Social Determinants, Demographics and Outcomes
Historical Background:
Beginning July 1, 2016, and through the process of administrative simplification, AHCCCS spent a great deal of time soliciting stakeholder feedback in a variety of ways regarding provider reporting of Demographic and Outcome Data Set (commonly known as the DUG) data. After extensive research, numerous workgroups, and a thorough review of this critical stakeholder feedback, AHCCCS developed a plan to transition the collection of demographic data. The goal of the transition plan was to relieve administrative burden for providers reporting this data, to ensure that the historical burdensome process was not duplicated with the implementation of the AHCCCS Complete Care (ACC) Program effective October 1, 2018, and provide a process and platform for an expanded group of providers to contribute this data.
AHCCCS’ transition plan consisted of a three-pronged approach to collecting members’ demographic data.
Use of Alternative Data Sources
Use of Social Determinants of Health Diagnosis Codes
Implementation of the DUGless – Demographic Portal
Where Are We Now:
Social Determinants, Demographics and Outcomes data continues to be critical to the AHCCCS program related to required reporting, member care management, etc.
Use of Alternative Data Sources
- AHCCCS, with the assistance of stakeholders, continues to identify demographic elements that currently exist in other AHCCCS data systems, and/or available through other data source agreements.
Use of Social Determinants of Health Diagnosis Codes
- AHCCCS began (April 1, 2018) to require Providers use of Social Determinants of Health diagnosis codes on applicable claims to track member outcomes. The Specific ICD-10 diagnosis codes representing Social Determinants of Health are a valuable source of information as to factors that impact or potentially impact member health. The Social Determinants of Health codes identify the conditions in which people are born, grow, live, work, and age. They include factors like:
- Education
- Employment
- Physical environment
- Socioeconomic status
- Social support networks
- As appropriate within their scope of practice, providers should be routinely screening for and document, the presence of social determinants. Any identified social determinant diagnosis codes should be provided on claims for AHCCCS members in order to comply with AHCCCS Billing requirements.
The DUGless - Demographic Portal
- For those social determinant/demographic/outcome elements with no identified alternative data source or Social Determinate diagnosis identifier, AHCCCS created an online portal (DUGless) accessed directly by providers for the collection of applicable identified data elements for members. It is AHCCCS’ intent that both the provider organizations that historically provided data for the DUG as well as all providers who might typically document or provide these types of data will provide the required data via the DUGless portal. Please review the guide below for more details.
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