Industry studies highlight large investments, yet ACOs struggle to integrate SdoH.
Several major research studies have emphasized the large sums being spent by healthcare organizations to better manage the social determinants of health (SDoH), amid ongoing struggles to mitigate service gaps, especially by Accountable Care Organizations (ACOs).
A study published in Health Affairs explored the degree to which U.S. health systems have directly invested in community-based efforts. Researchers scoured public announcements of new programs involving direct financial investments associated with the SDoH by U.S. health systems from the time period of Jan. 1, 2017 to Nov. 30, 2019.
Hefty investments were found across health systems and the five main SDoH domains, encompassing:
Health systems are clearly making sizable investments in these areas.
The three largest investments were by Kaiser Permanente for $760 million, the Johns Hopkins Health System for $162 million, and MetroHealth in Cleveland for $160 million.
The research excluded programs in which health systems used:
ACOs Behind the Curve
On another note, data from a recent Dartmouth study shows that despite strong efforts, ACOs continue to struggle integrating social services and medical care. The study pulled qualitative data from 22 ACOs, and used phone calls and site visits, the latter lasting anywhere from 3-5 days. The study also reflected diverse payor populations across the country. While there was high awareness of the importance of addressing the SDoH, the ACOs were way behind the curve:
Considering the strong value-based care emphasis by ACOs, the data has demonstrated surprisingly low awareness of how care and costs connect for the SDoH populations. With such strong industry attention to the development of cross-sector collaboration, partnerships with CBOs can become a solid way to address the social needs of any community.
Programming Note: Listen to Ellen Fink-Samnick’s live reporting on the State of the Social Determinants weekly on Monitor Mondays, 10-10:30 a.m. EST.
In my recent hospital travels, involving working with frontline case management staff, we completed an initial assessment and intervened with a patient who provides one
Last week, the chief medical officer (CMO) for the Centers for Medicare & Medicaid Services (CMS), Dora Hughes, MD, MPH, published a blog in Health
Please log in to your account to comment on this article.
Dr. Ronald Hirsch provides tried-and-true strategies and insight into outpatient in hospital bed stays including determining the applicable definition, who uses it, and when and how to bill for this circumstance, solidified with concrete case examples and expert insight.
Practical solutions for CDM departments to protect your hospital’s revenue.
This webcast teaches hospitals how to comply with CMS price transparency rules and compare their rates with peer hospitals. It covers creating a compliant machine-readable file, comparing negotiated rates, and improving pricing decisions.
The No Surprises Act (NSA) presents a challenge for hospitals and providers who must provide Good Faith Estimates (GFEs) for all schedulable services for self-pay and uninsured patients. Compliance is necessary, but few hospitals have been able to fully comply with the requirements despite being a year into the NSA. This webcast provides an overview of the NSA/GFE policy, its impact, and a step-by-step process to adhere to the requirements and avoid non-compliance penalties.
This expert-guided webcast will showcase tips for providers to ensure appropriate capture of the work performed for a visit. Comprehensive examples will be given that demonstrate documentation gaps and how to educate providers on the documentation necessary to appropriately assign a level of service. You will gain clarification on answers regarding emergency department and urgent care coding circumstances as well as a review of how/when it is appropriate to code for E&M in radiology and more.
Set yourself up for financial and compliance success with expert guidance that breaks down the impactful changes including MS-DRG methodology, surgical hierarchy updates, and many new technology add-on payments (NTAPs). Identify areas of potential challenge ahead of time and master solutions for all 2024 Proposed IPPS changes.
Do you struggle with selecting and appending the correct modifier for your medical claims? Join our must-attend webinar, “Mastering Modifier Usage: Preventing Denials and Ensuring Compliance” to reduce claim denials and improve your reimbursement rates.
Kay Piper reviews the guidance and updates coders and CDISs on important information in the AHA’s fourth quarter 2023 ICD-10-CM/PCS Quarterly Coding Clinic in an easy to access on-demand webcast.
Copyright © 2023 ICD10monitor. Powered by MedLearn Media.
