Leveraging RCM and Coding to Help Address the Health Equity Gap

By AGS Health

August 11, 2023

The term “social determinants of health” (SDoH) refers to the conditions of a person’s home, place of employment, and educational setting that impacts health risks and outcomes. These conditions are significant clinical care predictors, and they are influenced by how money, power, and resources are distributed globally, nationally, and locally. Positive SDoH conditions are linked to better clinical outcomes and lower expenses. Poor SDoH conditions have a negative impact, including hospital readmission rates, length of stay, and use of post-acute care.

Impact on Health

Proportional contribution to premature death Graphical Representation

Genetics, social circumstances, environmental exposures, behavioral patterns, and healthcare impact a person’s lifespan (Figure 1). Medical care plays a relatively small part in preventing early deaths. Only a small portion of these deaths could be avoided, even if the entire American population had access to top-notch healthcare, which it does not. Personal behavior offers the most potential for enhancing health and reducing preventable deaths.

In fact, behavioral factors are responsible for almost 40% of all fatalities in the U.S. Obesity and physical inactivity are the top two behavioral causes of premature death, but the precise number of deaths that can be linked to these two risk factors has been disputed. Smoking is another top behavioral cause of premature death.

Goals of Standardized Data on Patient Social Risk

By standardizing SDoH data within the EHR, health systems can advance five main goals:

  1. Better health
  2. Lower costs
  3. Greater health equity (the overall goal)
  4. Support the needs for SDOH
  5. Develop sustainable business models to pay for access to community services and connect patients with them

Health systems require an SDoH strategy to achieve these outcomes, one that will use data for risk stratification and link patients to the proper community services. Data interoperability, shared sets of values, and the ability to use SDOH data for analytics are essential.

Who can document SDoH?

If social workers, community health workers, case managers, or nurses provide documentation in the medical record, coding professionals may use it to access social information. As long as the patient’s self-reported information is approved and entered into the medical record by either a clinician or provider, patient self-reported documentation may be used to assign codes for social determinants of health.

What do Payers do with SDoH Data?

Payers with access to SDoH data are better able to:

  • Coordinate care
  • Identify patients who might benefit from care management programs
  • Locate patients who might need social, community, or governmental services, and direct them to regional and international resources

Payers can also monitor the effects on member/patient health outcomes.

What Can Coders Do?

The capacity to analyze patient outcomes and evaluate the efficacy of various initiatives will be crucial as providers, health systems, payers, policymakers, and researchers continue to address SDoH. To support these objectives, enhance health outcomes, and cut costs, coding professionals must take immediate action by consistently documenting SDoH information. SDoH alone accounts for more than 50% of all hospital readmissions (Fink-Samnick , p. 43)

How AGS Can help

Depending on your organization’s objectives, AGS Health can support you with several services. Code Auditing services include collecting, measuring, and analyzing the accuracy of ICD-10-CM coding and the caliber of SDoH documentation. When documentation is present in the chart, logic built into AGS Health’s CAC tool automatically suggests ICD-10-CM codes. We also can help you understand and address problems related to adherence and lack of follow-up in receiving care, as well as identify and address the most common social risk factors within a particular disease area or target patient population.

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AGS Health is more than a revenue cycle management company—we’re a strategic partner for growth. Our distinctive methodology blends award-winning services with intelligent automation and high-touch customer support to deliver peak end-to-end revenue cycle performance and an empowering patient financial experience.

We employ a team of 12,000 highly trained and college-educated RCM experts who directly support more than 150 customers spanning a variety of care settings and specialties, including nearly 50% of the 20 most prominent U.S. hospitals and 40% of the nation’s 10 largest health systems. Our thoughtfully crafted RCM solutions deliver measurable revenue growth and retention, enabling customers to achieve the revenue to realize their vision.

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