Postcard from Phoenix: Addressing SDoH in Medicare Advantage Plans

HealthedgeFebruary 25, 2020
The Edge Report

At the recent Medicare Advantage Leadership Innovations conference in Phoenix, AZ, individuals from health plans, health systems, provider organizations, community-based organizations (CBOs) and providers of technology platforms and services gathered to share information, insight and ideas on a wide variety of factors that impact the success of Medicare Advantage lines of business.

In sessions throughout the conference, it was clear one of the primary elements to success is addressing social needs that support timely, scalable, and cost-effective delivery of Social Determinants of Health (SDoH) programming, including accessibility, affordability, willingness to exchange information and infrastructure support to sustain meaningful change.

As an Educational Underwriter for the conference, HealthEdge moderated the panel, “Social Determinants of Health -- Focus on Implementation & ROI,” which featured an esteemed group of executives sharing insights and supporting metrics on how their organizations address patients’ social needs to improve health outcomes and reduce costs. Here are our key takeaways from the discussion.

Implementation and ROI of Addressing Social Needs in Medicare Advantage

Catherine Macpherson of Mom’s Meals shared several benefits her organization has seen after addressing food insecurity and condition-related nutrition – particularly when combined with home-delivery of meals, including:

  • 50-70% decrease in admissions associated with proper nutrition after a hospitalization – a 7%-50% decrease depending on population
  • Shorter length of stay on readmissions - 25-50% reduction with 37% faster discharge and 30-Day Readmissions reduced 25-50% depending on population
  • Better control of conditions - particularly COPD, renal and diabetes.
  • The more conditions a person has, the greater the benefit from addressing sdoh needs
  • Lower monthly average healthcare costs 30-40%

 As was shared by every other panelist – and also in other sessions at the conference – Catherine emphasized that the benefits and ROI of investing in social determinants as a means to improve health outcomes and lower overall costs is in the early stages with much study and analysis to be done.

Patrick Finnerty of DentaQuest shared with the audience, “You can’t have good overall health without good oral health,” and emphasized that people who’ve receive good preventive oral services have much lower overall healthcare costs – particularly with conditions like diabetes, cardiovascular disease and stroke – among others.

Patrick went on to highlight how many social determinants of health impact oral health – particularly the intersection of Age and Income. Further, he shared that regardless of plan type, emergency room visits for dental issues typically result in administering an antibiotic and painkillers but nothing else, leaving the underlying cause untreated. And prescriptions for painkillers can add to the opioid crisis.

Amanda Hazer shared how Oscar Health engages its members via a digital app to solicit information and collect data on member needs in a structured fashion. Oscar Health has a 45% engagement rate in collecting information on its member needs via its digital app, with food and nutrition (25%) most frequently cited as concerns. To help address these concerns, Oscar Health uses the following approaches:

  • Enhancing in-house data with data from partners and other 3rd parties
  • Coordinating referrals, data exchange and closing the loop through partners/CBO’s
  • Equipping caregivers and “people in the field” with the right information and tools.

The value of all stakeholders to see the full spectrum of services the individual has received and is currently receiving cannot be understated.

Now, understanding who’s best positioned and able to address member needs, who has the resources, and the true ROI of addressing social factors impacting health outcomes and costs was a big theme in the insights shared by Kevin Moore of United Healthcare.

Kevin focused on how the movement to address social determinants of health by health plans and providers is increasingly touted as synonymous with lowering costs and improving health outcomes. And that data collected over recent years has raised indications of the need for more research on clinical outcomes, establishing metrics to measure those outcomes, and the importance for health plans and provider organizations to support CBO’s and other 3rd parties through supportive infrastructure and information exchange. Experience with investing in housing for people with chronic illness, severe mental illness and Substance Use Disorders – particularly opiates can result in a huge decrease in claims expense of 45% to 55%. Yet providers and payers need to account for investments in rent and wrap-around services being made. Since Medicaid may not reimburse these expenses, a more realistic ROI – at least in this single housing example – may result in a more realistic 10-22% savings in the total cost of care.

Social Determinants of Health Examples and Common Themes

The panelists in this and other sessions at the Medicare Advantage Leadership Innovations Conference shared great insights and best practices for Medicare Advantage stakeholders to address Social Determinants of Health and other critical initiatives and priorities.

As more and more Medicare Advantage plans embark on SDoH strategies, we’ve distilled the following three key takeaways to keep in mind when rolling out these programs at your organization: 

  • Focus on Targeted Populations: It’s no longer practical or cost-effective to think all individuals and their healthcare and social needs can be addressed via a single program. And Medicare’s ‘uniformity of benefit design’ regulations recently offered by Medicare are demanding increasing flexibility in targeting specific conditions and populations.
  • Supportive Infrastructure and Information Exchange is Key to Positive ROI: Beyond the practical demands of establishing a closed-loop referral and reporting ecosystem, CBO’s and other important 3rd party service providers can struggle to accommodate demand for sdoh-related services. Infrastructures and data exchange processes may become unsustainable operationally. Supporting CBO to CBO referrals is key.
  • Get Upstream to Address Social Determinants of Health: There can be long and complex causal pathways linking these SDoH factors with health; often with multiple intervening factors. All stakeholders must understand address specific populations and different geographies of individuals may require different services.

To learn more about Social Determinants of Health examples, listen to HealthEdge’s webinar, SDoH: A Payer’s Strategic Advantage on-demand.

Contact us to learn more about how HealthEdge can help your organization address this rapidly evolving opportunity in a value–based care environment.

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