Demographics, Social Determinants and Outcomes

Beginning July 1, 2016, and 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.

  1. The Use of Alternative Data Sources

    AHCCCS, with the assistance of stakeholders, identified and continues to identify demographic elements that currently exist in other AHCCCS data systems, and/or available through other data source agreements. The initial elements identified included items such as those below:

    • T/RBHA ID
    • Date of Birth
    • Race
    • Gender
    • Diagnosis (behavioral health and physical health)
    • Behavioral Health Category
    • Assessment Date
    • Member Enrollment and Disenrollment From Services (will be determined through the AHCCCS Behavioral Health Enrolled and Served methodology, which identifies members who are actively receiving behavioral health services via claims and encounter data)
  2. The Use of Social Determinants of Health ICD-10 Diagnosis Codes

    AHCCCS began to use Social Determinants of Health diagnosis codes reported on applicable claims to track member outcomes where possible, requiring the usage of these codes beginning April 1, 2018, on all applicable claims.

    Specific ICD-10 diagnosis codes representing Social Determinants of Health have been identified as a valuable source of information that impacts 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 documenting, the presence of social determinants. Any identified social determinant diagnosis codes should be provided on all claims for AHCCCS members in order to comply with state and federal coding requirements

  3. The DUGless - Demographic Portal

    For those demographic elements with no identified alternative data source or Social Determinate identifier, AHCCCS created an online portal (DUGless) to be accessed directly by providers for the collection of the remaining 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 as of 10/01/2018. Please review the guide below for more details.

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