There is growing interest in improving patients’ health by addressing their social determinants of health (SDOH), though there is concern that the data needed for this effort lacks standardization and clinical meaningfulness.
Fortunately, initiatives started years ago have built a foundation that will help make the needed data easier to share and more clinically relevant, enhancing its value in the medical decision-making process.
AMA efforts toward this include:
- Launching the AMA Integrated Health Model Initiative (IMHI) data-standards group, which established a team of recognized leaders from the global health care data standards community to work on how to more accurately capture SDOH data.
- Becoming a founding member of the Gravity Project, a Robert Wood Johnson-funded initiative with more than 2,500 participants from organizations and entities representing health care, social services, payers, technology vendors, and government agencies working to develop consensus-driven data standards to support the collection, use and exchange of SDOH data.
“In my career, I've never seen such a community come together to work on solving these challenging problems,” said Corey Smith, AMA vice president for informatics and digital products.
“We recognize that collaboration is critical,” Smith added. “These problems are so foundational and so large—as it relates to data quality—that going it alone is not optimal.”
Smith spoke during an AMA webinar on the development of ways to help exchange of SDOH information among health care stakeholders and the role of the Current Procedural Terminology (CPT®) code set in facilitating physicians’ ability to improve patient outcomes by addressing SDOH.
Challenges in SDOH data capture include:
- A lack of standardization of SDOH data-collection and storage.
- Data sharing.
- Access and comfort with digital solutions.
- Social sector capacity and capabilities.
- Consent management.
- Unnecessary medicalization of SDOH.
The Gravity Project is working on the first two, with efforts split between working on technical aspects, developing terminology and validating and testing concepts through piloting.
Why standardization is so vital
Sarah DeSilvey, director of clinical informatics for the Gravity Project, noted in the webinar that one goal of their work is “semantic consistency,” with “everyone understanding what we mean.”
This work is intended to address barriers to addressing SDOH caused by the lack of terminology standardization and clinical relevancy.
“The work that we do in the terminology work stream is really addressing those two concerns by commonly defining and clearly stating the evidentiary and clinical ground for every single term that we use,” DeSilvey explained. “We base every single term that we develop on the literature of health risk to make sure they're on the right path.”
The data and terminology standards developed by the Gravity Project represent four clinical activities:
- Assessment and diagnosis.
- Goal setting.
- Treatment and interventions.
“We have referral and intervention terms to address all the critical roles in community-based organizations that so expertly address all the needs we identify in clinical practice,” DeSilvey said. “We might identify these risks in clinical settings, but we know that we solve them in communities.”
Signs of success
Signs that the effort is having an impact include the use of Gravity Project terminology in three federal grant applications and in the Centers for Medicare & Medicaid Services 2023 Medicare Advantage and Part D final rule, which mandates that Special Needs Plans include standardized questions on housing stability, food security and access to transportation as part of their required health-risk assessments.
Leslie Prellwitz, the AMA’s director of CPT content management and development, predicted that attention given to SDOH-related CPT provisions will continue to grow and may also shine light on the International Classification of Diseases 10th Revision codes (ICD-10-CM) that address SDOH.
ICD-10-CM Z codes represent subsets of diagnosis codes describing factors influencing health status. Code categories Z55–Z65 identify SDOH. Use of these codes is low, however, with an analysis finding that only 1.5% of Medicare fee-for-service claims included ICD-10-CM SDOH codes.
“ICD-10 talks about your diagnosis, and reflects what is impacting the services provided,” Prellwitz explained.
“The CPT is the counterpart,” she added. “It talks about what's being done about it.”
In 2021, SDOH were added as risk factors to the CPT table used to determine the level of medical decision-making for evaluation and management (E/M) services provided during visits in an office and other outpatient setting.
As of Jan. 1, the same table was added for E/M services delivered in other settings including inpatient, observation care, emergency departments, nursing facilities and at a patient’s home or residence.
“So that's going to increase that spotlight in terms of a diagnosis or a treatment significantly limited by social determinants,” Prellwitz said.
Smith also put out a call for volunteers for physicians and practices to participate in testing Gravity Project coding and terminology concepts.
“We'd like to develop data standards that get widely adopted and used, and piloting and testing is a critical part of that,” he said. If interested, email [email protected].
Learn more with the AMA Ed Hub™ course, “CPT Evaluation and Management (E/M) Guidelines: Implications for Patient Social Risk and Health Equity,” which is part of a broader collection of CPT education courses available.