making for E/M coding if documented in your chart.
Twelve years have passed since the WHO Report on the SDoH, in 2019 a review of the legacy SDoH framework was completed – the framework remains, and the time is ripe for evolution (5). Medicare, Medicaid, and commercial payers are increasingly interested in closing Z code gaps and standardizing SDoH data. Based on the Advis-Health-Survey, little to no direct reimbursement and inability to prove ROI are issues impeding progress in capturing the information of SDoH and addressing the issues of disparity (4).
What should we do with this information (2):
- Identify individuals’ social risk factors and needs
- Utilize MPP Community Resource Guides
- Trigger referrals to services that meet the individuals’ needs – for example, MPP Care Coordination referral
- Track referrals between providers and service organization for follow-up.
SDoH is not “one more thing we have to do”, it should be “one of the most important things we should do”. SDoH is part of health care – it affects risk factors, preventative services, treatment and patient outcomes. This is where McLaren Physician Partners can assist your practice:
- Educating the patient and practice units on the benefits of surveying for SDoH
- Educating the patient and practice units on the benefits of actively assisting the patient with a referral or resource,
- Educating the patient and practice units on the benefits of following up on the utilization of the SDoH resource.
1. Healthy People 2030, U.S. Department of Health and Human Service’
2.Nambi Ndugga, Kaiser Family Foundation, Disparities in Health and Health Care: 5 Key Questions and Answers, May 11, 2021
3. CMS.gov, Zcodes-infographic
4. Advis, Social Determinants of Health Survey, March 2020
5. John Frank, Int J Environ Res Public Health, The Social Determinants of Health: Time to Re-Think? 2020 Aug.