Technology and complementary services in MA can help improve the health of participants

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, social determinants of health (SDOH), along with concepts found in Maslow’s hierarchy of needs, have become important parts of health care for providers, health plans, and consumers. Each group strives to provide and receive an optimal care experience that leads to improved health outcomes. To address these goals, many Medicare Advantage (MA) plans are seeking to address the challenges presented by SDOH and Maslow by offering new services or expanding their current supportive services.

SDOH, the social, economic and environmental factors that can influence health, coincides with Maslow, who describes the process of securing basic life requirements such as food and shelter before focusing on other seemingly less immediate needs, which may include health care.

To help alleviate these challenges, some MA plans use supplemental services, specific benefits beyond those 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 and non-health services, including remote patient monitoring, healthy nutrition, home support and non-emergency medical transport (NEMT).

These services are available to varying degrees from individual MA plans:

  • 74% remote access technology
  • 67% benefit from food
  • 38% transport
  • 10% home support services

Using these services individually or, preferably, as a group of comprehensive, integrated support services can help MA members improve their health and reduce the effects of SDOH and Maslow. With master’s 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 prepared 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 the growing recognition that SDOH can have a greater impact on health outcomes of clinical care and increasing levels of social need among the Medicare population.”

Older populations, including those enrolled in Medicare, often feel the effects of SDOH more dramatically than others, necessitating not only a deeper understanding of the challenges but also a comprehensive approach to reducing 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 among older program members and people with disabilities. Screening and survey data often identify food, housing and transport as leading social risks.

Health benefits, creating savings

Despite the known benefits of these services, attempting to quantify nonmedical benefit outcomes can be difficult for MA plans, even when a significant amount of data exists.

“The key question related to the ultimate goal is whether the newly offered nonmedical services provide a return on investment (ROI) for the plan,” according to Health matters article. “Will these services save more money than it costs to provide them in a given year? The new benefits could generate savings by preventing the need for emergency medical care. If emergency room visits, hospital admissions, or other forms of emergency care are sufficiently reduced, the savings could theoretically exceed the cost of providing the benefit, resulting in a positive return on investment. Although this argument is powerful conceptually, it has proven challenging in practice.

Although the need for return on investment remains high from a health plan perspective, commitment to the additional benefits of MA continues to be a high priority for individuals and organizations offering the services.

“(MA) plans report that the ultimate goals of their SDOH programs are to achieve both improved health outcomes, or ‘health returns,’ and ROI through lower beneficiary health costs,” according to a case study from Better’s Center for Innovation Medicare Alliance in Medicare Advantage in NORC Report. “All health plans, providers, providers and CBOs [community-based organizations]…believed that the interventions they implemented would be effective in achieving the goals of improving the beneficiary’s health and creating a positive return on investment.”

MA plans continue to move in the right direction, helping to meet the needs of current and future members by enhancing traditional coverage with additional supportive care services. NEMT, nutrition, in-home personal care and remote patient monitoring are among the most important additional services offered today, and expanding them further can help members and the health plans that offer them.

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