February 9, 2023
Social determinants of health can play a significant role in cardiovascular health, according to the Centers for Disease Control and Prevention (CDC). Social determinants of health are non-medical factors that influence health outcomes. They include the social, economic and physical conditions where people live, learn, work, play, worship and age.
You and your staff may support our members who have risk factors for heart attacks or strokes. We encourage you to ask our members about their needs related to social determinants of health, such as issues with transportation or access to healthy food. They may need to be prompted to discuss non-medical issues that impact their health. On the claims you submit to us, you can include ICD-10 Z codes for social determinants of health so that we can help address barriers.
Why It Matters
Heart disease and stroke are among the leading causes of death in the U.S., according to the CDC. However, heart disease, stroke and their risk factors disproportionately affect some populations. According to the American Heart Association:
- Black adults have higher rates of severe high blood pressure, and it develops earlier in life.
- Low-income adults are less likely to be screened for cardiovascular disease.
- Adults living in less walkable neighborhoods have a higher risk of cardiovascular disease.
See our Health Equity and Social Determinants of Health webpage for more information.
Other Tips to Close Gaps in Cardiovascular Care
- Talk with our members about reducing and managing their risks for heart disease and stroke. This may include taking medications as prescribed, smoking cessation, increasing physical activity and eating a low-sodium diet. We’ve created resources for members, including information on high blood pressure and cholesterol.
- The U.S. Preventive Services Task Force (USPSTF) recommends blood pressure checks for adults age 18 and older at every visit. Ensure that screenings and results are documented in our members’ electronic medical records. See our preventive care and clinical practice guidelines for more information.
- Offer telehealth services when available and appropriate for preventive care appointments.
- Encourage members to return for follow-up visits. Reach out to those who cancel or miss appointments and help them reschedule as soon as possible.
- For members who need language assistance, let them know we offer help and information in their language at no cost. To speak to an interpreter, members may call the customer service number on their member ID card.
Tracking Our Members’ Progress
For the quality measure Controlling High Blood Pressure, we measure the percentage of members ages 18 to 85 who had a diagnosis of hypertension and whose blood pressure was adequately controlled. The National Committee for Quality Assurance (NCQA) defines controlling blood pressure as:
- Systolic blood pressure < 140 mmHg
- Diastolic blood pressure < 90 mmHg
We also track Statin Therapy for Patients with Cardiovascular Disease. It measures the percentage of male members ages 21 to 75 and female members ages 40 to 75 who:
- Have atherosclerotic cardiovascular disease, and
- Were dispensed at least one high- or moderate-intensity statin medication and remained on the medication for at least 80% of the treatment period
Learn more about statin therapy recommendations.
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their member contract or member guide for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.