Even as the summer winds down, the topic of using supplemental benefits to address social determinants of health (SDOH) in Medicare Advantage is getting hotter.
A recent JAMA study offers a closer look at MA plan sentiments around the new “SSBCI” benefit. A total of 38 leaders from 17 health plans across the US shared their thoughts about social determinants of health, community partnerships, member engagement, and more. The plans varied in size, quality rating, and geography, so this survey represents a useful snapshot to explore.
Plan Leaders Speak Up
Plan leaders agreed that SDOH represents a key strategy in their population health programs.
Several respondents reported interest in addressing SDOH directly by offering supplemental benefits to beneficiaries via new programs and services, or even by expanding existing initiatives:
“I think we feel pretty strongly that it [offering a new benefit to address SDOH] is the right thing to do. Then on top of that, if you can align the right thing to do with the cost, then it’s a no-brainer...So, whatever we can do to provide treatment in place and proactive care and intervention makes sense from quality and cost and member experience.”
- Regional, mid-sized MA plan
“Now, it’s getting into...things that are just above and beyond what we’ve ever seen before, and it’s being produced from that consumer block. So those expectations are evolving, rightfully so, as they all have indirect relationships to utilization and cost management. We all see it as being in the appropriate bucket, but it’s great when you see the actual beneficiaries expecting it, because it means that they’re going to engage [in] that. We’re not prescribing it as much as we’re meeting a need of the market.”
- Regional, mid/large-sized MA plan
Executives also commented about the potential to increase their enrollment by making their plans more attractive to members, decreasing “member churn,” and increasing competition in local markets.
“I’m looking to grow my membership. We’re a for-profit company, so the other thing that I’m looking at is what are going to be the things that are [going to] resonate out in marketplace that people want to see and want to have.”
- National, mid/large-sized MA plan
Another group of respondents emphasized the central strategy of partnering with community-based organizations (CBOs) to address SDOH, rather than doing it directly.
“There’s a mosaic here, and we know that we aren’t yet able to cover all the pieces of this mosaic. If you have a piece that you can add, whether that’s education and support or something totally different, we’re completely open-minded to that. And in fact, we support anyone who is supporting us in enhancing community-based care because, ultimately, this is a village effort. I don’t think there’s going to be a day where the payer just steps in and saves everything and fixes everything.”
- National, small-sized MA plan
“Increasingly, we’re looking at care management programs that leverage community resources. We have a program that is kind of an aggregator of those services that is made available to our care managers... kind of [a] person-centered multidisciplinary care management program. It’s becoming increasingly local like that, and it is focusing more and more on addressing those social determinants with community-based purposes.”
- National, large-sized MA plan
“Our philosophy as we kind of get into the social determinant space is that we want to serve as an anchor system to help our community partners be successful. We feel that we have a responsibility as a health care organization to do that, but, in the same sense, we don’t want to build these services out…We really want to develop programs that can help our community partners be sustainable.”
- Regional, small/mid-sized MA plan
Moving from Talk to Action
As the SDOH opportunity becomes clearer for MA plans, so do the challenges of revamping plan operations around benefit design, product/market strategy, and member services. Leaders shared concern about the ongoing lack of clarity on how to measure and assess the return on investment (ROI) in early years, and especially how to tie these new benefits to bonus payments through CMS’ star ratings program.
Another set of concerns involves partnership selection, quality assurance, and ongoing management of social service providers. Health plans shared some of their ideal requirements in selecting partners who can help deliver results.
- The ability to scale services, particularly as enrollment grows in the coming years
- Proven success in delivering community care, especially to avoid members filing grievances that could affect plan ratings
- The technical savvy to use data to build a convincing case for buy-in at all levels
- Appetite to “share the risk of providing a new benefit.”
- Ability to incorporate existing CBO partners with whom plans have a shared relationship
Taking the Next Step
At Signify Health, we’ve been building and managing networks of community-based care teams for the past decade.
The success of our SDOH solution comes from a partnership-driven collaboration at the community level, rather than one-size-fits-all approach. This has allowed us to drive proven, clinically-impactful outcomes for our customers that span member engagement and retention, improved quality measures, and reduced hospital readmissions and ED utilization.
To learn more about Signify Community, download our Product and Services Overview Sheet.