Social determinants of health present many health-related challenges for Medicare Advantage (MA) plan members, something these plans are looking to overcome by diversifying their service offerings.
Over the years, social determinants of health (SDOH), along with the concepts found in Maslow’s Hierarchy of Needs, have become important parts 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 looking to solve the challenges presented by SDOH and Maslow by offering new services or expanding their current supportive care services.
SDOH, the social, economic, and environmental factors that may have an impact on health—dovetails with Maslow, which describes the process of securing basic living requirements such as food and shelter before focusing on other seemingly less immediate needs that can include health care.
To help alleviate these challenges, some MA plans leverage supplemental services, specific benefits beyond what’s 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 offering a variety of health care and non–health care services, including remote patient monitoring, healthy meals, in-home support, and nonemergency medical transportation (NEMT).
These services are offered at varying degrees by individual MA plans:
Utilizing these services individually or, preferably, as a group of comprehensive, integrated supportive care services can help MA members improve their health and lessen the effects of SDOH and Maslow. With MA enrollment expected to grow from 26.9 million in 2021 to 29.5 million in 2022, health care organizations have a unique opportunity to help mitigate the effects of these socioeconomic challenges.
Per 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 may have a more significant influence on health outcomes than clinical care and the increasing levels of social need within the Medicare population.”
Older populations, including those who participate in Medicare, often feel the effects of SDOH more dramatically than others, necessitating not only a deeper understanding of the challenges, but a comprehensive way of diminishing them.
According to the NORC report, “Medicare beneficiaries experience many of the same social needs as the general population, but certain social risk factors are more pronounced in the program’s more elderly and disabled membership. Screening and survey data have frequently identified food, housing, and transportation as leading social risks.”
Benefiting Health, Creating Savings
Despite the known advantages of these services, attempting to quantify the results of nonmedical benefits can be difficult for MA plans even when a considerable amount of data exists.
“The key question related to the bottom line is whether newly offered nonmedical services deliver a return on investment (ROI) for the plan,” according to a Health Affairs article. “Will these services save more money than they cost to deliver in any given year? New benefits could 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 powerful conceptually, it has proven challenging in practice.”
Although the need for ROI remains high from the health plan point of view, the commitment to MA supplemental benefits continues to be a high priority across the board for the people and organizations offering the services.
“Plans (MA) report that the ultimate goals of their SDOH programs are to produce both improved health outcomes, or ‘return on health,’ and ROI through lower beneficiary health costs,” according to a case study from Better Medicare Alliance’s Center for Innovation in Medicare Advantage in the NORC report. “All health plans, providers, vendors, and CBOs [community-based organizations]…believed the interventions they are implementing would prove effective at accomplishing the goals of improving beneficiary health 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 improving traditional coverage with supplemental supportive care services. NEMT, nutrition, in-home personal care and remote patient monitoring are among the most important supplemental services being offered today and expanding them further can help benefit members and the health plans that offer them.