MedCity News November 5, 2023
Medicare needs to incentivize providers by reimbursing them for identifying and addressing social determinants of health. Doing so will ultimately improve patient health outcomes and simultaneously save risk-bearing organizations money.
Research shows that sixty to eighty percent of population health outcomes are driven by non-clinical factors, mainly social determinants of health (SDoH). SDoH includes the environmental factors that affect where people work, live, learn, and play and are a significant discussion topic among providers and payers. Yet health plans, specifically Medicare and Medicaid, do not reimburse providers for identifying and addressing these social determinants. As a result, Z- codes, ICD-10-CM used to report on social and environmental conditions affecting patients are only captured in less than 2% across all claims.
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