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CIVHC: Social Needs Codes in the CO APCD

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Social factors such as race, education, income, housing and transportation can have a major impact on a person’s ability to live a healthy life. These social determinants of health play a powerful, fundamental role in health outcomes and health equity for individuals and entire communities. In fact, studies have found that up to 80% of a person’s health is related to social factors that are often out of their control and systemic in nature. In an effort to better understand social needs and the impact on patient health, “Z Codes” were introduced as part of the ICD-10 codes released in late 2015. Using these codes, providers and others in the health care system can improve patient care, recognize opportunities to make referrals and better coordinate care, and identify patient and community health equity needs.

If a person is experiencing a social need, their provider can choose to indicate their particular need(s) by documenting one of several Z codes on their health insurance claim. Z codes are divided into major categories of non-medical conditions that may influence a person’s health.

In Colorado, the percent of people with claims that indicate a social need is similar to the national data. Since 2016, the first full year the codes were available, use of the codes has increased, but still only 1.6% of Coloradans in the CO APCD in 2020 across all payers had a claim with a Z code. It is important to note that a person may have more than one health-related social need identified, depending on their situation.

Breakdowns by payer show people with commercial insurance have consistently fewer Z codes, which could be due to less social need for commercially covered Coloradans compared to those covered by public plans, in addition to the lack of financial incentive for providers to document social needs for commercially covered patients.

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