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

Apr 3, 2019, 22:30 IST

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UnitedHealthcare is working with the American Medical Association (AMA) to develop new billing codes that would better equip insurers to tackle their members' social determinants of health (SD OH) - factors that drive the lion's share of US healthcare spending.

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For context, SDOH are health-influencing factors outside the hospital setting, like diet, education, and income, that account for 80% of patient health outcomes. If UnitedHealthcare's proposed billing codes are implemented, doctors will be able to diagnose patients with unmet social needs, such as unsafe housing, and trigger patient referrals to community-based programs.

Here's what it means: UnitedHealthcare's partnership is the latest sign that US payers are racing to address their members' SDOH.


  • Humana collaborated 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.
  • UnitedHealthcare invested $400 million in affordable housing to help mitigatehealth problems associated with homelessness. UnitedHealthcare has built over 4,500 homes as of March, with early success: In one state, UnitedHealthcare registered a 50% drop in total cost of care for members enrolled in a housing program.
  • And Blue Cross Blue Shield (BCBS) launched a healthy food delivery service to help address expensive conditions like diabetes. BCBS rolled out foodQ in February to improve access to nutritious food for members who reside in areas that lack fresh food options. The program should help BCBS better manage chronic conditions that are exacerbated by poor diet, like diabetes. Diabetes afflicts more than 30 million US citizens and racks up $327 billion in annual costs in the US.

The bigger picture: Formalizing billing codes would be a boon to payers' efforts to address SDOH.

  • 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, according to 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.

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