6 ways health plans are investing in SDOH strategies within the growing Medicare Advantage market

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By Robert Pittman

Medicare Advantage is taking precedence in health plan markets with no intention of slowing down. Today, 48% of Medicare beneficiaries are enrolled in Medicare Advantage (MA) health plans (the enrollment more than doubled in the last 15 years from just 19%), according to the Kaiser Family Foundation. Now more than ever, as the number of MA health plan members continues to grow, healthcare organizations are taking a close look at strategies that help mitigate the effects of health-related social needs among MA members.

Health-related social needs, or social determinants of health, such as food insecurity, poor quality housing, lack of transportation and low or fixed income are a few of the many issues older adults face. In fact, social determinants of health affect nearly 50% of health outcomes, an article by the Office Health Policy confirms, meaning key factors impacting one’s health often take place far beyond the four walls of a clinician’s office.

Knowing that the number of MA health plan members continues to grow, that these individuals want to live independently and that healthcare services often take place in settings other than a provider’s office, the industry is, seemingly, at a crossroads.

The future of Medicare Advantage

So where exactly is MA headed? Health plans must devise new supplemental benefits and find creative ways to tackle health-related social needs while keepings costs down. Below are several ways health plans can–some already have–make changes to enter the space or improve their standings among MA members and CMS:

  1. Engage brokers during pre and post discussions: Allowing brokers to engage with members during and after the enrollment process gives members a better understanding of their MA health plan options. This also keeps communication concise and helps to keep important information from becoming “lost in translation,” which we know is important as medical and policy jargon can quickly become complicated. As part of the conversations, members can share their needs and expectations of what they hope to gain from a MA health plan, such as non-emergency medical transportation, personal care, remote patient monitoring, meal delivery services or any number of additional supplemental services that address specific health concerns.
  1. Provide a concierge experience: Healthcare is personal and so should the conversations be. “Concierges” can help members identify and use supplemental benefits through a conversational and personal approach. As new generations become eligible for MA health plans, these members will expect that their yearslong concierge-type experiences with streaming and online buying will be replicated throughout the MA health plan enrollment process.
  1. Launch digital platforms: Health plans are investing big dollars into technology and for good reason. Members can experience MA with a more simplified, modern enrollment and orientation platform. MA health plans that take benefits further by introducing technology advancements that are tied to health improvement opportunities may be able to carve out significant market share (think fitness trackers, brain games, mental wellness and sleep quality apps, and remote patient monitoring devices, to name a few).
  1. Utilize give-back dollars: A recent journal study found that financial strain was the most common issue among all social determinants of health. This means having extra funds towards utilities or pet care can be instrumental for MA health plan members. Building premium paybacks into health plan designs can help lessen the impact of this ongoing issue.
  1. Deliver fresh food: Access to healthy food isn’t always an option for those living in rural and lower-income areas, especially those suffering from financial hardships. Health plans are capitalizing on this and removing the barrier older adults face by delivering fresh food and nutritious meals right to their doors.
  1. Build community support: Loneliness and social isolation are important social determinants of health to recognize because they play a large role in MA members’ quality of life and mortality rates. The journal PLOS Medicine reported 50%  of individuals who had stronger social relationships had an increased likelihood of survival versus those without. This statistic remained the same regardless of the individual’s age, gender and initial health status. Like regular physical health screenings, social well-being “check-ins” are just as critical to the wellbeing of MA health plan members. Insurers should continue to partner with digital platforms to connect MA members with in-person engagements and neighborhood connections.

The financial benefit of strategic implementation

Now that we know where Medicare Advantage is headed, what does that mean financially for health plans?

Insurers have already seen $1 billion in cost savings by implementing MA supplemental benefits across the country that employ strategies to address social determinants of health. In addition, CMSencourages states to implement these strategies to help lower costs and improve members’ lives. The cost savings and improved MA member health outcomes driven by supplemental benefits is a win-win for MA health plans and their members.

Medicare Advantage is a positive, growing trend that’s gaining favorable support across the country. Nevertheless, health-related social needs will continue to be a major factor impacting the health and well-being of older adults nationwide, and that need will not subside any time soon, if ever. As an industry, we will need to continue to build and execute strategies that are effective and impactful for older adults while keeping an eye toward financial risks.

Robert Pittman is Senior Vice President of Government Affairs at Modivcare.


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