BMA: Number of MA plans offering social determinants of health benefits increased threefold in 2021

The number of Medicare Advantage plans investing in supplemental benefits to address social determinants of health tripled in a single year, but additional guidance and standards from the Biden administration are needed, a new report said.

The report, released Thursday by the Better Medicare Alliance, comes as the Biden administration has made it a priority to address health equity and has called for collection of race and ethnicity data from providers and payers.

“This report paints an encouraging picture of the significant investments Medicare Advantage plans and partners are already making in this space, with the number of Medicare Advantage plans providing [supplemental benefits] increasing more than three-fold in a single year,” said Kenneth Thorpe, chair of the Better Medicare Alliance’s board of directors, in a statement.

The report found that 845 separate Medicare Advantage plans offered special supplemental benefits for the chronically ill this year, compared with 245 in 2020, according to data from NORC at the University of Chicago.

The plans typically offer benefits that target social determinants of health such as social isolation, food and housing. But a major barrier among plans is trying to find out how to identify a patient’s social determinants of health.

“We lack a systematic approach for identifying social needs, paying for interventions to address those needs and evaluating the outcomes of these programs,” said Caroline Pearson, NORC’s senior vice president, in a statement.

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The Centers for Medicare & Medicaid Services (CMS) needs to add new standards for collecting social determinants of health in Medicare.

Some health plans reported including social determinants of health questions in their beneficiary surveys and have mined data and beneficiary interactions for clues on risk factors.

But CMS can help by increasing data collection on beneficiaries’ social needs, the report said. These include adding consistent social determinants of health “data elements to Medicare Wellness visits,” researchers said. “More comprehensive and standardized data collection would enable better data sharing and evaluation.”

CMS also needs to adjust its reimbursement and risk methodology to account more for social risk factors.

This includes adjusting the MA payment in annual risk adjustments to include an assessment of social risk factors among the plan beneficiaries. The agency also must explore modifying MA star rating quality performance measures to account for risk factors.

CMS should also permanently authorize value-based insurance design (VBID) authority to promote innovation on social determinants of health, the report recommends.

VBID has grown steadily since expanding to a nationwide program but has been slow to expand to supplemental benefits.

“One potential reason could be hesitancy around VBID’s status as a demonstration program under the Center for Medicare and Medicaid Innovation and its resulting uncertain future,” the report said.

The report comes as the Biden administration has made several moves to address health equity gaps in care.

Director of the Center for Medicare and Medicaid Innovation Liz Fowler, Ph.D., said earlier this year that the agency’s payment models are going to explore health equity including potential requirements in models to collect race and ethnicity data.