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Social Determinants Collaborative

Years of research have shown that living, learning and working environments can explain more of the variance in health outcomes than is true for medical care. That’s why when ICD-10 was implemented in the United States in 2015, CMS included a range of codes (Z55-Z65) of that were intended to diagnose a number of problems related to socioeconomic and psychosocial circumstances. Unfortunately, since these “Z codes” have not been typically tied to reimbursement, they are rarely and inconsistently reported.

The Social Determinants Collaborative was founded to change that. Jointly administered by SCDHHS and SCHA, the Collaborative has been allocated 5% of the funds from the new Medicaid Quality-based Payment Program for the 2019-2020 program year. While this program is likely to evolve over the years, hospitals will now have the opportunity to align their health equity goals with true financial incentives for the first time.

The Collaborative will work to assist hospitals in adapting these “Z codes” by preparing educational materials, hold educational sessions, and conduct research on trends associated with these codes to support our member in deploying these social determinant codes as appropriate and to establish constructive referral mechanisms for Medicaid patients presenting with such needs.