Measuring efficacy
Dr. Bruce Chernof
“Today we really don’t know enough about how social determinants of health are driving utilization and costs, or how to design mechanisms that will allow us eventually to change our payment systems in response,” says Bruce Chernof, MD, president and CEO of the SCAN Foundation, an independent California-based foundation devoted to transforming the health care of older adults.
The new codes proposed by UnitedHealthcare could provide powerful layers of information to make something that’s invisible more visible. “You can’t really improve what you can’t measure, but it’s not enough to just identify social factors in health. If you identify and don’t refer, or if you refer and programs are not available to respond, then what have you really accomplished?” asked Dr. Chernof, an internist,
“We were trained as internists to discuss the patient’s social history. But what has become clearer, as the population ages and we learn more about the challenges internists face today, social determinants of health are not an area where we have received enough training. And doctors already feel like they are up to their eyeballs in codes,” he said. “If we are going to start collecting this data, it is incumbent that the data actually be used to improve outcomes.”
AHIMA is advising a cautious approach. In its comments on the 23 proposed new ICD-10 codes, AHIMA recommended delaying implementation until more information is available from initiatives such as the Gravity Project of the Social Interventions Research and Evaluation Network at the University of California, San Francisco. The Gravity Project is a national collaborative to advance interoperable social risk documentation.
“There may be other, better ways to capture social factors. ... I’m not sure ICD-10-CM codes are the best way to do this because these issues are somewhat outside the scope of what ICD-10 is designed to capture,” Ms. Bowman said. There are also privacy concerns, and some of the social factors change frequently in the lives of patients.