The social determinants of health pose a number of health challenges for Medicare Advantage (MA) plan members, some of which will be addressed 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 components of healthcare for providers, healthcare plans, and consumers. Each group strives to provide and achieve an optimal care experience that leads to better health outcomes. To achieve these goals, many Medicare Advantage (MA) plans attempt to address SDOH and Maslow challenges by offering new services or expanding their existing supportive care services.
SDOH, Social, Economic and Environmental Factors That Can Impact Health – Concordance with Maslow, which describes the process of securing basic necessities of life, such as food and shelter, before focusing on other, less urgent needs, including health care.
To mitigate these challenges, some MAs use specific benefits, complementary services offered by traditional Medicare to encourage plan participation and support better health outcomes for plan participants. In 2022, the average Medicare beneficiary has access to 39 MA plans that offer a variety of health and non-health services, including remote patient monitoring, healthy eating, home assistance, and non-emergency medical transportation (NEMT).
These services are offered to varying degrees by different MA plans:
- 74% remote access technology
- 67% food gain
- 38% traffic
- 10% in-house 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 reduce the impact of SDOH and Maslow. With MA enrollments projected to grow from 26.9 million in 2021 to 29.5 million in 2022, healthcare organizations have a unique opportunity to mitigate the impact of these socioeconomic challenges.
According to a report by the National Opinion Research Center (NORC) at the University of Chicago, “The focus on SDOH reflects broad trends in the American healthcare system, including the growing recognition that SDOH has a significant impact on clinical outcomes. potentially have more significant implications than rising levels of care and social needs within the Medicare population.”
Older populations, including those participating in Medicare, often feel the effects of SDOH more dramatically than others, which requires not only a deeper understanding of the challenges, but also a comprehensive way to mitigate them.
According to the NORC report, “Medicare beneficiaries have social needs similar to those of the general population, but some social risk factors are more pronounced when more elderly and disabled members participate in the program. Screening and survey data often included food, shelter and transport.” identified as major social risks.
Health Benefits, Savings Creation
Despite the well-known benefits of these services, attempting to measure the outcomes of non-medical benefits can be difficult for MA plans, even when there is a large amount of data.
“The key question in terms of the bottom line is whether the newly-offered non-medical services provide a return on investment (ROI) for the plan,” said one health issues Article. “Will these services save more money in any given year than it costs to deploy? The new benefits could result in savings by avoiding acute medical care. When emergency room visits, hospital admissions, or other forms of acute care are sufficient. , the savings could theoretically exceed the cost of delivering the benefit and yield a positive ROI. Although this argument is conceptually compelling, in practice it has proved difficult.”
While ROI needs remain high from a healthcare plan perspective, commitment to MA ancillary services remains a high priority across the board for individuals and organizations that provide services.
According to a case study from the Better Medicare Alliance Center for Innovation, “Plans (MAs) report that the ultimate goal of their SDOH programs is to achieve both better health outcomes, or “return to health,” and an ROI through lower health care costs for beneficiaries. “ Do.” In the Medicare Advantage in NORC report. “All health plans, providers, providers, and CBOs” [community-based organizations]…believed that the interventions they delivered would prove effective in meeting the goals of improving the health of beneficiaries and generating a positive ROI.
The MA plans continue to move in the right direction by helping to meet the needs of current and prospective members by enhancing traditional coverage through supplemental supportive care services. NEMT, nutrition, home personal care and remote patient monitoring are among the key complementary services offered today and their pursuit can benefit members and the healthcare plans offered to them.