News: UnitedHealthcare boosts efforts to address SDOH

UnitedHealthcare hopes newly added data analytics will bolster its efforts related to social determinants of health (SDOH), its Chief Consumer Officer, Rebecca Madsen, MBA, told HealthLeaders. Its three-pronged approach includes:

1. Data analytics: UnitedHealthcare worked with the American Medical Association to develop 23 new ICD-10 codes. These ICD-10 codes more precisely capture SDOH, according to Madsen, flagging needs such as food security or housing. Predictive analytics focused on these ICD-10 codes can proactively identify, on both the individual and community level, who is most likely to need support. It could also leverage data into personal dashboards, ranked by value to have informed conversations with an individual.
2. Active listening: UnitedHealthcare advocates are specifically trained to identify “trigger words,” such as “I'm hungry. I'm having trouble making ends meet,” to identify SDOH needs and take appropriate action.
3. Social needs questionnaire: The third approach is a questionnaire that UnitedHealthcare equips their advocates with to ensure that they are asking the right questions to identify SDOH elements.

"We have had a longstanding focus on [SDOH]. Since 2000, we have contributed more than $1 billion to 4,600 communities for such things as housing and access to care. We have been at this for a long time, but this capability became more robust in the second quarter of this year with the addition of a data analytics program," Madsen said.

Social determinants are a substantial part of overall health, Madsen said. “We want to make sure that we are not only looking at the clinical aspect but also the entire individual… providing them with the support that they need as well as being a true partner and advocate."

Additionally, UnitedHealthcare developed a curated database to connect members with social services, Madsen says.

"If someone has food insecurity, or isolation, or financial stress, we can look in the curated database and plug a health plan member into low- or no-cost community-based resources. This database has more than 500,000 community resources across the country. For example, if a member says they are housing insecure, our advocates can then pull up an agency or community-based organization that can support that individual," she says.

SDOH is also becoming an increasing focus for CDI professionals. Poor SDOH conditions have been shown to negatively affect outcomes such as hospital readmissions rates, length of stay, use of post-acute care, among other items, states Margaret (Maggie) M. Foley, PhD, RHIA, CCS, associate professor for HIM at Temple University in Philadelphia and Suzanne Rogers, RHIA, CCS, CHDA, director of data applications and insights for Vizient Inc., based in Irving, Texas, in their upcoming ACDIS conference presentation “Risk Modeling and Coding for Social Determinants of Health.”

Population Health is not a new term or a new idea, they point out, but CDI specialists may be hearing more about it because of the move to greater risk sharing or value-based purchasing payment models. Now large health systems or accountable care organizations [ACOs] are contracting with insurers to manage the overall health of a large group of patients. Through these contracts the health system or ACO share in the risk associated with poorer outcomes related to SDOH and CDI professionals play an important role in collecting that documentation and data. 

Editor’s note: This article was originally published by HealthLeaders. To learn more about sessions slated for the upcoming ACDIS conference in October, click here.