Press ReleasesBLOG POST: Report highlights SDOH gains, challenges for MA plans

Although significantly more Medicare Advantage plans are offering benefits that target social determinants of health (SDOH), challenges in gathering beneficiaries’ SDOH data persist due to “routine policy and operational barriers,” a recent report found.^1,2

MA plans’ offerings of primarily non health-related benefits, enabled by policy initiatives including Special Supplemental Benefits for the Chronically Ill (SSBCI), have skyrocketed recently.³ According to the report, which was commissioned by the Better Medicare Alliance and conducted by NORC at the University of Chicago, the number of MA plans participating in primarily non health-related benefits jumped to 845 in 2021, compared with 245 last year, which was the first time SSBCI benefits were made available.³ The report also noted that plans were satisfied with the results of their participation in SSBCI. Meals, social needs and nonmedical transportation were among the top benefits offered by plans this year.³

While major strides have been made with SDOH-focused benefits, gathering beneficiaries’ data on SDOH has proven trickier. Barriers to data collection include:

• The limited options health plans have to directly address social needs or facilitate SDOH services
• Difficulties identifying social needs because of data silos among social service and health providers
• A lack of up-to-date data on the social needs of beneficiaries.³

Researchers recommended several actions MA plans and other stakeholders can take to better address SDOH, such as:

• Increased use of supplemental benefits to provide access to SDOH-related services
• Bolstered guidance and new standards from CMS on SDOH data collection in Medicare
• Coordination among MA plans and federal and state governments to share data on beneficiaries’ enrollment in social service programs
• Expanded provider use of ICD-10 Z codes, which help health plans see external factors that affect members’ health status.³

A proactive, collaborative mindset will help MA plans – as well as policymakers, providers and other stakeholders – more effectively address SDOH for beneficiaries.

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^References

1. Moran, Nick. Medicare Advantage benefits targeting social determinants of health tripled since 2020. Becker’s Hospital Review. Aug. 9, 2021. Accessed Aug. 17, 2021. https://www.beckershospitalreview.com/payer-issues/medicare-advantage-benefits-targeting-social-determinants-of-health-tripled-since-2020.html
2. Waddill, Kelsey. Tracking Social Determinants of Health Data in Medicare Advantage. Health Payer Intelligence. Aug. 5, 2021. Accessed Aug. 17, 2021. https://healthpayerintelligence.com/news/tracking-social-determinants-of-health-data-in-medicare-advantage
3. NORC at the University of Chicago/Better Medicare Alliance. Innovative Approaches to Addressing Social Determinants of Health for Medicare Advantage Beneficiaries. August 2021. Accessed Aug. 17, 2021. https://bettermedicarealliance.org/wp-content/uploads/2021/08/Innovative-Approaches-to-Addressing-SDOH-for-MA-Beneficiaries-FINAL.pdf