Increase in Medicare Advantage Activity to Address Social Determinants of Health, But Barriers Still Remain

Recommendations include stronger CMS standards on SDoH data collection, greater transparency on supplemental benefit offerings within Medicare Plan Finder, and modifications to Star Ratings and risk adjustment to account for social risk factors

As Medicare Advantage continues to serve a proportionally higher-risk and more diverse enrollment population, a new report highlights innovative approaches to addressing social determinants of health (SDOH) for Medicare Advantage beneficiaries, while acknowledging barriers that remain.

Social determinants of health are non-medical factors that account for up to 55% of an individual’s health outcomes, according to the World Health Organization.

The report, conducted by NORC at the University of Chicago on behalf of Better Medicare Alliance’s Center for Innovation in Medicare Advantage, is informed by interviews with more than 20 experts from 14 organizations representing health plans, providers, health plan associations, not-for-profit social service organizations, and service and technology vendors.

NORC’S findings show a “dramatic increase in plan activity to address social needs” within Medicare Advantage – particularly in the areas of social isolation, transportation, housing, and food – buoyed by recent flexibilities allowing Medicare Advantage to offer expanded supplemental benefits for non-primarily health-related services and targeted to the chronically ill. Separate research cited in the report shows that 845 separate Medicare Advantage plans participated in Special Supplemental Benefits for the Chronically Ill (SSBCI) in 2021, compared to 245 the year prior.

NORC’s research also depicts how Medicare Advantage plans and partners collect data on beneficiaries’ social risk factors in the absence of consistent data collection guidelines and standards from the Centers for Medicare & Medicaid Services (CMS), including through investing in Artificial Intelligence and predictive analytics, and incorporating SDOH questions into Health Risk Assessments.

Still, barriers to further SDOH innovations remain. This includes technology limitations, misaligned incentives, and the disconnect between health care systems and social services. The report proposes potential solutions to spur greater investment in SDOH, including:

  • Stronger CMS guidance and new standards for collection of SDOH information.
  • Information sharing between HHS and state Medicaid agencies on beneficiaries’ eligibility for social support programs.
  • Promoting the identification of social needs by health providers by encouraging the use of ICD-10 Z codes.
  • Permanently authorizing Value-Based Insurance Design (VBID) authority to promote greater SDOH innovation in Medicare.
  • Modifying Medicare Advantage risk adjustment and Star Ratings to account for beneficiaries’ social risk factors.

“As Medicare Advantage enrollment continues to soar – driven by diverse, medically complex, and at-risk beneficiaries – it is crucial that it be equipped with the tools to deliver whole-person care to this increasingly vulnerable population,” said Kenneth Thorpe, PhD, Chair of the Better Medicare Alliance Board of Directors and Chair of the Department of Health Policy and Management in the Rollins School of Public Health at Emory University. “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 SSBCI increasing more than three-fold in a single year. Sensible policy changes can spur further innovation. From clear, consistent standards on SDOH data collection, to putting Value-Based Insurance Design to work for beneficiaries and modernizing risk adjustment and Star Ratings to reflect the reality of SDOH’s impact on health outcomes, this report offers a vision for a future where social needs are seen, met, and fully integrated into the health care experience.”

Caroline Pearson, senior vice president at NORC said the healthcare system recognizes the significant impact of unmet social needs on peoples’ health and wellbeing.

"However, we lack a systematic approach for identifying social needs, paying for interventions to address those needs, and evaluating the outcomes of these programs," Pearson said. "With policy support, Medicare Advantage plans can play a crucial role in addressing these social determinants of health."