In 2018, Congress allowed Medicare Advantage plans to offer supplemental, non-medical benefits for chronically ill subscribers, and CMS expanded the definition of primarily health-related supplemental benefits to include more non-medical benefits.1
MA plans have risen to the challenge. The number of plans offering benefits targeting social determinants of health has risen from 626 in 2020 to 1,851 in 2022. Meals and in-home modifications are most common, but plans offer a range of benefits from transportation to support for caregivers to pest control.1 Early results are positive, but policymakers, insurers and other stakeholders need concrete information on outcomes and return on investment. 2
That’s easier said than done. Some benefits may have immediate effects, but many take years for the effects to become apparent. Meanwhile, subscribers may change plans in the interim, complicating long-term measurement. The lack of control groups, variation in community-based organizations, technology limitations, misaligned incentives and disparate healthcare and social service systems also contribute to complexity.2
Nonetheless, MA plans can and should measure outcomes, say ATI Advisory’s Allison Rizer and Laura Benzing. They suggest first evaluating utilization and access trends. Second, instead of focusing on spending or hospitalizations, plans should consider using member surveys to measure well-being, satisfaction and retention.1
The National Center for Quality Assurance recently released new measures for tracking emergency department visits for hypoglycemia in older adults with diabetes, and social need screening and intervention. The first gives MA plans an opportunity to measure observed-to-expected emergency department visits, implement interventions and measure outcomes. The second encourages plans to assess unmet food, housing and transportation needs using prescribed instruments, then connect members with resources.3
Plans should establish baselines before attempting to measure outcomes. The Rural Health Information Hub has assessment tools and resource lists that could help, including community-level indices, screening tools for healthcare settings, and decision-support resources.4
MA plans can also partner with vendors, academic institutions, community organizations, hospitals and health systems to assess interventions. For example, they can provide incentives for physicians to track SDOH and work with academic researchers to measure program ROI.1,2
Further policy changes can also help, as can opening more opportunities for demonstration projects and funding research.1 Meanwhile, MA plans can and should develop measurable goals for their SDOH programs to ensure they are meeting needs for their members and the plan itself.
To stay up to date on the latest from RAM Technologies, follow us on LinkedIn
References
1 Rizer, Allison; and Laura Benzing. Filling The Gaps: The Role And Value Of Supplemental Benefits In Medicare Advantage. Health Affairs. Aug. 5, 2022. https://www.healthaffairs.org/content/forefront/filling-gaps-role-and-value-supplemental-benefits-medicare-advantage
2 Better Medicare Alliance. Innovative Approaches to Addressing Social Determinants of Health for Medicare Advantage Beneficiaries. Aug. 2021. https://bettermedicarealliance.org/wp-content/uploads/2021/08/Innovative-Approaches-to-Addressing-SDOH-for-MA-Beneficiaries-FINAL.pdf
3 National Center for Quality Assurance. NCQA Updates & Releases New Quality Measures for HEDIS® 2023 with a Focus on Health Equity. Aug. 1, 2022. https://www.ncqa.org/news/ncqa-updates-releases-new-quality-measures-for-hedis-2023-with-a-focus-on-health-equity-stratifying-measures-by-race-ethnicity-and-affirming-gender-identity-helps-tackle-health-disparities/
4 Rural Health Information Hub. Tools to Assess and Measure Social Determinants of Health. Mar. 6, 2020. https://www.ruralhealthinfo.org/toolkits/sdoh/4/assessment-tools
