Technology and complementary services in MA can help improve participants’ health

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 the concepts found in Maslow’s Hierarchy of Needs, have become important components of health care for providers, health plans, and consumers. Each group strives to provide and maintain an optimal care experience that leads to improved health outcomes. To achieve these goals, many Medicare Advantage (MA) plans attempt to solve SDOH and Maslow challenges by offering new services or expanding their current supportive care services.

SDOH, the social, economic, and environmental factors that can affect health, fits Maslow’s description of the process of securing basic necessities of life, such as food and shelter, before focusing on other seemingly less immediate needs, one of which is health care can belong.

To alleviate these challenges, some MA plans leverage additional services, specific benefits that go beyond what traditional Medicare offers to encourage participation in the plans and support improved 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 meals, home support, and non-emergency medical transport (NEMT).

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

  • 74% remote access technology
  • 67% meal advantage
  • 38% transportation
  • 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 broader trends in the US healthcare system, including the growing recognition that SDOH can have a more meaningful impact on health outcomes than clinical care and the increasing social neediness 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 a comprehensive way to mitigate them.

According to the NORC report, “Medicare beneficiaries share many of the same social needs as the general population, but certain social risk factors are more pronounced among the program’s elderly and disabled members. Screening and survey data have frequently identified food, housing and transportation as the top social risks.”

Promote health, create savings

Despite the well-known benefits of these services, attempting to quantify the outcomes of non-medical benefits can be difficult for MA plans, even when there is a significant amount of data.

“The key question in relation to the bottom line is whether newly offered non-medical services deliver a return on investment (ROI) for the plan,” says a health matters Article. “Will these services save more money in any given year than it costs to deploy? New services could result in savings by preventing the need for acute medical care. If ER visits, hospitalizations, or other forms of acute care are reduced enough, the savings could theoretically outweigh the cost of delivering the benefit and result in a positive ROI. While this argument is conceptually compelling, it has proved difficult in practice.”

Although the ROI needs remain high from a healthcare plan perspective, the commitment to MA ancillary services remains a high priority for the individuals and organizations that provide the services.

“Plans (MA) report that the ultimate goals of their SDOH programs are to achieve both improved health outcomes or ‘return on health’ and ROI through lower health care costs for beneficiaries,” according to a case study from Better’s Innovation Center Medicare Alliance in Medicare Advantage in the 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 continued expansion can benefit members and the healthcare plans they offer.

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