Insurers have a slew of avenues to address social needs in Medicare Advantage, and a new report from the Better Medicare Alliance highlights best practices born from multiple payers' success stories.
The research, conducted by NORC at the University of Chicago, lumps case studies into three main categories: data sources and beneficiary identification, intervention and evaluation. For example, Humana has developed a data ecosystem that compiles clinical, community and individual member data to identify risks and gaps.
While building out the ability to compile that data poses a challenge, having access to such information is critical to predict members' needs.
"Social determinants and social needs are really new spaces, from a data perspective,” Andrew Renda, M.D., vice president of Bold Goal and Population Health Strategy, told the researchers.
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Here's a look at three more case studies highlighted in the report.
SummaCare
SummaCare's efforts to address members' transportation needs highlight the importance of building strong partnerships with vendors that are mutually aligned to the same goals, according to the report.
The insurers' transportation benefit does not include solely a ride-share option, but also extends to assistance with wheelchairs and other medical supplies. In addition, members can request one-way rides as SummaCare found it's not uncommon that they can secure a ride with a family member to a visit, but may not have a way to return home.
With the relationship established in transportation, SummaCare was able to lean on the same vendor to provide additional services such as massage therapy and durable medical equipment.
“I guess the best way to describe it is, we've built a relationship and they're interested in innovation as much as we are; we found them to be so service-oriented. We continue to find ways to address these social determinants of health or other needs and it's one [telephone] number," Anne Armao, vice president of member experience and product development, said in the report.
Aetna
At Aetna, which is owned by CVS Health, offering a variety of benefits targeting SDOH needs is a key tactic, according to the report.
For example, the insurer partners with Papa, which provides "grandkids on demand" to assist seniors with light housework and provide companionship. Social isolation has been linked to a slew of other health conditions, and has been a particular concern under the pandemic.
Papa pivoted to a virtual option due to COVID-19, and members report high satisfaction with these virtual visits, according to the report.
Aetna approaches these benefit options by acknowledging that individual members' needs will vary widely, so it's critical to have options that can meet those needs.
“We have long been supportive of this idea that not all benefits are appropriate for all people, that everyone has different needs, and meeting them where they are is critical,” Rose Mollitor, senior director of Medicare product innovation, told the researchers.
UnitedHealthcare
UnitedHealthcare, the country's largest insurer, is working with the American Medical Association to develop diagnostic codes that focus on social needs. Implementing such codes would help standardize data as well as make it easier for providers to flag potential risks.
Engaging providers around social needs earlier in the members' care journey can drive more meaningful partnerships between them and insurers, according to the report.
In addition, standardized approaches like defined codes make it easier to train providers to spot potential social risks.
“The trainings are key, the partnerships are key. In the work we did addressing social determinants of health and health equity with focus on housing and health, for example, we identified a critical need of a particular health system like Maricopa Integrated Health System in Arizona; we helped them to better understand the population of people experiencing homelessness being served within their health system and came to the table with a solution," Cyrus Batheja, national vice president of enterprise transformation and strategic solutions at UnitedHealth Group, said. "We had [housing] units available and community health workers with wraparound trauma informed supports, so we could go to their leadership team with some sophisticated analysis and support.”