As the understanding of social determinants of health or social drivers of health (both abbreviated SDoH) has evolved, the need for a more holistic approach has become evident. We call this “social care.” As with healthcare, to make a significant and lasting impact, elements of care need to be integrated and an iterative relationship needs to sit at the center. At BeneLynk, we believe a social care plan should be a tangible document laying out mutually agreed-upon challenges and steps to be taken.
Creating a Partnership with the Member
The first stage in the development of a social care plan is comprehensively understanding the challenges the member faces. Ideally, this should be done using a tool that meets evolving regulatory requirements. The member must understand a couple of key principles from the beginning:
- Your interaction is about more than just documenting challenges. You intend to work with the member to develop a plan to address these barriers, beginning today. Information gathering is often perceived to solely benefit the health plan. You need to be clear that the goal is both understanding challenges and taking the first steps toward addressing these challenges.
- The member’s priorities will come first. Too often member outreach is focused on the plan’s needs. To build trust, you need to start with the member’s concerns.
Once the member understands the proposed partnership to address these challenges, a structured approach to gathering the necessary information needs to be combined with an empathetic, human understanding of the challenge. Ideally, the written plan should be a deliverable associated with the interaction where the social care information is uncovered and discussed.
Understanding the Member’s Social Care Needs
Broadly, the plan needs to capture information, including SDoH barriers and the important context of a member’s life. This may include living situation, veteran status, social life, and family support (among other elements). These social barriers need to be captured using questions in a format applicable to all relevant regulations. It is important to understand the member’s life story, including military service and any “hidden” care they may receive at the VA. Too often social care is limited to addressing income challenges. Instead, it should reflect the totality of the member’s life experience and the needs he or she currently has. Knowing that a person served in the military is a crucial key to understanding that person’s life journey and opens an array of possible benefit programs available to veterans.
A Social Care Plan's Most Crucial Component
For Medicare Advantage members, accessing or keeping Medicaid benefits is often the most crucial component of a social care plan. Medicaid offers a range of benefits, but generally, the most important one for this population is state payment of the member’s Medicare Part B premium. For low-income MA members, this results in an approximately 10% increase in available monthly capital. Securing this available cash and ensuring that it is retained is fundamental.
- Build a Medicaid application together (including LIS) - It is important when building a Medicaid application to consider all available Medicaid programs in a given state and be aware of the relevant income and asset requirements. Medicaid applications should never be “one-size-fits-all.”
- Capture information on the Medicaid renewal date and make a plan for Medicaid renewal – In a post-continuous coverage requirement world, Medicaid renewal dates are changing. A social care plan predicated on maintaining Medicaid must be flexible to capture changes to each member’s renewal schedule.
A Multi-Level Approach: Addressing Barriers Short, Mid, and Long Term
Broaden your approach to address SDoH barriers by accessing both governmental and non-governmental resources. Barriers should also be addressed in the short, mid, and long term. Take this example of a Medicare member with food insecurity:
- Short-term: Link with a local food pantry
- Mid-term: Apply for SNAP benefits
- Long-Term: Secure Medicare Savings Program benefits
By addressing challenges in the short term, advocates can build the trust and commitment necessary to take more involved steps for longer-term solutions.
The Power of a Human Connection
Advocates should demonstrate an understanding of a member’s areas of concern and the steps agreed upon to address these challenges.
“I learned the following about you. I heard that these are areas of concern. We agreed on the following steps to meet these challenges. Here are the next steps and how you can reach me at any point.”
Finally, an ongoing dialogue should be built. A true plan should incorporate steps to be taken immediately, as well as planned interactions for the future. This requires an ongoing partnership with the member and the building of a human-to-human connection. This partnership is the foundation of durable, ongoing social care.
About the Author
Sean Libby has been an advocate for seniors, people with disabilities, veterans, and individuals with low income for over 20 years. At BeneLynk, we are committed to helping managed care plans deliver superior social care solutions to their members. We are always looking to learn more and would like to hear your ideas on how best to assist members in need. Drop us a note at Sales@BeneLynk.com.