There’s an old saying, “You can’t manage, what you can’t measure.” When it comes to the Social Determinants of Health (#SDOH), it is clear that the healthcare industry has a long way to go to be able to manage and measure the factors, experiences, and barriers beyond traditional healthcare that impact our health. At BeneLynk, we have set ourselves the ambitious goal of helping managed care organizations to document and positively impact SDOH within their populations.
I was both encouraged and impressed to see UnitedHealthcare working with the American Medical Association (AMA) to jointly develop billing codes for SDOH. The truth is that health is impacted by more than traditional healthcare. And effective care must consider a member’s life experiences and address barriers that prevent a member from living his or her healthiest life.
The new ICD-10 codes (more than two dozen of them according to the article) represent a significant step forward. Managed care providers know that members face a wide array of challenges that go beyond traditional healthcare – from food instability, to social isolation, to lack of transportation options.
As UnitedHealthcare’s Sheila Shapiro was quoted (in the linked Forbes article) as saying “If benefits do not exist, we are seeking to assist that member with other types of services.” And this is, of course, the central point. Ultimately, the identification of these barriers, and the objective documentation thereof, is the first step. Managed care organizations need to put in place comprehensive programs to help members remove the barriers to their healthiest lives. A key component of this service Dual Eligible Advocacy and Recertification, has been in place for many #MedicareAdvantage plans for over two decades. Linking members with Medicaid benefits for which they are eligible has long been recognized as important work that Medicare Advantage plans must conduct. But financial need is just one of many barriers. And Medicaid programs are just one of many benefit programs available to address SDOH barriers. As the industry progresses toward full SDOH solutions, Medicare Advantage MCOs need to be able to link their members with the thousands of federal, state, and local benefit programs that can address SDOH barriers and improve lives.
SDOH is not just about barriers though. It is also about life experiences. Managed care organizations need to document not just their member’s challenges, but also what is important to them. 22% of Medicare Advantagemembers are Veterans of the United States Armed Forces, but many Medicare Advantage MCOs don’t know who among their members are Veterans.
They also often don’t know which of their members receive care at the Department of Veterans Affairs — even though 5% of all MA members get care at the VA every year! Being a Veteran, and using the VA, these are important SDOH that Medicare Advantage MCOs should systematically document within their membership.
At BeneLynk we are working with our Medicare Advantage MCO clients to refine our comprehensive offering to understand, document, and positively impact SDOH. As SDOH ICD-10s gain adoption, we believe that will be a key step along a timeline toward Medicare Advantage (and other!) MCOs being measured and capitated based on the SDOH barriers and experiences within their populations. Just as Dual Enrollment came to be seen as an excellent predictor of medical complexity and a disproportionate driver of medical expenses, SDOH complexity will soon be a key factor in understanding MA populations and in setting appropriate capitation and measurement expectations for MA MCOs. And once you can measure it, of course the exciting next step is to manage (and improve!) it.