female doc, male nurse, patient Medical care accounts for only about 20 percent ofwhat determines a person's health. The rest comprises behavior,social and economic factors, and environment. (Photo:Shutterstock)

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(Bloomberg) –If you get struck by lightning or bitten by a pig,a physician can record that information with a code shorter thanyour phone number.

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But if you can't afford your bills, doctors and healthplans have no consistent way to document that.

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Now the biggest U.S. insurance company and the country's mostinfluential association of doctors want to create new ways tobetter capture information about patients' social conditions.

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It's part of a shift in the health-care industry to addressaspects of people's lives that influence their well-being beyondmedical care, so-called social determinants of health.

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“Having a standardized diagnosis allows for everyone in thesystem to understand that there's an unmet social need,” saidSheila Shapiro, a senior vice president at UnitedHealthcare.

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The company, a unit of Minnetonka, Minnesota-based UnitedHealthGroup Inc., announced the plan Tuesday with the American MedicalAssociation.

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Medical care accounts for only about 20 percent of whatdetermines a person's health. The rest comprises behavior, socialand economic factors, and environment. While the U.S. spends muchmore than peer countries on health care, it spends far less on athinner social safety net.

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Just as medical diagnoses trigger prescriptions or referrals to labs andspecialists, the proposed codes are meant to help clinicians referpatients to assistance for food, housing, transportation or otherneeds.

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Since 2017, UnitedHealthcare's Medicare Advantage plans havemade more than 700,000 referrals to outside social-serviceprograms. The insurer's Medicare plans cover about 4.9 millionpeople.

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Among the more than 20 new codes under consideration:

  • unable to pay for prescriptions
  • unable to afford child care
  • worried about losing housing
  • unable to count on family and friends
  • feeling unsafe in current environment

Having standard designations for such conditions would letdoctors, hospitals and health plans share the information throughmedical records and insurance claims forms.

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“Everyone can start reading from the same sheet of music,” saidTom Gianulli, chief medical information officer at the AMA'sIntegrated Health Model Initiative.

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While the codes wouldn't immediately lead to reimbursementchanges, capturing data about patients' social needs may be a steptoward paying for interventions that address them.

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“Collecting data is a big part of this right now, and trying tofigure 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 proceduresclinicians perform, rather than the overall health of patients.That's slowly changing, and the effort to treat social needs ispart of the transformation.

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For example, a diabetic who can't get to the pharmacy to pick upmedication may wind up in an emergency room with uncontrolled bloodsugar. Traditionally, insurance would pay for the emergency roomvisit but not for the cab ride to the pharmacy that might haveprevented it.

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The taxpayers and employers who finance America's $3.5 trillionmedical system ultimately pay the cost of that hospital visit. Thehealth-care industry and policy makers are struggling to figure outhow to get people those cab rides, as well as other interventionsthat could make people healthier and reduce overall spending.

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The industry has already taken steps in that direction. In 2016,the new codes were adopted to indicate whether a patient ishomeless, poor or lacking adequate food, for example. The latestproposal would build on that effort. A federal committee willdecide whether to adopt the proposal later this year.

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New codes are a useful first step, but there are limits to whatthe health-care system can do, said Melinda Abrams, a vicepresident at the Commonwealth Fund, a foundation focused on healthresearch.

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Society also needs to properly finance the social-service systembecause inadequate funding contributes to high health-care costs,Abrams said.

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“The health-care sector has had a blind eye to it.”

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READ MORE:

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How Americans cope without healthinsurance

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ACA strikedown would affect nearly allAmericans

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How financial health is affecting Americans'physical health

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Pay cuts, other strategies middle-class earners useto afford health insurance

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