Monday, May 6, 2019

Insight on Expanding ICD-10 Codes to Support Social Determinants of Health

The 16th Annual WorldHealth Care Congress (WHCC19) took place in Washington DC last week. 

What a great mix of people sharing ideas, opinions, policies, technologies, and regulations - and other thoughts on their minds - for transforming our screwed-up healthcare system in the United States! 

And I was given the opportunity to attend and participate in this gathering of healthcare leaders, champions, thought-leaders, media personalities, influencers and others attending the WHCC19 event.

Social Determinants of Health - aka. Barriers to Health

As has been the case for most healthcare-related conferences over the past few years, ‘social determinants of health’ (SDOH) were one of the hot topics – if not THE hottest topic at the event.

Small Sample of Previous Shares on SDOH

Given my personal interest in addressing social determinants of health and the barriers to care they present, I’m going to share some information about social determinants of health that I observed at the WHCC19 event. 

What was shared in sessions, what I heard in the hallways, and what journalists and others shared during and after this year’s WHCC event.

RELATED: More Social Determinants of Health

WHCC TV Shares Great Insight in Snackable Bites

My first share will be a transcript of Mabel Jong’s interview with Sheila K. Shapiro, SVP of National Strategic Partnerships - Clinical Services at United Healthcare. 

I’ll add some links and commentary to this post to hopefully add some context and value to Mabel Jong's interview.

[For other Healthcare Conference Goers like me, you’re probably aware of the trend that started about 5-6 years ago where conference organizers do live interviews during their events. While we all have our favorite interviewers, it would be hard for anyone to argue that Mabel Jong is NOT among the best true journalist interviewers: smart, engaging, and not giggling all the time.]

Need for Coding Social Determinants Explored at WHCC19

Mabel Jong:
Good morning, I'm Mabel Jong. Thanks for watching continuing coverage of the World Health Care Congress here on WHCCTV

We're going to be talking about the work with [medical] codes and we're going to do that with Sheila Shapiro who's Senior Vice President - National Strategic Partnerships - Clinical Services at United Healthcare. Sheila thank you so much for your time.

Sheila K. Shapiro:
Gosh thank you for having me.

Mabel Jong:
So, you spent a lot of your time at United Healthcare thinking about [medical] codes and working with those. Tell me where you're at with that now and why it's significant.

Sheila K. Shapiro:
Well at United Healthcare we're really looking at redefining healthcare to whole person health. And one of the things that we've been doing over the last several years is looking at how we can capture information related to social determinants of health and take action on that information.

Yes! We Need to Speak a Common Language

And one of the key things that need to be done in order to utilize information is to have a common language. And that the common language that we are promoting is the use of ICD-10 coding - those are diagnosis codes that physicians and the healthcare community use to share information with each other about an individual.

Just like when you go to the doctor and they diagnosed you with some condition - maybe diabetes.

Now everyone within the healthcare system can understand what that condition is and work to solve that problem. The same thing goes with the [diagnoses] codes that we have been asked - that we have requested from the ICD-10 committee to assist the industry in getting that common language by expanding those codes for social determinants of health.

Y'all Cool with United Health Care Setting the Agenda?

Mabel Jong:
Okay. Why is United Health Care taking the lead on this?

Sheila K. Shapiro:
Well, we believe that every individual regardless of whether they are uninsured or underinsured should have access to care. And that care includes social determinants of health. So, we believe taking that information and being able to utilize it to help our members lead healthier lives is part of our mission.

And in that regard, we have already had members tell us that they need assistance. And over 2 million of them so far have asked for that help and we've been able to make referrals for over a million people already. That equates to over a quarter of a billion dollars of social value to the people that we're trying to serve.

Who’s Involved With Defining ICD-10 Codes for SDOH?

Mabel Jong:
Is the rest of the healthcare community happy to let United [United Health Care] take the lead in establishing the codes for the social determinants of health area?

Sheila K. Shapiro:
We are partnering with many different organizations. We have a collaboration with the American Medical Association, the National Association of Quality Assurance [Sic: per transcript]- now NCQA. And many state regulators - one of them being the Medicaid agency in Arizona known as AHCCCS

[Comment from Steve: Oh Boy! Now we know we're hosed because the AMA wants to somehow start collecting royalties on SDOH coding!]

RELATED: ICD-10 Codes Covering SDOH - From AHCCS.

We have the National Association of Community Health Centers and many other organizations - including payers - are coming together to really think about how we simplify this work so it can fit into the workflow of not only health payers but providers. So, leveraging those ICD-10 codes that are used today for diagnosis actually create that common language for the industry.

Another Patented Algorithm from Large Payers & American Medical Association?

Mabel Jong:
Okay. How far into the work are you now and where do you want to end up?

Sheila K. Shapiro:
So, we know at UnitedHealthcare that this is a journey and we have just begun to think about how to incorporate social determinants of health into whole person care. 

And we believe that redefining healthcare is part of our mission. As we have done this work, we've begun to partner with various social and governmental agencies to provide those referrals. That's where that social evaluation also begins to play a critical component.

So, we have a patent-pending imputed market price social valuation model that allows us to take that information around a referral and that fulfillment of that service and understand how that affects people's overall quality. 

[Comment from Steve: Oh Shit! Another 'patented algorithm' from a corporate entity!]

And the outcomes that we're trying to achieve for the populations that we're here to serve.

[Comment from Steve: Who does UHC serve? Shareholders or executives? Members?]

Impact of ICD-10 Codes for Social Determinants of Health

Mabel Jong:

Would that replace anything that's already in place now or it would become a completely new tool?

Sheila K. Shapiro:
It's not a new tool at all and that was really what we were striving to stay away from because we know that the system is taxed and our providers are already have a significant workload - which is why we were looking at the ICD-10 codes to leverage. [i.e. Codes to track SDOH, mostly so-called 'Z-Codes.']

There are existing codes around social determinants that many doctors already bill on their claim forms. The codes that we are asking for really are an extension of that - to allow all of us within the system to help each other. 

So, when we make a referral today, we're able to share that information back with our providers through existing mechanisms - not new tools.

Social Determinants of Health at WHCC19

Mabel Jong:
Alright Sheila Shapiro. Thank you so much. May I ask how you're enjoying the conference?

Sheila K. Shapiro:
So far I love the conference. You know I think all the speakers are great. We really appreciate the World Health Care Congress allowing us to come participate. United Healthcare knows that social determinants are a critical part of people's overall health.

And we are anxious to see that whole person care become a reality.

Mabel Jong:
All right Sheila. Thank you again. And I'm Mabel John thanks for tuning in.

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