According to a recent GoHealth analysis, the continued expansion of supplemental benefits in Medicare Advantage plans can provide an ideal platform for addressing risk factors and giving seniors resources to drive better health outcomes.
Learning from Adversity
A crisis often exposes society’s most deep-seated inequities, and the COVID-19 pandemic has brought many of the stark disparities in America’s healthcare ecosystem to light. Racial and ethnic minorities face notably higher mortality rates, while underserved communities struggle to access care.
Risk factors that affect health outcomes can go beyond the traditional scope of care; therefore, many remain unaddressed. Thanks to the efforts of public health experts and scientific research, we now know some of these factors as Social Determinants of Health (SDOH), which reflect a close yet convoluted relationship with everyday life for us.
Pain Points and Root Causes
We all experience the effects of SDOH disparities, which lead to $93B in excess medical spending and $42B in lost productivity annually.
At the population health level, history has shown how difficult it can be to screen and engage MA members in preventative care to counter SDOH issues given the realities of reimbursement and complexities of healthcare. The failure to consider and address these issues is most prevalent among marginalized communities, who may not have access to evidence-based resources or education to equip them to take action on their health.
These factors, which we explore in our report, Addressing Social Determinants of Health for Seniors, prevent our neediest populations from accessing the right care, in the right setting, with the right provider, at the right time. As a result, health plans, providers, and strategic partners will need to play an important role in driving access to care by promoting the proper utilization of quality care and benefits available in today’s Medicare Advantage plans.
As we now know, there is much more to learn when it comes to understanding the role of social determinants as they apply to health equity. Higher awareness, coupled with a team effort among members, providers, health plans, and partners will help us achieve better outcomes and more cost savings. We have outlined six SDOH domains as follows:
Employment, income, expenses, medical bills, support
Neighborhood & Physical Environment
Housing, transportation, safety and walkability, parks and playgrounds, ZIP code/geography
Literacy, language, early childhood education, vocational training, higher education
Hunger, access to healthy options
Community & Social Context
Social integration, support systems, community engagement, discrimination, stress
Health coverage, provider availability, provider linguistic and cultural competence, quality of care
“After speaking with my agent, Asha, I was glad I called. She found me a plan that is going to give me $95 back on my Social Security check each month. That’s money I can now use to pay bills and other expenses. On top of that, my plan gives me $1,000 every year for dentures, so now I can finally get the work done that I’ve wanted.”
– Elbert S., GoHealth Medicare Member
Disparities in health outcomes underscore the increasing importance of addressing SDOH issues, especially during the COVID-19 pandemic. At the same time, screening and solving for these determinants remains difficult. While the rise of supplemental benefits in MA gives us reason for optimism, availability is only part of the battle if members cannot utilize these benefits.
In order to drive better utilization among MA members, the benefits must fit into the daily lives of seniors. “Features” like telehealth visits, home modifications, and pet services sound great, but must tie to health outcomes and find their way to seniors in order to be useful. Furthermore, ensuring the availability of supplemental benefits is only one piece of the equation. The next step is to ensure the member is aware of – and is encouraged to use – these benefits.
GoHealth is committed to serving as a trusted advisor to seniors, helping them navigate the healthcare ecosystem and understand the benefits included in their plan.