New Medical Codes to Track Social Determinants of Health

A male and female hiking Vermont trails

Health care providers now have the ability to track a patient’s social determinants of health through new medical codes championed by a Family Nurse Practitioner and Blue Cross and Blue Shield of Vermont.

As of October 1, 2021, health care providers now have the ability to track a patient’s social determinants of health through new medical codes championed by Family Nurse Practitioner Sarah DeSilvey and Blue Cross and Blue Shield of Vermont (Blue Cross). When the Centers for Medicare and Medicaid Services (CMS) approved a suite of new medical codes this spring, it was the culmination of years of work and collaboration between Blue Cross and DeSilvey.

“All too often, we are so focused on doing good work in the positions we are in that our systems inadvertently draw boxes around themselves. Our professional areas of focus are siloed, creating barriers in care,” says Dr. Joshua Plavin, Vice President and Chief Medical Director at Blue Cross and a practicing physician of Pediatric Internal Medicine. “When a mother struggles to provide three healthy meals for her child each day, or when her family is not exactly homeless because a kind friend has offered their couch, these are stark struggles that the person endures. Using medical codes that speak a language that mirrors a patients’ needs is critical to be able to begin to track our progress on social determinants of health.” 

As of October 1st, health care providers are able to track those social determinants of health. 

“Using medical codes, providers will be able to create a data trail of referrals to community services and supports for a whole swath of social determinants of health that have been largely missing from a patient’s medical history,” says DeSilvey.  

The literature shows that when a person is food or housing insecure, it makes it considerably harder for them to manage chronic conditions like diabetes, asthma, or hypertension. In our modern medical system that has a regular migration of providers and specialists in and out of a patient’s life, those codes offer continuity in the patient’s story.   

DeSilvey calls herself an “accidental informaticist.” She entered into clinical practice with the primary goal of addressing food insecurity. Along the way she began to focus on the absence of language for the social determinants of health. In 2017, DeSilvey and Chris Denis a Medical and Clinical Coding Specialist at Blue Cross, were connected through Dr. Plavin. They developed an application for ICD-10-CM terminology for food insecurity concepts to align with the ACO and anticipate codes that could support the connection between food insecurity and health care. A former faculty at the University of Montana in the Missoula organic agriculture program, and now a Family Nurse Practitioner with the Northwestern Georgia Health Center in Georgia and Fairfax, DeSilvey also holds a position of clinical faculty at the University of Vermont Larner College of Medicine. Her work has evolved and she is now the Director of Clinical Informatics at the social determinant data standards initiative called the Gravity Project.

“I became a specialist in social informatics through integrating my experience in community activism and social justice initiatives, clinical practice and expertise in how social risk effects personal and public health, and by understanding the gaps and needs in that space,” says DeSilvey. 

DeSilvey worked closely with Dr. Plavin and Denis at Blue Cross who DeSilvey calls, “Partners in the Good.” The team has worked since 2017, to quantify and create the codes. The work has since merged into Gravity Project’s objectives and DeSilvey carries it forward. Ultimately the project petitioned the Centers for Disease Control and Prevention (CDC) ICD-10-CM Coordination and Maintenance Committee to approve codes not just for food insecurity, but new housing instability and homelessness terms as well. 

“This conversation that began in mighty little Vermont will have implications nationally on our understanding of the health and wellbeing of our population,” says DeSilvey. “This is one more example of how coming together across disciplines can lead to real change.”

Blue Cross and Blue Shield of Vermont is the state’s only local, not-for-profit health plan. For over 30 years, the company has been enhancing the health and well-being of the Vermonters by offering innovative plans to individuals, seniors and businesses. Our employees are dedicated to developing new ways to support high quality care and programs and events that promote health and wellness. Blue Cross and Blue Shield of Vermont is an independent licensee of the Blue Cross and Blue Shield Association.