CMS defines health equity as the attainment of the highest level of health for all people, where everyone has a fair and just opportunity to attain their optimal health regardless of social economic and geographic factors, preferred language, or other factor that affect access to care and health outcomes. Measure developers need to use clear terminology when describing what and how their measures are addressing social economic and geographic factors. They also need to use data standards as much as possible.

The data critical for measuring factors related to closing gaps in care numerous categories of information. Measured entities have not traditionally collected many of these categories (e.g., sexual orientation and housing status), and others have not been collected consistently (e.g., social economic and geographic factors). Standardization of health data, equity data included, is essential for interoperability, which is a CMS priority. Learn more about this priority in the CMS Office of Minority Health’s white paper, The Path Forward: Improving Data to Advance Health Equity Solutions. 

Examples of data standardization work include

• the Gravity Project, a Health Level Seven International® (HL7®) Fast Healthcare Interoperability Resources® accelerator project, which brings together interested parties across the U.S. to develop and test consensus-based standards to facilitate social economic and geographic factors data capture and exchange across systems, care settings, and social services.
• HL7's Gender Harmony Project (GHP) developed a gender-inclusive logical model. To classify individuals, the Model identifies sex as male, female, or specified and can be based on anatomy, other biological characteristics, or physical and physiological features. 

Z Codes

CMS and others, e.g., Blue Cross Blue Shield of Illinois recommend collecting social economic and geographic factors and coding them in the patient's record with International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) Z codes. This aligns with USCDI v2 data element SDOH Problems/Health Concerns.

While Z Codes have been available for some time, measured entities have not been using them regularly or consistently, as insurers do not require their use. To address the gaps in standardized collection of Z codes, CMS developed an infographic for health care administrators and other team members to understand the best practices and importance of both gathering and tracking social, economic and geographic factors data.

Equity-Related Screening Tools 

There are several screening tools available to assist with collecting social economic and geographic factors. For example,*

• Accountable Health Communities Health-Related Social Needs Screening Tool
• American Academy of Family Physicians Social Needs Screening Tool
• HealthBegins
• Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE)
• Virginia Commonwealth University Health System: Social Needs Assessment

As more screening tools and standards become available for collecting social, economic and geographic factors, the feasibility of including those data in quality measures increases. Measure developers should look for sources of social economic and geographic factors and include within quality measure specifications to assist with measuring equity.

*This a non-exhaustive list and is not an endorsement of specific tools.