While the codes wouldn’t immediately lead to reimbursement changes, capturing data about patients’ social needs may be a step toward paying for interventions that address them.
“Collecting data is a big part of this right now, and trying to figure out what’s effective, and advocate for funding around that,” said Steve Nelson, chief executive officer of UnitedHealthcare.
Slowly Changing
Payments are still largely tied to the number of procedures clinicians perform, rather than the overall health of patients. That’s slowly changing, and the effort to treat social needs is part of the transformation.
For example, a diabetic who can’t get to the pharmacy to pick up medication may wind up in an emergency room with uncontrolled blood sugar. Traditionally, insurance would pay for the emergency room visit but not for the cab ride to the pharmacy that might have prevented it.
The taxpayers and employers who finance America’s $3.5 trillion medical system ultimately pay the cost of that hospital visit. The health-care industry and policy makers are struggling to figure out how to get people those cab rides, as well as other interventions that could make people healthier and reduce overall spending.
The industry has already taken steps in that direction. In 2016, the new codes were adopted to indicate whether a patient is homeless, poor or lacking adequate food, for example. The latest proposal would build on that effort. A federal committee will decide whether to adopt the proposal later this year.
New codes are a useful first step, but there are limits to what the health-care system can do, said Melinda Abrams, a vice president at the Commonwealth Fund, a foundation focused on health research.
Society also needs to properly finance the social-service system because inadequate funding contributes to high health-care costs, Abrams said.
“The health-care sector has had a blind eye to it.”