Mega Medicare Advantage Market Mandated For the SDoH

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Original story posted on: August 28, 2019

California-based Zing Health latest to join SDoH market of payers.

Since 2018, there has been common language introduced by insurers that includes the verbiage “so-and-so is uniquely positioned to address the SDoH (social determinants of health),” all followed by, “with new programming” promising to:

  • Enhance health outcomes;
  • Be customized to member need;
  • Address value-based care; and
  • Assure return on investment

California-based Health 2047’s new  Medicare Advantage (MA) offering, Zing Health, has now joined the club, bringing their own set of promises to the ever-growing SDoH mega-market.

The Latest MA Player
Zing Health’s efforts present as well-intended: using technology-driven platforms and local field teams, Zing anticipates having intimate knowledge of their clients’ needs. Employing in the trenches interprofessional teams is expected to promote solid clinical partnerships and connections that will ensure that plan members receive proper treatment and necessary ongoing care.

Zing expects to leverage technology toward the effective exchange of communication among the involved stakeholders. This will be especially interesting to monitor, considering that recent industry intelligence has conveyed that only 4 out of 10 hospitals are able to successfully share data with other healthcare systems, counter to the intent of electronic health records and manifesting interoperability. Evidence continues to suggest that providers, practitioners, and patients have ongoing struggles with access to portals, whether due to wifi and/or device access, platform incompatibilities, or other reasons.

Despite industry scrutiny over Medicare Advantage’s return on investment, its product numbers continue to rise. A recent report produced through RBC Capital Markets identified that the five largest managed care organizations (UnitedHealthcare, Humana, Aetna, Anthem, and Cigna) all continued to grow their MA membership in August 2019. The program has more than doubled its users since 2012, with almost 20 million Americans now enrolled.

The Mega MA Market
A Milliman Brief was posted on the Healthcare Financial Management Association (HFMA) website during the summer, reviewing the brisk activity of MA plans targeting the SDoH during 2019. The brief, titled, Review of Contract Year 2019, Medicare Advantage supplemental health care benefit offerings, includes an extensive list of health plans across the U.S. that incorporated “supplemental benefits” (in other words, the SDoH), noting that they are expected to enhance health outcomes for the following:

  • Home-based palliative care;
  • Non-skilled in-home support and services;
  • Non-opioid pain management; and
  • Benefits expansion to cover temporary home modifications and bathroom safety devices

The Centers for Medicare & Medicaid Services (CMS) allowed Medicare Advantage plans to offer these supplemental benefits with certain conditions and received both praise and criticism for doing so. Roughly 270 out of 3,700 plans provided enrollees with the new benefits in 2019. As we approach 2020, the list of benefits and needs for beneficiaries continues to grow, including:

  • Non-medical transportation for appointments and clinic visits, plus other non-clinical needs such as grocery shopping;
  • Meal delivery;
  • Home environment services, including payment of utilities; and
  • Expanded caregiver support

Each week brings new plans, coverage recommendations, and legislative actions to prompt reimbursement and payment associated with services focusing on the SDoH. Follow this continuing story weekly on Monitor Mondays and on RACmonitor.com.

Programming Note:
Listen to Ellen Fink-Samnick’s live reports on SDoH every Monday during Monitor Mondays, 10-10:30 a.m. EST.

Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP

Ellen Fink-Samnick is an award-winning healthcare industry expert. She is the esteemed author of books, articles, white papers, and knowledge products. A subject matter expert on the Social Determinants of Health, her latest books, The Essential Guide to Interprofessional Ethics for Healthcare Case Management and Social Determinants of Health: Case Management’s Next Frontier (with foreword by Dr. Ronald Hirsch), are published through HCPro. She is a panelist on Monitor Mondays, frequent contributor to Talk Ten Tuesdays, and member of the RACmonitor Editorial Board.

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