News: Humana to reimburse providers for identifying SDOHs

Humana recently launched an initiative aimed to help clinicians address nonmedical health risk factors. The social determinants of health (SDOH) value-based program targets these nonmedical issues such as homelessness, inconsistent access to food, and housing instability, Healthcare Dive reported.

Although CMS had initially proposed several new codes for SDOHs, they were not implemented in the 2020 inpatient prospective payment system (IPPS) final rule. Humana, however, is choosing to base reimbursement on SDOH with the newly launched initiative.

The program for members in Medicare Advantage plans is designed to encourage clinicians to provide more holistic care that goes beyond traditional medical treatment. The initiative promotes patient screenings and other assessments to address such social factors that could negatively affect health outcomes. Humana says it will reimburse for such coordination, although it is yet to be made clear exactly how this will work.

The first provider to participate is Ochsner Health in Louisiana. Ochsner is Louisiana’s largest non-profit, academic healthcare system. Humana officials said the company “will be looking to expand the program to include participation by other providers elsewhere in the country.”

Editor’s note: To read Healthcare Dive’s coverage of this story, click here. The Humana initiative can be found here. To read more about CDI and SDOH, click here. To read about the 2020 IPPS final rule, click here.