The number of Medicare Advantage plans investing in additional benefits to address the social determinants of health has tripled in a single year, but additional guidelines and standards from the Biden administration are needed, according to a new report.
The report, released Thursday by the Better Medicare Alliance, comes as the Biden administration has made health equity a priority and called for the collection of data on race and ethnicity 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] tripled more than three in a single year, ”Kenneth Thorpe, chairman of the board of the Better Medicare Alliance, said in a statement.
The report found that 845 separate Medicare Advantage plans offered special additional benefits for the chronically ill this year, up from 245 in 2020, according to data from the University of Chicago’s NORC.
Plans generally offer benefits that target social determinants of health such as social isolation, diet and housing. But a major hurdle among plans is trying to figure out how to identify the social determinants of a patient’s health.
“We lack a systematic approach to identify social needs, pay for interventions to meet those needs and assess the results of these programs,” Caroline Pearson, senior vice president of NORC, said in a statement.
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The Centers for Medicare & Medicaid Services (CMS) must add new standards for collecting social determinants of health in Medicare.
Some health plans said they included questions on the social determinants of health in their beneficiary surveys and extracted data and beneficiary interactions to obtain clues about risk factors.
But CMS can help by increasing data collection on the social needs of beneficiaries, according to the report. These include adding consistent social determinants of health “data elements to Medicare wellness visits,” the researchers said. “More comprehensive and standardized data collection would allow better data sharing and evaluation. “
CMS must also adjust its reimbursement and risk methodology to take more account of social risk factors.
This includes adjusting the MA payment in annual risk adjustments to include an assessment of social risk factors among plan beneficiaries. The agency should also consider modifying the performance metrics for the quality of the MA star rating to reflect risk factors.
CMS should also permanently allow the Value-Based Insurance Design Authority (VBID) to promote innovation in the social determinants of health, the report recommends.
VBID has grown steadily since its extension to a national program, but has been slow to expand to supplementary benefits.
“One potential reason could be the reluctance regarding 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 taken several steps to address health equity gaps in care.
Center for Medicare and Medicaid Innovation director Liz Fowler, Ph.D. said earlier this year that the agency’s payment models will explore health equity, including potential requirements for models to collect. data on race and ethnicity.