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3–2–1 Contract! MA Plans’ Emerging Supplemental Benefits Strategy for Social Determinants

Takeaways from the recent IEN Conference

Patchwise Labs
Aug 30, 2019 · 7 min read

This month we had the opportunity to attend Insight Exchange Network’s two day conference on optimizing supplemental benefits in downtown San Diego.

Along with many of our readers, we’ve been eagerly following the latest policy developments shaping how the Medicare Advantage program will allow health plans to spend money to address non-clinical determinants of care.

This proved to be a terrific opportunity to sit in a room full of health plan executives, technology vendors, consultants, ask questions, and listen to experienced benefits veterans of all stripes share their insights on operations and strategy.

A standard repetition of canned talking points this was not: The speakers and panelists rolled up their sleeves and got into the knitty gritty details. Health plan benefits represent the true sausage factory of how insurance works, with technical, clinical, economic, actuarial, and other expertise meshing together like so many gears in the machine.

So at the risk of oversimplifying the discussion, we’ll zoom out and focus on the three key themes that emerged for health plans planning for 2020 and beyond:

  1. Leadership Strategy
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Leadership Strategy

This is where it all starts. Buy-in at the C-Suite is essential, as the VPs, Directors, and Managers who make sure the trains run on time take their cues from the top. Some of the specific tactics that emerged from discussions:

  • Carve out Bandwidth to Focus: Developing a multi-year strategy to design, test, improve, re-test, and ultimately scale new benefits is hard enough; doing so in competitive, highly regulated markets with high rate of member churn makes it even more of a challenge. This underscores the sentiment around the industry that 2020 will be a year of listening and learning.
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Membership Strategy

Member Engagement is always a challenge, and especially so when designing, marketing, delivering, and scaling new benefits. But social determinants of health represent a new ballgame for even seasoned insurance veterans due to the added complexity of designing new products, evolving the engagement strategy, complying with regulations, optimizing enrollment, and more.

  • Clinical Considerations: With CMS removing the uniformity requirement, plans have flexibility to design benefits for any subgroup of members without having to make them available to everyone. This flexibility adds the challenge of where to start selecting the right group of members. The easy answer is to look at costs to determine who might be in need of additional help, but even that is not straightforward. Bruce Chernoff from the SCAN Foundation suggested the use of claims data alone is like looking for your keys under the lamppost. He also explained the cost phenomenon of “persistence versus transience” (left)
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Partnership Strategy

Bringing in new partners like social services providers, community-based organizations, volunteers, and other non-credentialed groups to deliver any form of member engagement represents a major challenge. On the one hand, health plans are reluctant to recreate the wheel; on the other they need to set a high bar for partnership when it comes to coordinating social services.

As one VP put it, “Anything that’s going to touch my membership, I’m very cautious with it.” Another speaker echoed this sentiment, underscoring the stakes: “If [the benefit] is not implemented flawlessly, you’ll get complaints, you get CTMs. Supplementals can be a driver of dis-enrollment.”

  • Build versus Buy: When it comes to finding non-clinical partners, “It’s better to buy that than to try to build it,” opined one of the speakers from a mid-sized health plan. “The smaller parts of those relationships are what we tend to keep in house, like managing authorizations to deliver a service.” Another challenge is growth: “With direct services, we’ve seen struggles from our smaller local partners as volume grows. The right vendor brings scaling ability.”

A special thanks to IEN for inviting us to the show! Check out their upcoming SDOH Action Forum November 13–15 in Miami (use ‘H121PAT’ for a discount)


Patchwise Labs

Stories and analysis of emerging innovations to address the…

Patchwise Labs

Written by

We are a creative strategy firm with one simple goal: To make the healthcare system work better for the people who need its help. http://www.patchwiselabs.com

Patchwise Labs

Stories and analysis of emerging innovations to address the social determinants of health (SDOH)

Patchwise Labs

Written by

We are a creative strategy firm with one simple goal: To make the healthcare system work better for the people who need its help. http://www.patchwiselabs.com

Patchwise Labs

Stories and analysis of emerging innovations to address the social determinants of health (SDOH)

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