Recently, I had the pleasure of co-authoring a blog post on Medicare’s initiative to align our nation’s social services infrastructure with the benefits of the Medicare Advantage program (the Kaiser Family Foundation reports that 1 in 3 Medicare beneficiaries receive their Medicare benefits through a Medicare Advantage plan and that number is growing quickly).
The initiative encourages Medicare Advantage plans to address their members’ social determinant of health (SDOH) needs by offering (and paying for) targeted social services for their chronically ill members. This is important because a growing body of evidence demonstrates that social service needs are preventing many older adults and people with disabilities from achieving their health and well-being goals and adhering to the care recommendations of their doctors.
These social services are often as simple as providing the Medicare recipient with transportation to their medical appointments or the pharmacy to pick up their medications. It could be a few days of nutritious meals for a patient recovering from a hospitalization or basic non-medical personal services (like assistance with bathing). Other social services include medication reconciliation (to ensure that patients are taking the right medicines in the right way at the right time), activity-based wellness programs, chronic disease self-management classes, and programs to address social isolation.
Why is Medicare opening the door to allow Medicare Advantage plans to provide these services and won’t it simply add costs to an already too expensive health care system? Medicare and the health plans offering these new supplemental benefits (known by the acronym “SSBCI”) don’t think so; to find out if they’re right, Medicare is encouraging Medicare Advantage plans to test the theory that, if health plans provide targeted social services and supports to people with chronic conditions, those individuals will be healthier and therefore less costly overall. A number of recent pilots offer encouraging preliminary results. For example, several pilots are demonstrating positive results by reducing unnecessary hospital readmissions and emergency room visits as well as helping at-risk individuals to remain in their community home rather than needing much more costly nursing home care.
The natural next question is – who will provide these services? This certainly isn’t in the wheelhouse of most health care organizations, right? The good news is that our nation already has the basic infrastructure in the form of social service agencies (often referred to as community-based organizations, or CBOs) in almost every community across the nation. For older adults, the leaders in this field are the area agencies on aging (AAAs). Over 600 local AAAs are ready and able to coordinate these social services for older adults in their communities. This new Medicare initiative offers the potential to help these agencies serve more people and do so in coordination with Medicare Advantage plans. Together, they can help older adults and people with disabilities to optimize their health and well-being goals…and achieve cost savings for our nation’s taxpayers. Now there’s a win-win!
For those interested in health policy trends, I encourage you to read the new blog post.