By Robert Pittman
With the Medicare Advantage (MA) member enrollment period fast approaching for the 2023 plan year, health plans have already begun to take stock of supplemental benefits they may offer in 2024.
Between a growing number of attractive supplemental and zero-dollar plans, the MA market continues to evolve and relegate plans with lower Star ratings—typically three stars or fewer—to a less competitive status among their MA plan peers.
That dynamic creates the existential question for all MA plans in summer 2022: What benefits should we offer in 2024?
HRSNs drive utilization
Market research, success with or challenges caused by previous plan offerings, changes in state and county demographics, plan utilization information and other data points all play a role in determining which supplemental benefits are offered by MA plans in upcoming years.
Health-related social needs (HRSN), such as food insecurity or lack of reliable transportation have proven to lead to negative health outcomes without consistent and timely interventions. This is in large part why HRSNs continue to serve as a driving focus of many MA plans because of their potential impact on member health and service utilization.
Looking forward, an article published by the JAMA Network may offer some insight into what MA plan members will see as new benefits in 2024. As part of this effort, researchers conducted a study of more than 56,000 MA plan members to better understand the impact of demonstrable, self-reported health-related social needs on the utilization of acute medical services, specifically emergency department utilization and avoidable hospital stays.
Their results found that health-related social needs were prevalent among MA members and that approximately half of all MA members had at least one key HRSN, such as food insecurity, financial strain, loneliness, unreliable transportation, utility insecurity, housing insecurity or poor housing quality. Importantly, the researchers reported statistically significant results pointing toward the relationship between specific unmitigated health-related social needs and the utilization of potentially unavoidable medical services.
“These findings provide evidence of the unique association between certain HRSNs and different types of acute care utilization, which could help refine the development and targeting of efforts to address HRSNs,” according to the researchers.
Because MA plans have significant latitude in offering supplemental benefits, there’s a unique opportunity to address HRSNs by improving existing benefits or offering new ones.
“Within the Medicare program—where health-related social needs (HRSNs) such as food insecurity, financial strain, and unreliable transportation are estimated to affect roughly half of beneficiaries—policy makers, payers, and delivery organizations are increasingly investing in efforts to identify and address HRSNs,” according to the study.
Health-related social needs and utilization
Overall, the study found MA members with one or more HRSN, compared to those without, had a statistically significant higher rate for any type of hospital visit. For hospital stays specifically, those MA members with at least one HRSN had a 53.3% higher hospital utilization rate than those without.
Of note, unreliable transportation was specifically called out as a MA member challenge that is independently associated with higher rates of hospital stays than other HRSNs.
Unreliable transportation was linked to increased:
“Among all-cause hospital stays,” the research found, “unreliable transportation had the largest association, with a marginal effect of 51.2 hospital stays per 1000 beneficiaries.”
Looking to 2024
As MA plans consider supplemental benefits for 2024, if this study is any indication, they should consider adding or expanding transportation, meals and other benefits that may lessen HRSNs, which, in turn, could yield a positive impact by lessening utilization of already scarce medical services. For “older adults enrolled in Medicare Advantage,” the researchers explain, “self-reported HRSNs were common and associated with statistically significantly increased rates of acute care utilization….”
By utilizing supplemental benefits as a means to address HRSNs, a significant opportunity exists for MA plans to not only attract and retain members—thereby growing revenue—but to improve member health, lessen the impact of HRSNs and decrease utilization of expensive—and often avoidable—medical services.
Robert Pittman is Senior Vice President of Government Affairs at Modivcare.