Eating healthy is easy—if you can afford nutritious food. Going for a walk sounds simple—if you live in a safe neighborhood. Attending a medical appointment is a no-brainer—if you have access to transportation. A growing body of evidence highlights how these types of non-medical factors greatly influence health outcomes.
The social determinants of health (SDoH) or the conditions of the environments where people are born, live, work, and age, impact various quality-of-life outcomes and risks related to health. Socioeconomic barriers decrease the ability to access quality care and increase the risk of developing chronic conditions, leading to more medical appointments, hospital admissions, and ultimately, higher costs. While there are many factors that impact an individual’s health outcomes, one analysis found that SDoH contributes to 40% of health outcomes, while clinical care only accounts for 20%.
The healthcare industry is increasingly more focused on addressing SDoH to improve health outcomes and reduce health disparities in response to the latest research. While all population groups, regardless of age, race, or ethnicity, include individuals who face socioeconomic risk factors, certain populations are more vulnerable. Older adults and individuals with disabilities are disproportionately affected by socioeconomic barriers, particularly related to social isolation, transportation, housing, and food.
CMS Changes Empower Medicare Advantage Plans
In 2019, the Centers for Medicaid and Medicare Services (CMS) implemented changes to Medicare Advantage coverage to help address SDoH. CMS expanded coverage for benefits that go beyond the basic, traditional offering. The most impactful change is to the criteria for supplemental benefits. Previously, a benefit had to meet all three criteria, including “must be primarily health-related.” As we now know, various factors impact one’s health; and CMS responded by changing the policy—a benefit can meet any one of four criteria—including “compensates for physical impairment” and “reduces emergency and healthcare utilization.” With the new regulations in place, Medicare Advantage plans have more flexibility than ever and are well-positioned to meet the unique needs of their beneficiaries.
It’s not only important for health plans to acknowledge that SDoH affect their members’ health outcomes, but it’s necessary to make changes that aim to improve the well-being of their population. Medicare Advantage plans serve more than 30 million members—mainly older adults and individuals with disabilities—and are under pressure to offer supplemental benefits that address the leading SDoH.
Leveraging Technology to Improve Health Equity
To move the needle towards better health equity, simply promoting healthy choices or sending encouraging messages to members isn’t going to cut it. Medicare Advantage plans need to invest in solutions that will drive tangible change. Before adding new supplemental benefits, Medicare Advantage plans should determine which SDoH significantly impact the majority of their population and focus on finding solutions designed to address those issues.
While there isn’t a one-size-fits-all solution to eliminate the SDoH, resolving certain risk factors can be more beneficial for meeting members’ socioeconomic needs. Transportation access is one of those most pressing needs.
For Medicare Advantage beneficiaries, multiple SDoH depend on getting from point A to point B—such as going to the gym for a workout class, picking up nutritious food at the grocery store, or refilling a prescription at the pharmacy. Access to reliable transportation is a key factor in eliminating the main barriers—social, economic, and environmental—for most of the Medicare Advantage population.
In the past, Medicare Advantage plans may have overlooked transportation as a paradigm-shifting benefit for addressing SDoH. A primary reason could be that these transportation programs have been historically managed by legacy non-emergency medical transportation (NEMT) brokers who made the benefit costly for plans and complex for members. To meet the needs of their growing and aging population, Medicare Advantage plans need to move away from legacy NEMT brokers and invest in modern transportation solutions. Leveraging technology to power NEMT programs offers real-time data transparency, simplifies ride logistics, and enhances the overall member experience.
Technology-First NEMT Addresses SDOH
As the healthcare industry strives to become more equitable, the technology and services industries are leading the charge with innovative solutions aimed at addressing SDoH, including technology-first NEMT. Technology-enabled partnerships between Medicare Advantage plans and modern NEMT solutions will provide our communities with the transportation opportunities they deserve.
Eliminating barriers to transportation with NEMT benefits helps level the playing field across the SDoH domains. Expanding transportation access beyond medical appointments—to fitness centers, grocery stores, and pharmacies—could help Medicare Advantage members improve and maintain their physical, mental, and emotional health, and ultimately reduce costs for the health plan. By better meeting members' social needs and creating a better member experience, Medicare Advantage plans have the opportunity to improve plan 'stickiness' and drive member retention.
As Medicare Advantage plans prioritize their members’ socioeconomic needs and consider new supplement benefits, it’s important to understand the value of adding NEMT for improving the quality of life of members. While there’s still a lot of room for improvement, providing equitable access to on-demand transportation is key to empowering Medicare Advantage beneficiaries to reach their full potential.