560,000 Referrals …. To Social Services

Like a page out of the famous Rent Broadway song, United Healthcare has made over a half million referrals in the last couple years to social services for its Medicare enrollees. And it hopes to start creating diagnosis codes for social determinants of health, like housing, food and transportation…actual diagnosis codes (ICD-10 codes) have been rolled out first for helping address social determinants of health in Medicare patients. Medicaid related codes are next. About 1 million Medicare Advantage enrollees identified a social related issue connected to their health, a United spokesman confirmed. The Parkland Center for Innovation in Texas has done this work too, focusing on finding psycho-social data to identify causes of hospitalization, such as a male who loses his apartment or sneakers for a couple months. How existing physician groups and health systems make use of these codes and services may be an important differentiator, particularly for MA and managed Medicaid positioning. Also watch out for new kinds of vendors entering into capitated arrangements with Medicaid and MA plans to focus exclusively on social services – the precedent is there and this kind of contracting is already beginning to occur in select markets. How much the social service sector takes from traditional healthcare providers is hard to project but it would seem they are at a minimum beginning to take a share of the value dollar.

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