The social determinants of health present many health-related challenges for Medicare Advantage (MA) plan members, something these plans seek to overcome by diversifying their service offerings.
Over the years, the social determinants of health (SDOH), along with concepts found in Maslow’s Hierarchy of Needs, have become an important part of health care for providers, health plans, and consumers. Each group aspires to provide and receive an optimal care experience that results in improved health outcomes. To address these goals, many Medicare Advantage (MA) plans are seeking to solve the challenges posed by SDOH and Maslow by offering new services or expanding their current supportive care services.
SDOH, Social, Economic, and Environmental Factors That May Influence Health – aligns with Maslow, who describes the process of securing basic living requirements such as food and shelter before focusing on other seemingly less immediate needs that may include health care.
To help mitigate these challenges, some MAs plan to use additional services, specific benefits beyond what is offered by traditional Medicare, to encourage plan enrollment and support improved health outcomes for plan participants. In 2022, the average Medicare beneficiary has access to 39 MA plans that offer a variety of health and non-health care services, including remote patient monitoring, healthy meals, home support, and non-emergency medical transport (NEMT).
These services are offered to varying degrees by individual MA plans:
- 74% remote access technology
- 67% meal benefit
- 38% shipping
- 10% home support services
Using these services individually or, preferably, as a set of comprehensive, integrated supportive care services can help MA members improve their health and reduce the effects of SDOH and Maslow. With MA enrollment expected to grow from 26.9 million in 2021 to 29.5 million in 2022, healthcare organizations have a unique opportunity to help mitigate the effects of these socioeconomic challenges.
According to a report conducted by the National Opinion Research Center (NORC) at the University of Chicago, “The focus on SDOH reflects broader trends in the US health care system, including growing recognition that SDOH can have a more important in health outcomes than clinical care and increasing levels of social need within the Medicare population.”
Aging populations, including those participating in Medicare, often feel the effects of SDOH more dramatically than others, requiring not only a deeper understanding of the challenges, but a comprehensive way to reduce them.
According to the NORC report, “Medicare beneficiaries experience many of the same social needs as the general population, but some social risk factors are more pronounced in the program’s older and disabled membership. Screening and survey data have often identified food, shelter and transport as key social risks.
Benefiting health, creating savings
Despite the known advantages of these services, trying to quantify nonmedical benefit outcomes can be difficult for MA plans even when a substantial amount of data exists.
“The key question related to termination is whether the newly provided nonmedical services provide a return on investment (ROI) for the plan,” according to a Health issues article. “Will these services save more money than they cost to provide in any given year? New benefits can generate savings by preventing the need for acute medical care. If emergency department visits, hospital admissions, or other forms of acute care are sufficiently reduced, the savings could theoretically exceed the costs of providing the benefit, yielding a positive ROI. While this argument is conceptually powerful, it has proven challenging in practice.”
Although the need for ROI remains high from a health plan perspective, the commitment to additional MA benefits continues to be a high priority across the board for the people and organizations that provide the services.
“Plans (MA) report that the ultimate goals of their SDOH programs are to produce improved health outcomes, or ‘returns to health,’ and ROI through lower beneficiary health costs,” according to a case study from Better’s Center for Innovation Medicare Alliance. in Medicare Advantage in the NORC report. “All health plans, providers, vendors and CBOs [community-based organizations]… it is believed that the interventions they are implementing will be effective in meeting the goals of improving the health of beneficiaries and producing a positive ROI.”
MA plans continue to move in the right direction by helping to meet the needs of current and future members by enhancing traditional coverage with additional supportive care services. NEMT, nutrition, home personal care and remote patient monitoring are among the most important additional services offered today, and expanding them further can help benefit members and the health plans that provide them.