Part 1: SDoH capture, coding and analytics to succeed in value-based care

I was recently interviewed for an Inside Angle blog post on population health and its potential impact on physician burnout. In this post, I will address how the move toward value-based care provides a significant opportunity to equitably address social drivers of health (SDoH) while improving value and quality of care

Value-based care can allow greater flexibility in services that can be delivered while providing accountability for sustainable population health improvements. But the shift from a fee for service model to a full-risk model with capitated rates and bundled payments involves much more than just changing billing practices. This payment shift requires a new way of thinking, and a restructure of most health care practices.

With value-based care models, it becomes more important to track and understand what’s happening with patients and their outcomes using data; and better understand the social, non-clinical barriers to improving those outcomes. Collecting social risk data from your population and coding it as Z codes are one important way to understand and analyze your population to design appropriate population and individual level interventions. SDoH-related Z codes, ranging from Z55-Z65, are the ICD-10-CM encounter reason codes used to document SDoH data. 

Once you understand your patient population, and the type and frequency of their social drivers of health, you can then design appropriate interventions. These interventions could involve increasing access to primary care providers, enhanced hours, telehealth availability or aligning with other stakeholders to help patients navigate the health system more seamlessly.

Another focus could be medication affordability with a shift in prescribing patterns to accommodate a person’s current economic situation. A few health systems and larger practices have focused on enhancing access to affordable housing, transportation and nutrition by partnering with the corresponding community-based organizations. The common thread in each of these areas of focus is the major restructuring of practices in staffing, workflow, data management and partner data sharing arrangements required to be patient centered, team-based and outcomes focused.

Patient-centered care is an intrinsic part of being successful at population health and value-based care, regardless of the socioeconomic status of your patients. However, those practices that have a greater proportion of patients with adverse social drivers of health often need more upfront resources to make these changes. Data from value-based payment programs show lower participation rates of these practices less data reporting and lower rates of improvement in health indices of patients.

So, it is important to be able to quantify the amount of both clinical and social risk in your patient population to level the playing field in value-based purchasing arrangements. Newer payment models like the Centers for Medicare & Medicaid Services’ (CMS) ACO REACH, require collection of SDoH data and help health care providers that manage patients with a higher social need to receive up-front resources for the types of practice transformation changes that will enhance patient outcomes. 

In the next part of this series on value-based care, I discuss an approach to how health systems can better quantify clinical and social risk to be successful in a value-based care model.

Melissa E. Clarke, MD, CMQ, is senior medical director, health care transformation and health equity, at 3M Health Information Systems.