THRIVE has been used to screen 60,000 patients at the medical center since 2017.
The patient completes the screening tool and a medical assistant enters the information into the medical record, which takes an average of one minute, he said. If patients answer that they are homeless or need help obtaining food, the EHR automatically generates a printed resource guide and a medical navigator is called. Data indicates that 85% of eligible patients at BMC have been screened, and of those who ask for help, 80%-90% are offered resources.
The THRIVE screening tool also automatically generates a code on the bill, and an accountable care organization of MassHealth, the state’s Medicaid authority which contracts with BMC’s HealthNet managed care plan, has begun recognizing the physician’s role in assessing problems like homelessness. Social factors that can be captured with ICD-10 codes, primarily homelessness, are now being included in the bill. And MassHealth is increasing its physician payment accordingly to take into account the physician’s role in addressing the issue.
More than half of the THRIVE caseload is covered under the Medicaid Accountable Care Organization (ACO). Other health plans have been slower to catch on. “Our patients have many different coverage models, and it gets very complicated,” he said. “That’s why ACOs and value-based payment models are so important to recognizing the business case that, if you address patients’ social needs, you are helping to better manage the ACO’s covered population,” he said.
Dr. Buitron de la Vega added that except for homelessness and food insecurity, existing ICD-10 codes aren’t that helpful in identifying social needs, so he looks forward to adoption of new codes such as those proposed by UnitedHealthcare. “At this time, the evidence that universal screening for [social determinants of health] will decrease cost and improve health outcomes is not there. Meanwhile, healthcare institutions need to make massive investments to help community organizations to grow and help all those patients that we are referring to them for social needs.”
Codes that spark actions
Sheila Shapiro
Sheila Shapiro, senior vice president of National Strategic Partnerships for UnitedHealthcare, said that “for populations covered by our plans, UnitedHealthcare has also created alternate coding methodologies, for example for transportation, as placeholder codes in lieu of an ICD-10 code, allowing us to bring this information forward.”
If identified patient needs are reported on the claim, UnitedHealthcare case managers use the information to assist members directly with referrals to social and governmental services, and then share those names and numbers with the medical providers, Ms. Shapiro said. A total of 600,000 UnitedHealthcare members have been assisted with over 760,000 such referrals.
If adopted, the new coding proposal could capture more data and trigger more referrals to service programs. The hope would be a savings in health expenditures and an improvement in patient outcomes.
Through its Integrated Health Model Initiative (IHMI), the AMA is collaborating with UnitedHealthcare on processes for incorporating social determinants of health into routine medical care, said Tom Giannulli, MD, chief medical information officer for IHMI. It’s hard to assess patients’ risks and outcomes without a rich data set to allow comparisons across populations, he added.
The proposed codes “will also help us do more research, with the idea that once we understand the risk, we can see how to mitigate it,” he said. “How do we take adjacent social resources and pull them into the medical space and create benefits – which could make the doctor’s life easier?”