A new report from the New York City-based Commonwealth Fund examines some of the innovations taking place among Medicare Advantage plans to incorporate some of the social determinants of health (SDOH), in order to better serve plan members, particularly under the CHRONIC Care Act, passed in 2018, and focused on improving and expanding the degree to which Medicare beneficiaries can participate in managed or accountable care programs.
The report, entitled, “In Focus: CHRONIC Care Act Prompts Some Medicare Advantage Plans to Incorporate Social Services,” was published on Jan. 9 by the Commonwealth Fund’s Martha Hostetter and Sarah Klein. As Hostetter and Klein write in their introduction, “You know times are changing when a health plan starts paying for dog food, as Anthem and its affiliated health plans will do in some markets this year. It’s not a marketing gimmick, but a recognition that people who rely on service dogs may need help in supporting them — and that these dogs can play a key role in members’ overall health. The change is one of many Anthem is making to its Medicare Advantage plans in response to the CHRONIC (Creating High-Quality Results and Outcomes Necessary to Improve Chronic) Care Act, which became law in 2018. The act marks a significant shift in Medicare policy, one that recognizes that many things apart from medical services contribute to health, including whether people can afford basic necessities.
Under the law, which kicks in fully this year, Medicare Advantage plans can opt to pay for benefits like healthy meal delivery (e.g., low-salt dinners for those with heart failure), transportation to the pharmacy or grocery store, home modifications to accommodate walkers and wheelchairs, and other services that may promote health but are not strictly medical in nature.”
Further, they write, “While health plans were previously allowed to offer supplemental benefits to prevent, cure, or diminish a disease, like a diabetes management class, now they can offer services designed to improve functioning, ameliorate symptoms, and otherwise reduce use of emergency departments or hospitals. Before, health plans were allowed to deliver meals to members after they’d been hospitalized; now, they can provide meals at any time if they think it could help keep people out of the hospital. In addition, the law waives the uniformity requirement under which plans must offer the same benefits to everyone in a region. Starting this year, plans may offer additional benefits to people with serious chronic conditions.”
The authors note, among other statistics, that:
> One in three Medicare beneficiaries is enrolled in a Medicare Advantage plan, and that proportion is expected to continue to grow.
> Eleven percent of Medicare Advantage beneficiaries are enrolled in special needs plans for those dually eligible for Medicare and Medicaid.
> Thirty-seven percent of Medicare Advantage beneficiaries have annual incomes below $20,000.
> Thirty-seven percent of Medicare Advantage beneficiaries have both chronic conditions and functional limitations.
> And, 44 percent of Medicare Advantage beneficiaries reported difficulty with at least one activity of daily living, and 33 percent reported difficulties with two or more.
The report describes innovations taking place at the Indianapolis-based Anthem, the Minneapolis-based UCare, and the Louisville-based Humana, among others. Among numerous innovations it mentions are the fact that Anthem now provides access to those with certain clinical criteria to eight sessions per year with a dietician as well as the monthly deliver of pantry staples; UCare’s offering an acupuncture benefit to members who need help managing pain related to such conditions as cancer, multiple sclerosis, and fibromyalgia; and Humana’s Bold Goal initiative, focused on improving members’ health 20 percent by 2020 and partnering with community organizations to address its members’ social determinants of health.
And the report makes note of such innovative programming as Humana’s program in Tampa that invites seniors that its data flag as being at risk for loneliness to join a grandkids-on-demand program, in which college students offer companionship, help with chores, technology lessons, and other support.
And it describes the activities of organizations like Lutheran Services in America, a national network of 300 health and human services providers, which is offering services to seniors including housing and residential care, caregiver support, transportation, and nutrition.
