|Submitted By: Raymonde Uy / National Association of Community Health Centers (NACHC)|
|Data Element Information|
|Use Case Description(s)|
|Use Case Description||Giving the nature of the American health care system, having insurance is a significant determinant of one’s ability to receive care.
Insurance coverage affects access to care and quality of care. More importantly being underinsured, or not insured at all greatly effects a person’s ability to be seen in a clinical care setting and can ultimately be the determining factor in an individual’s continuity of care as well as their overall physical and mental health and well-being
|Estimated number of stakeholders capturing, accessing using or exchanging||Generally, all healthcare institutions and all federally qualified health centers (FQHCs) gather data about insurance. This encompasses, in 2019, 29 million patients at 1400+ FQHCs with more than 13000 health care delivery sites. The evaluation of social determinants of health, however, should be considered a required component of a patient-centered, value-based approach to care and therefore should be potentially relevant for any patient or care setting.|
|Maturity of Use and Technical Specifications for Data Element|
Z59.7 Insufficient social insurance and welfare support
419808006 - Finding related to health insurance issues (finding)
185952002 - Private health insurance held (finding)
93025-5 -Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]
|Current Use||Extensively used in production environments|
Almost all healthcare institutions, including Community Health Centers, Health Center Controlled Networks and Primary Care Associations routinely capture these data elements in different electronic health record systems
|Number of organizations/individuals with which this data element has been electronically exchanged||5 or more. This data element has been tested at scale between multiple different production environments to support the majority of anticipated stakeholders.|
Payers and Commercial vendors including Aunt Bertha, UNITEUS and NowPow consume insurance data which can be used to link individual patients to social interventions.
|Restrictions on Standardization (e.g. proprietary code)||None|
|Restrictions on Use (e.g. licensing, user fees)||The PRAPARE tool has very minimal licensing and user fees, but collecting this insurance information does not require PRAPARE.
|Privacy and Security Concerns||None|
|Estimate of Overall Burden||Very low burden, especially because this is almost always routinely asked and captured.|
Information from the submission form
Captures patient medical insurance source or type