NHN Pharmacist Outlines Value of Z-codes and Addresses Health Inequities in New Article

June 22, 2022

Adam Schulte, PharmD, Presents Findings to Identify and Address Barriers of Care

Journal of Managed Care and Specialty Pharmacy

(Omaha, Neb., 6/22/2022): Adam Schulte, PharmD, NHN pharmacist, recently had an article published in the Journal of Managed Care and Specialty Pharmacy (JMCP), along with affiliates, Anthony Donovan, PharmD, UNMC postdoctoral research associate and Carrie McAdam-Marx, MSCI, PhD, RPh, professor at UNMC.

Their article, titled “From Access to Equity: The Devil is in ‘Z’ Details,” encapsulates the current situation on health inequities related to social codes not consistently being captured by health-care professionals and how to address it.

Social determinants of health (SDoH) are the social conditions that influence individual and group differences in health status such as health-care access, financial stability, education, transportation, food and housing. Z-codes are used to document SDoH information during a medical encounter to improve awareness of these situations across the care team. In his article, Dr. Schulte identifies a systemic problem of not capturing SDoH-related Z-codes, causing vulnerable patients to go unidentified.

According to Medicare and Medicaid Services data from 2016 to 2017, “[…] SDoH-related Z-codes were captured in only 1.9% of hospital discharges,” yet, “30% of patients in a primary care setting screened positive for at least one social risk factor. Thus, we recognize that socially determined barriers to health exist, but we lack the data and processes to identify, target and address them,” Dr. Schulte said.

Z-code capture plays an important role that will benefit the patient and the provider by proactively identifying vulnerable patients so they can get the help they need. “Empowering health plans and providers with additional information such as SDoH enables the entire care team to proactively develop a personal care plan to address each patients’ specific situation,” Dr. Schulte said. There is currently and opportunity for managed care organizations to financially incentivize providers to capture more information about these social factors through value-based reimbursement models.

NHN sponsors a free, online resource to help address these SDoH in our community. This program is called Community Relay and allows those in the local area to search for free or reduced-cost SDoH resources near them. More information can be found at https://communityrelay.com.

  • About the NHN

    Formed in 2010, Nebraska Health Network is the accountable care organization for two leading health systems in Nebraska: Methodist Health System and Nebraska Medicine. We have more than 5,500 primary care and specialty physicians and advanced practice providers working throughout the Omaha metropolitan area, Fremont and western Iowa. Together, we work to transform health care and provide patients with the highest possible quality of care at the lowest cost. 


    The NHN team welcomes the opportunity to speak with you on a number of industry topics including, but not limited to:

    • Value-based Care
    • Advanced Payment Models
    • Cost and Quality Initiatives
    • Medicare Shared Savings Program
    • Social Determinants of Health
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