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Two Things Medicare Advantage Plans Can Do Right Now to Tackle Social Determinants of Health


When we think of healthcare consumer engagement today, especially for Medicare populations, we typically think of ways to help close critical care gaps—reaching out with reminders, scheduling appointments, helping select providers and more. These are essential interactions that change lives and improve bottom lines. But we also know that social determinants of health (SDOH) play a vital role in whether or not a gap can be closed at all.

Significant evidence shows that SDOH may be responsible for up to 90% of an individual’s long-term health and outcomes. These factors are typically outside of the clinical realm and include availability of resources (such as housing, technology and access to healthcare), social factors (such as family and social support, income and education), behaviors (such as diet and exercise, and tobacco, alcohol and drug use), and environment (such as housing, transportation, crime and safety). Seniors aren’t immune to this issue; one recent study showed 68% of seniors have challenges in at least one social determinants of health category, and more than half are considered moderate to high risk in at least one category.

Combine these realities with the higher prevalence of chronic conditions in elderly adults, and there can be a significant SDOH impact on healthcare outcomes and costs.

The good news is that there are two strategies that Medicare Advantage plans can implement now that may help mitigate some of their population’s social determinants of health and improve outcomes.

#1 Help seniors navigate social program eligibility and enrollment.

Nearly 40% of Medicare beneficiaries are below the poverty line, and many may already be eligible for a multitude of other social programs, such as food stamps, drug subsidies and help with premiums. The challenge is that many either don’t know about available assistance or they don’t know how to apply for it. By implementing a service to help educate and enroll your members in programs such as the Qualified Medicare Beneficiary Program, the Low Income Home Energy Assistance Program or Supplemental Nutrition Assistance Program (SNAP), you may be able to help them get into a position where they can more effectively address their health issues.

There’s already evidence that it works. One health plan found that 70% of its high-risk patients were food insecure. It also discovered that more than half of those patients were eligible for SNAP benefits but didn’t realize it. So the plan went to work helping its high-risk patients complete the SNAP application. The result? The readmission rate for the high-risk patients who received help with their applications and subsequently utilized SNAP benefits dropped by 67%.

However, be prepared for pushback. A recent survey of consumers showed that 20% of those on Medicare did not want to discuss SDOH challenges—highlighting the need for specialized engagement teams who have experience interacting with vulnerable populations.

#2  Address possible mental health issues.

Seniors experience mental health issues at a higher rate than other age groups. In fact, 20% of those over age 55 have some mental health condition, with anxiety and depression topping the list.

One vital way to help your Medicare members get the treatment they need is through the use of virtual care, or telehealth services. The delivery of behavioral health services via telemedicine has seen promising growth over the past few years. Telehealth is especially helpful for seniors with mobility and transportation challenges, and it has been shown to help reduce cancellations and no-shows.

Better yet, a growing body of evidence shows that behavioral health services administered via telehealth are not only as effective as office-based therapies, but they also resulted in lowered depression, better overall mental health, increased satisfaction with mental healthcare and coping skills, and increased confidence in handling depression.

Put these ideas in motion

Proactively reaching out to your Medicare Advantage members to educate, motivate and engage them to make better healthcare decisions should be a key element of your member wellness strategy.

At Carenet Health, our highly trained engagement specialists and proprietary Intelligent EngagementTM methodology have made measurable impacts for our clients, helping them close gaps in care, complete health risk assessments, curb avoidable ER visits and readmissions, and more. Our telehealth nurses and Virtual Clinic also offer significant ways to help Medicare plan members. Let us know if we can help your organization.


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