Social Determinants of Health

AHIP 2024: Execs Say Health Disparities Persist Despite Higher Awareness

Ever since racial justice activism swept the country in 2020 following the death of George Floyd, racial disparities in health care have become a focus in the health care industry. Perhaps even more than in recent years, health equity was one of the most-discussed topics at the AHIP 2024 conference in Las Vegas.

But presenters at the conference made clear — as have their counterparts at other industry meetups — that health equity is a work in progress. Awareness of racial health disparities may be at an all-time high, but tangible progress is as elusive as ever.

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Elevance Research Touts Supplemental Benefits’ Impact on Utilization

The use of supplemental benefits in Medicare Advantage can markedly improve health care utilization, decreasing members’ inpatient admissions and increasing wellness visits and preventive screenings, suggests new research from Elevance Health, Inc.’s Public Policy Institute. And the effect is especially pronounced for Medicare-Medicaid dual eligibles, who are more likely to have greater care needs and face socioeconomic vulnerabilities.

Following legislation and regulatory changes in 2018 and 2019 that established new types of supplemental benefits and expanded the definition of what CMS considers “primarily health-related,” payers began to offer supplemental benefits that target these health-related social needs, such as food insecurity and lack of access to transportation.

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Plans That Adopt Supplemental Benefits See Modest Member Experience Boost

Medicare Advantage plans that adopt supplemental benefits can improve their plan experience ratings, according to new research published June 5 in JAMA Network Open. Researchers found that plans that adopted both expanded primarily health-related benefits (PHRB) and Special Supplemental Benefits for the Chronically Ill (SSBCI) in 2021 increased their mean plan rating, measured via the Consumer Assessments of Healthcare Providers and Systems (CAHPS) survey, by 0.22 points. (Members rate plans between a low of 0 and a high of 10 points.) The study is among the first research available on any link between supplemental benefit adoption and plan quality ratings.

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Under New Rule, DACA Recipients Can Sign Up for ACA Marketplaces in 2025

Under the Biden administration’s new regulations — which will allow Deferred Action for Childhood Arrivals recipients to receive federal health care coverage — more than 100,000 uninsured DACA recipients are expected to enroll in Affordable Care Act (ACA) marketplace plans next year, according to CMS.

As of Dec. 31, 2022, there were 580,000 active DACA recipients and almost 28% of them resided in California. A KFF survey showed that most people who were likely eligible for DACA lived in a family with at least one full-time worker and over half of them worked full time themselves. However, they were much less likely than U.S.-born individuals in their age group to receive health care coverage.

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News Briefs: CMS Extends Medicaid Redetermination Deadline

CMS on May 9 said it would allow states to complete their Medicaid eligibility redeterminations through June 30, 2025. The agency previously required states to finish the “unwinding” process by the end of 2024. During COVID-19, states were required to keep people enrolled in Medicaid or the Children’s Health Insurance program until the public health emergency ended, but starting last April, states were allowed to resume their eligibility checks for Medicaid coverage. As of May 10, states and Washington, D.C., reported they had completed about three-quarters of their eligibility decisions, according to KFF. About 48.1 million people had their coverage renewed, while 21.9 million people were disenrolled and 24 million people had not found out about their status. KFF reported that 69% of people who were disenrolled had their coverage terminated for procedural reasons.

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Amount of Medicaid Funds Flowing to MCOs Is Poised to Rise, KFF Predicts

Taking a look at the overall state of Medicaid managed care, KFF earlier this month compiled data from prior years of its surveys and analyses to identify notable trends. About 75% of all Medicaid beneficiaries are enrolled in risk-based managed care — with that percentage set to grow as Oklahoma transitions away from fee-for-service (FFS) Medicaid — and most states spend at least 40% of total Medicaid dollars on payments to MCOs. KFF noted that spending could increase as states shift higher-cost, higher-need beneficiaries, such as disabled individuals and adults aged 65 and older, into managed care. Moreover, most states (32 states including Washington, D.C.) with managed care carve in their pharmacy benefits to MCO contracts, observed KFF.

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CMS Minority Health Report Suggests Similar Patient Experiences, Varied Outcomes

As CMS continues efforts to advance health equity, the agency on May 2 released its annual report on disparities in the Medicare Advantage program based on race, ethnicity and sex. Racial and ethnic minorities are consistently more likely to enroll in Medicare Advantage versus the traditional, fee-for-service Medicare program. The 2024 report, released by the CMS Office of Minority Health in partnership with The RAND Corp., examined patient experience measures based on responses to the 2023 Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, as well as clinical care measures based on the Healthcare Effectiveness Data and Information Set (HEDIS) that is collected from administrative data and patients’ medical records, reflecting care received in 2022.

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SCAN CEO Challenges Industry to Take Stock of Mission-Driven Work

In recent years, publicly traded managed care organizations have jumped on a growing corporate trend of publishing annual environmental, social and governance (ESG) reports designed to spotlight the larger impact their company is having on society. Alignment Healthcare Inc., for one, in 2022 released its inaugural ESG report highlighting efforts from the previous year that focused on delivering high-quality care at a lower cost compared to fee-for-service Medicare and addressing social determinants of health (SDOH). In 2023, The Cigna Group’s 98-page ESG report categorized similar efforts into four “pillars” — healthy society, healthy workforce, healthy company and healthy environment — and included efforts to reduce greenhouse gas emissions in the latter category.

In a 2022 podcast hosted by law firm K&L Gates LLP, speakers suggested that the health care industry by nature is “mission-driven…focused on the improvement of the human condition” and “is particularly well suited to address ESG issues.” And insurers’ efforts in recent years to address health inequities mirror the increased focus from the Biden administration and CMS on tying health equity to reimbursement, such as the CMS Innovation Center incorporating health equity into models that drive value-based care.

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Pharmacists Play Key Role in Addressing Health Inequities, Execs Say at Conference

PBMs and health plans are increasingly relying on pharmacists to manage their members’ medication costs and improve adherence, particularly among marginalized groups who have often been overlooked, according to speakers at the third annual Pharmacoequity Conference, held May 3 at the University of Pittsburgh. The panelists also said pharmacists adopting a so-called “cost-plus” model can help bring more transparency to drug pricing, make medications more affordable, and help people become healthier and save payers money.

The term “pharmacoequity” was popularized in 2021 by Utibe Essien, M.D., an internal medicine physician and former professor at the University of Pittsburgh who is now at the University of California, Los Angeles. Essien has defined pharmacoequity as “equity in access to pharmacotherapies or ensuring that all patients, regardless of race and ethnicity, socioeconomic status, or availability of resources, have access to the highest quality of pharmacotherapy required to manage their health conditions.”

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Racial Health Care Disparities Persist in All States, With Significant Divides in Premature Deaths

Substantial racial and ethnic disparities in health and health care are pervasive across all states in the U.S., according to The Commonwealth Fund 2024 State Health Disparities Report.

The report evaluated 25 health indicators of health system performance for Black, white, Hispanic, American Indian and Alaska Native (AIAN), and Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations. It found that racial health disparities are a bigger problem in some states than in others. Massachusetts, Rhode Island and Connecticut saw relatively high performance for all racial and ethnic groups, while Oklahoma, West Virginia and Mississippi performed poorly for all groups.

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