Few Medicare Advantage plans cover social needs for chronically ill patients

(Reuters Health) - Most Medicare Advantage plans are not offering chronically ill enrollees supplemental benefits to address social needs that were added to the government health program in 2018 in an effort to improve health outcomes and achieve cost savings, a U.S. study suggests.

Researchers examined publicly available data on benefits and plan design for Medicare Advantage plans to see which ones offered new benefits under the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2018.

In 2020, 139 of 3,052 plans (4.6%) offered benefits for social needs under the CHRONIC Care Act. The most commonly offered benefit was pest control, provided by 2.2% of plans, followed by produce at 2.1%, and meal delivery at 1.8%.

“For Medicare beneficiaries who need assistance, ability to access benefits for things like meals, transportation, pest control, and air quality control matter because it could prevent health exacerbations and unnecessary healthcare utilization,” said coauthor Kali Thomas, an associate professor at the Brown University School of Public Health in Providence, Rhode Island.

“For example, research suggests receiving meals is associated with reductions in the likelihood of hospitalization and nursing home placement among Medicare beneficiaries who are food insecure,” Thomas said by email.

A growing number of research studies are also finding that social determinants of health may have a stronger impact on patients’ health and well-being than medical care, Thomas added.

“Medical entities, including Medicare Advantage plans, have recognized this and are looking for ways to address individuals’ social needs as a way to improve their quality of life and health, and reduce potentially unnecessary, and often costly, healthcare utilization,” Thomas said.

Plans with higher ratings, as well as health maintenance organizations (HMOs) and older, more established insurers were more likely to offer these social needs benefits than other Medicare Advantage plans, Thomas and colleagues report in JAMA Network Open.

The study found that 6.2% of HMOs offered these benefits, compared with just 1.1% of preferred provider organization (PPO) plans.

While only 2.7% of plans established between 2014 and 2020 offered social needs benefits, the benefits were offered by 5.7% of plans established between 2006 and 2013 and 4.3% of plans established before 2006.

None of the plans with quality ratings of 2 to 2.5 stars offered these benefits. However, 5.3% of plans with 3 to 3.5 stars offered social needs benefits, as did 5.4% of plans rated from 4 to 4.5 stars and 4% of plans with top ratings of 5 stars.

One limitation of the analysis is that Medicare Advantage plans determine which groups of enrollees to target for these supplemental benefits, but researchers lacked data on which groups of enrollees were eligible to receive these benefits.

It’s also possible the benefits may not have been classified correctly or labeled clearly in the data set used for the study, leading researchers to underestimate the availability of social needs benefits.

“We knew that growth in the adoption of supplemental benefits by Medicare Advantage plans has been relatively slow,” said Amber Willink, an associate professor at the University of Sydney, in Australia, who wasn’t involved in the study.

Many Medicare Advantage plans may be waiting to see the merits of these social supplemental benefits in terms of improving outcomes or containing costs before they make a widespread commitment to offer these benefits, Willink said by email.

“This is important for Medicare beneficiaries and families as many may assume that because MA plans now can provide supplemental benefits that they will,” Willink added. “The plan benefit fine print is more important than ever.”

Plans that do add these benefits should see them pay off, said Melony Sorbero, a senior policy researcher at the RAND Corporation and co-director of the RAND-University of Pittsburgh Health Institute.

“There is evidence that shows the provision of services such as meals and non-medical transportation, help maintain the health of Medicare beneficiaries, reduce hospitalizations, particularly readmissions, and reduce the use of the emergency department,” Sorbero, who wasn’t involved in the study, said by email.

Reduced utilization in turn reduces out of pocket medical costs for beneficiaries, many of whom have limited financial resources, Sorbero added.

“However, the evidence base is a bit of a patchwork and Medicare Advantage plans are still learning which services are most effective for what types of enrollees.”

SOURCE: JAMA Network Open, online May 12, 2020.