Friends with Benefits: MA Plans Weigh in on Social Determinants
How does Medicare Advantage feel about Supplemental Benefits, Community Partners, and SDOH?
Supplemental Benefits for Social Determinants have become a trending topic in healthcare, well in advance of the new rule’s 2020 start date. As a quick recap, the new Supplemental Benefits program in Medicare Advantage (MA) will improve plans flexibility to spend on services and programs to support members’ social determinants of health (SDOH).
Despite widespread excitement, general expectations for the program in the first year remain lukewarm. While SDOH remains a hot topic, we’re still in the early innings of market maturity. Plans are now actively trying to figure out what their strategy should look like. A new paper published in JAMA provides a closer look at MA plan sentiments around the new “SSBCI” benefit.
To understand MA Plans’ sentiments about this new opportunity, authors interviewed 38 leaders from 17 plans across the country of varying size, quality, and geographic location. While these data were collected in 2018 and may likely be slightly dated, they represent one of the only such assessments to date. Some of their key findings:
There seemed to be unanimous consensus that SDOH is a key pillar of their population health strategies moving forward. But when it came to how to address SDOH through this program, sentiments differed in two camps:
Some MA Plans Want to Address SDOH Directly
One group was keen on addressing SDOH directly by offering supplemental benefits to members in the form of new programs or services, or expansion of existing initiatives.
They discussed the opportunities presented to design targeted benefits to patient subgroups (a new option enabled by the uniformity rule change). Some of them mentioned that “it’s the right thing to do,” particularly in light of triple aim goals of cost, quality, and member experience.
Plans also commented about the potential to increase their enrollment by making their plans more attractive to members. Anthem reportedly saw a 14% increase in enrollment in the first quarter alone, partially attributed to new benefits.
Some MA Plans Want to Partner with CBOs
The second group was leaning towards partnering with and referring to community-based organizations (CBOs) to address SDOH, rather than doing it directly.
They spoke to the importance of collaboration and the desire not to duplicate CBOs existing efforts and expertise. While the paper didn’t go into a great amount of operational detail, some respondents described building an aggregate resource hub for internal care managers to refer out, while other discussed writing grants to invest in CBOs as a way of promoting sustainability.
This last point is slightly problematic on face, as consensus from SDOH experts suggests that relying on grant-funded programs is the opposite of sustainability. A better option that several groups around the country are actively exploring would involve measuring CBO performance through technology platforms and including them in value-based payments.
Either Way, Challenges Abound
To be clear, the choice of offering programs directly versus partnering externally is probably a false distinction: Most plans will have to go both ways. Existing programs and services such as home visits or medically tailored meals could easily be ramped up with the added payment flexibility, while plans partner up to address loneliness, transportation needs, or other SDOH.
Either way, both groups described conflicting pressures as they devised their strategy for supplemental benefits. All plans reported a few key areas of concern:
- Return on Investment (ROI): Plans remain in the dark about the details of how these programs and services fit into their financial books, which is a key criterion for figuring out pricing, benefit design, and bidding.
- Specifically, plans wondered whether investing in new supplemental benefits will result in cost-savings; How to identify certain high-cost subgroups to tailor custom benefits, as per the new flexibility allowance; Which benefits or services carry the strongest evidence of impact; How these new programs might impact their star ratings and therefore bonus/penalty payments.
- Benefit Design and Eligibility: Plans reported that members switching plans frequently (“churn”), as well as high variability of partners, payments and patients across counties, as well as a host of other factors made benefit design even more complex to plan for in advance.
- Finding the right CBO partners: Plans’ ideal requirements to partner with CBOs include: The ability and capacity to scale services; Evidence of success and ability to deliver, especially to avoid members filing grievances that could affect star ratings; Willingness to “share the risk of providing a new benefit.” Plans generally reported feeling more comfortable building on existing relationships rather than developing new partnerships.
Timing Is Everything, and We Ain’t There Yet
The biggest caveat to this paper: The survey was conducted in 2018, following the passage of the law, but preceding the publication of the final rule. Participants would have understandably been reluctant to move forward at that time with program development until CMS had published key details.
However, with those details now published, and the program going into effect on January 1 2020, it appears that the above concerns, challenges, and complexities are all more valid than ever. Beyond the rule itself, CMS is running an experiment on value-based insurance design that includes supplemental benefits for social supports as well; this will inform how some of these policies work n the real world.
Anecdotally, we’ve heard from investors, consultants, technology vendors, and even some health plan executives themselves that 2020 will be a year of “wait and see,” to gather evidence of what works and doesn’t, and to see how the various efforts around the country (e.g. Centene’s Social Health Bridge) begin shaping up.
Here are Three Key Questions on our mind as we enter the second half of the year:
- Will CMS penalize marketing? Questions remain around member engagement and the nearly invisible line CMS has drawn between making sure people know about these new benefits (which is encouraged) and making sure plans are not using these new benefits to market their plans to people (which is illegal). It doesn’t appear to be slowing down plans but time will tell how zealous CMS is about enforcement.
- How fast will the CBO networks develop? Several vendors have revamped the Social Service Resource Directories of yesterday into what are essentially ‘narrow networks’ of community partners. By vetting their quality and delivering an off the shelf stable of partners, companies are removing some of the risk for health plans. This trend is happening more broadly, such as in home care, and it will be a key one to monitor.
- How Creative will plans get to address SDOH? This is a rhetorical question, as the answer is most likely ‘not very.’ Year One will most likely see activity occurring with better-known cost/ROI items, e.g. home visits, rides, meals, and caregiving. But the rule about benefits doesn’t have any rules, outside of a “reasonable expectation of improving or maintaining the health or overall function;” These new SSBCI could theoretically promote a diversity of social supports and services, from peer supports to music therapy to puppies on demand.
What do you think? What are you seeing or hearing related to new supplemental benefits? Send us a note to share your perspectives or questions.
