As Medicare and Medicaid plans seek ways to improve overall care quality by addressing members’ social determinants of health, an emerging source of beneficiary-level SDOH data is a subset of ICD-10 “Z Codes,” which can be attached to claims and encounters to identify causes other than a disease or injury. While there is payer enthusiasm for using these codes, new research suggests that plans have a long way to go to increase provider uptake and establish best practices in this area.

According to an analysis of the most recently available Z code data from the CMS Master Beneficiary Summary File, NORC at the University of Chicago found that just 1.3% of all Medicare beneficiaries had their social needs tracked with a Z code in 2018. In Medicare Advantage, that percentage was slightly higher at 1.5%, compared with 1.2% in fee-for-service Medicare. In an August report prepared on behalf of the Better Medicare Alliance (BMA), NORC estimated that 1.4% of FFS Medicare enrollees had an SDOH-related Z code in 2017.

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