Current health care payment methods do not reflect the need for effective chronic disease prevention, nor do they address the social determinants of health. Historically, common payment standards intended to link private healthcare providers with payers did not factor in coding or language to cover services provided by nonmedical personnel. Nonmedical personnel, specifically those in the social services sector, remain at a financial disadvantage relative to their peers. Payment structures and coding systems are not neutral administrative directories but reflect the social and political environment in which they were produced. The inclusion or exclusion of covered services in the standard coding language has multiple downstream consequences and can lead to health inequities.

 

This one-year developmental study will evaluate a novel mechanism for incorporating social services into existing health billing codes, thereby allowing both social and healthcare services to be reimbursed within one system. Review of regulations governing coding methodologies, insurance agency payer plans, and feedback from stakeholder interviews will inform recommendations on changes to policies that would codify social services and potentially improve access to services that address the social determinants of health.