The social determinants of health present many health-related challenges for Medicare Advantage (MA) plan members, which these plans seek to overcome by diversifying their service offerings.

Over the years, the social determinants of health (SDH), along with the concepts found in Maslow’s Hierarchy of Needs, have become important elements of healthcare for providers, health plans, and consumers. Each group aspires to provide and receive an optimal care experience that results in better health outcomes. To achieve these goals, many Medicare Advantage (MA) plans seek to address the challenges presented by SDOH and Maslow by offering new services or expanding their current supportive care services.

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

To help alleviate these challenges, some MA plans leverage additional services, specific benefits beyond what is offered by traditional health insurance, to encourage plan enrollment and support improved health outcomes. health for plan participants. In 2022, the average Medicare beneficiary has access to 39 MA plans offering a variety of healthcare and non-medical services, including remote patient monitoring, healthy meals, home support and non-emergency medical transportation (NEMT).

These services are offered to varying degrees by individual MA plans:

  • 74% remote access technology
  • 67% meal benefit
  • 38% transportation
  • 10% home support services

Using 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 enrollments 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 socio-economic challenges.

According to a report by the National Opinion Research Center (NORC) at the University of Chicago, “The emphasis on SDOH reflects broader trends in the US healthcare system, including the growing recognition that SDOH may have a greater influence on health outcomes than clinical care and increasing levels of social need among the Medicare population.

Older 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 also a comprehensive way to lessen 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 and disabled members of the program. Screening and survey data frequently identified food, housing and transportation as the main social risks.

Benefit from health, create savings

Despite the known benefits of these services, attempting to quantify the outcomes of non-medical benefits can be challenging for PA plans, even when a considerable amount of data exists.

“The key question related to the bottom line is whether the newly offered non-medical services provide a return on investment (ROI) for the plan,” according to a Health Affairs article. “Will these services save more money than it costs to provide in a given year?” New benefits could generate savings by avoiding the need for acute medical care. If emergency department visits, hospital admissions or other forms of acute care are reduced sufficiently, the savings could theoretically exceed the costs of providing the benefit, giving a positive return on investment. While this argument is conceptually powerful, it has proven difficult in practice. »

While the need for return on investment remains high from a health plan perspective, commitment to MA complementary benefits continues to be a high priority at all levels for individuals and organizations providing the services.

“The (MA) plans report that the ultimate goals of their SDOH programs are to produce both better health outcomes, or ‘return on health’ and return on investment through lower health costs for beneficiaries,” according to a case study from the Better Medicare Alliance’s Center for Innovation in Medicare Advantage in the NORC report. “All health plans, providers, vendors and CBOs [community-based organizations]…I believed that the interventions they implement would prove effective in achieving the goals of improving the health of beneficiaries and producing a positive return on investment.

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, personal home care, and remote patient monitoring are some of the most important additional services offered today, and expanding them further can help members and the health plans that offer them.