Health Plan Investment in Social Determinants of Health Likely to Accelerate


In recent years, Medicare Advantage (MA) plans have increasingly turned their attention to addressing members’ social determinants of health (SDoH), with the home playing a crucial role.

That’s according to a new report from NORC at the University of Chicago. NORC conducted the report on behalf of Better Medicare Alliance’s (BMA) Center for Innovation in Medicare Advantage.

“The focus on SDoH reflects broader trends in the U.S. health care system, including growing recognition that SDoH may have a more significant influence on health outcomes than clinical care and the increasing levels of social need within the Medicare population,” the report states.

Food access, transportation options, a sense of community and other social determinants of health account for up to 55% of an individual’s health outcomes, according to the World Health Organization. 

To better understand such factors, NORC researchers interviewed more than 20 experts from health plans, community-based organizations, technology vendors and other groups. The team additionally reviewed recent policy changes within MA, such as health plans’ relatively new ability to offer supplement benefits that aren’t primarily health-related.

Among their findings, researchers wrote that health plans are making “significant new investments,” especially when it comes to obtaining insights into SDoH needs of their members.

Those investments include ramped up internal outreach in the form of member surveys and health assessment, but also access to data from external sources like in-home care providers. 

“Many health plans indicated that in-home interactions present a key opportunity to obtain SDoH data through direct questionnaires and more general conversations or observations about the beneficiary’s living conditions and functional limitations,” the report continues.

UnitedHealth Group Inc. (NYSE: UNH) and Humana Inc. (NYSE: HUM), in particular, have made significant investments in at-home care.

Humana, for example, is working to acquire 100% of Kindred at Home, the largest home health provider in the nation, while also partnering with several other home-based care providers. Meanwhile, UnitedHealth Group has invested in an internal house calls division that conducts millions of visits per year, partly to complete health-risk assessments (HRAs)

“The HRA is a nice source that we’ve actually added very specific SDoH questions to, because a lot of beneficiaries have to get an HRA,” Kurt Johnson, vice president of operations at UnitedHealth Group, told NORC researchers. “And we do millions of home visits a year, so that’s a place where we’ve added screenings around social determinants of health.”

Although the report itself doesn’t focus on home care, it bodes well for operators that have invested in SDoH and their ability to gather data in the area.

In October 2019, for instance, national home care franchiser Senior Helpers rolled out its Life, Independence, Function, Evaluation (LIFE) Profile assessment tool to identify “micro-social determinants of health.”

While focus on the topic has been strong, NORC and BMA suggested several actions that policymakers can take to double down on SDoH.

For starters, the U.S. Centers for Medicare & Medicaid Services (CMS) should strengthen guidance and add standards for collecting SDoH information in Medicare, the report argues. Additionally, the CMS Innovation Center should continue to develop new models that provide MA plans, providers and community-based organizations greater flexibility.



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