The Underutilization of Z-Codes in Documenting Social Determinants of Health: A Missed Opportunity in Healthcare

By Jessica Robinson, Chief Platform Officer, The Garage

When it comes to the evolving healthcare landscape, it has become increasingly important that we understand and address social determinants of health so we can achieve health equity. Z-codes, added as part of the ICD-10 coding system, serve as a tool for healthcare providers to document and track the social determinants of health affecting patients. According to two recent studies published in Health Affairs Scholar, it has been revealed that these Z-codes are being vastly underutilized, which is a cause for concern. Two unrelated studies conducted by researchers from the NYU School of Global Public Health and the Colorado School of Public Health and John Hopkins shed light on this underutilization of z-codes.

NYU School of Global Public Health's study analyzed z-code adoption in the United States utilizing data from the American Hospital Association (AHA) Annual Survey and total Medicare Fee-for-Service (FFS) claims. This data consisted of 42 million patients that were aggregated at the hospital level. The AHA Survey featured data from 6,000+ US hospitals and health care systems over a 5-year period between 2017-2021. The second study by the Colorado School of Public Health and John Hopkins analyzed the use of SDOH Z-codes in 48.9 million Medicaid population patients and 203.9 million patients of commercially insured health plans. During the study, researchers discovered that z-codes were present in less than 2% of patient records in both patient populations, with z-code use being 50% more prevalent among Medicaid patients compared to commercially insured beneficiaries.

These studies underscore a significant deficiency in the healthcare system's readiness to tackle social determinants of health despite the existence of Z-codes for various SDOH factors. The underutilization is especially concerning considering that social determinants of health account for approximately 30-55% of health outcomes, according to WHO. Seeing this data, we conducted research on 10 of our customers at random with an expansive dataset of 1.4 million unique patients and all claims data from 2022.

During this research, we found:

  • Merely 1.28% of the total patient cohort had documented z-codes. Given that industry studies estimate that 68% of patients are impacted by at least one social factor, this is critically low
  • 60% of patients with documented z-codes were female, signaling potential gender-specific vulnerabilities to social determinants of health that warrant further exploration
  • Unsurprisingly, the highest concentration of patients with documented z-codes were found in the Medicaid population
  • Understandably, Institutional claims carried the highest number of documented z-codes
  • The most prevalent z-code category was Z59, Problems related to housing and economic circumstances, which encapsulates homelessness, inadequate housing, food and transportation insecurity, and material hardship
  • The second most identified z-code category was Z60, Problems related to social environment

These findings collectively emphasize the need for a comprehensive strategy to address the multifaceted impact of social determinants on patient health. Knowing that non-clinical factors contribute to about 80% of community health outcomes enables us to make this a core focus in Bridge with our customers in the coming weeks, leveraging our North Star strategy and setting organizational goals for maximum impact.

In conclusion, the underutilization of z-codes in documenting social determinants of health is a missed opportunity for healthcare providers to offer more effective and patient-centric care. As the industry grapples with evolving payment models and growing emphasis on addressing SDOH, bridging the gap becomes paramount. It is essential for healthcare organizations to invest in training on why it's important to prioritize SDOH z-code capture to bridge the gap in healthcare delivery and achieve health equity. At The Garage, we are helping our customers tackle z-code underutilization head on by enabling an end-to-end solution for addressing unmet social needs with a data-first approach. Contact us today to learn more!

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