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Spotlight on Innovation

SCAN Health Plan Addresses Social Determinants of Health to Enable Medicare Advantage Beneficiaries to Live Independently

Mini Spotlight Social Determinants of Health Series

Overview

Access to quality, timely clinical care is essential. But, when it comes to health outcomes, social and economic factors matter. Food insecurity, lack of social supports, unsafe housing, and insufficient income—often referred to as social determinants of health (SDOH)—impact overall health status, especially in older populations. The research shows that addressing patients’ SDOH can improve their quality of life and lower health care costs. As a result, many Medicare Advantage plans are now focusing on identifying and addressing social risk factors for their senior populations.

Medicare, both Traditional Medicare and Medicare Advantage, are being encouraged by policy makers to transition to value based care. These efforts include new payment models in Traditional Medicare and greater flexibility for Medicare Advantage plans to address beneficiaries’ SDOH through innovative care delivery solutions. Most recently, provisions in the Bipartisan Budget Act (BBA) of 2018 are giving Medicare Advantage health plans benefit flexibilities to better integrate medical and non-medical care, particularly for chronically ill beneficiaries.

Medicare Advantage plans and providers are using these new flexibilities and partnering with community-based organizations and private companies to address beneficiaries’ barriers to improved health outcomes. With full financial responsibility for care and outcomes, Medicare Advantage is suited to provide the clinical benefits in Medicare and initiate non-clinical services, particularly for those with chronic conditions.