Health Industry Leaders Offer Recommendations to Improve Medicare Advantage Effectiveness in Addressing Social Determinants of Health

Healthcare Leadership Council Response to CMS Request for Information Applauds Ongoing Efforts to Reduce Health Inequities

WASHINGTON – In its response to the Centers for Medicare and Medicaid Services’ request for perspectives on how to further strengthen the effectiveness of the Medicare Advantage program, the Healthcare Leadership Council (HLC) – an association of health industry leaders from all health sectors – has recommended a number of steps to better address the social determinants of health such as food insecurity and access to transportation that have a profound effect on health and well-being.

In her letter to CMS, HLC president Mary R. Grealy credited existing policies that include access to telehealth services, in-home care and supplemental benefits that address social determinants of health with reducing avoidable hospitalizations, lowering hospital readmission rates, and increased utilization of preventive services.

Among the actions HLC recommended to further bolster effectiveness in addressing social determinants of health:

• Granting health plans more flexibility in targeting supplemental benefits to address social risk factors. Currently, supplemental benefits can only address social determinants of health if they maintain or improve health function, and social determinants alone cannot be used to determine Special Supplemental Benefits for the Chronically Ill (SSBCI) eligibility.

• Testing the expansion of access to supplemental benefits by increasing rebate percentages to health plans offering SSBCI benefits. Current Medicare Advantage rules allow plans to fund supplemental benefits through rebates. The HLC letter said this “would enable health plans to further address health-related social needs, in addition to improved data collection and analysis.”

• Standardizing social determinants of health data capture and measurement and leveraging resources currently available to health providers. HLC wrote, “providers still struggle to incorporate addressing social determinants of health into care delivery because they lack the necessary data capabilities to uniformly assess and identify potential social risk factors among all patients.

• Instituting additional efforts to improve health and wellness and the prevention and treatment of chronic disease, such as physical activity. While Medicare plans currently offer supplemental benefits for gym memberships, these benefits should be broadened since there are a variety of other ways to engage in physical exercise.

In its letter, HLC noted the continuing growth and success of the Medicare Advantage program, citing a 94 percent satisfaction rate among enrollees and the fact that 90 percent of Medicare Advantage beneficiaries in plans that offer prescription drug coverage are enrolled in plans with a quality rating of four or more stars, higher than previous years.

For Immediate Release August 31, 2022
Contact: Kelly Fernandez 202-449 3452