Practice improvements that engage community resources to support patient health goals - ICD-10-CM Quality Payment Program Measure
| Quality Measure | Description | High Priority | Submission Methods |
|---|---|---|---|
| Practice improvements that engage community resources to support patient health goals | Select and screen for the health-related social needs (HRSN) that are relevant for your patient population using tools that have been tested with underserved populations. If possible, use a screening tool that is health IT-enabled and includes standards-based, coded question/field for the capture of data. After screening, address HRSNs identified through at least one of the following:• Maintain formal relationships with community- based organizations to strengthen the community service referral process, implementing closed-loop referrals where feasible; or • Update a guide to available community resources, or work with community partners to provide a community resource guide and provide it to patients who are found to be at risk in one or more HRSN area; or• Record findings of screening and trigger follow-up within the electronic health record (EHR); then analyze EHR data on patients with one or more HRSN needed to identify and implement approaches to better serve their holistic needs through linkages with community resources. HRSNs prioritized by your practice might include health-harming legal needs, which require both health and legal support to resolve, areas such as food and housing insecurity, or needs such as exercise, nutrition, or chronic disease self-management. | NO |
Linked ICD-10 Codes
The following ICD-10-CM codes are linked to the quality measure practice improvements that engage community resources to support patient health goals when used as part of a patient's medical record. This Quality Measure is part of Medicare's Quality Payment Program (QPP).
| ICD Code | Description | Category |
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