UnitedHealthcare and the AMA are developing new billing codes for social determinants of health

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If UnitedHealthcare’s proposed billing codes are implemented, doctors will be able to diagnose patients with unmet social needs:

Here's what it means:

UnitedHealthcare's partnership is the latest sign that US payers are racing to address their members' SDOH.with ride-hailing service Lyft to address transportation's role in US healthcare's costly missed medical appointment problem. Humana announced a partnership with the ride-hailing giant in February to coordinate Lyft rides to appointments for qualifying members, which could help put a dent in the US healthcare industry's $150 billion no-show problem.

A lack of payment mechanisms is currently the top barrier to social health programs. Health firms cite a lack of payment structures as the biggest barrier to implementing SDOH programs,a survey conducted by health IT firm Change Healthcare of 185 leaders at US health firms. Ironing out a standardized reimbursement process could encourage doctors to direct patients to social programs and facilitate reimbursement for agencies providing social benefits.

And standardizing data collection could help payers parse which social health programs are most effective and worthy of investment. For example, US payers could track patient outcome metrics to determine which community-based programs best reduce customers' medical costs. Insurers could then use this data to prioritize spending on more effective interventions and funnel more members to the most effective programs.1.

 

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