Social Determinants of Health

2022 Outlook: MA Insurer Execs Plan Investments Supporting Equity, SDOH

For our annual series of forward-looking articles, AIS Health recently featured the perspectives of multiple industry experts on what Medicare Advantage stakeholders will be focusing on in 2022. For a follow-up installment, we asked several health plan leaders to share how their respective organizations will be innovating this year to meet aging members’ needs, advance health equity and address social determinants of health (SDOH) amid the backdrop of the ongoing COVID-19 pandemic.

“The pandemic emphasized how our most daunting challenge — reaching our members in a new remote, digital-first landscape — remains our most compelling opportunity. Delivering home-based care to our nearly 10 million Medicare members and equipping them with the resources they need to age in place are central to our 2022 agenda,” says Jamie Sharp, M.D., vice president and chief medical officer of Aetna Medicare, a CVS Health company.

As Medicaid Enrollment Soars, States Ask MCOs to Intensify Social Determinants of Health Efforts

States are moving to better address social determinants of health (SDOH) and improve health equity in their Medicaid programs, and they’re asking MCOs to drive the change, according to an analysis of recent requests for proposals (RFPs) from advocacy group Together for Better Medicaid. The report identified RFPs from 10 states that have extensive SDOH and equity-based requirements for MCOs, from member screenings and staff training to close collaboration with community-based organizations (CBOs). Meanwhile, Medicaid enrollment has surged in all 10 states amid the COVID-19 pandemic. National Medicaid enrollment climbed 18.4% from March 2020 to December 2021, according to AIS’s Directory of Health Plans. See an overview of the most common SDOH requirements and the 10 states’ recent enrollment patterns below.

Regulators, Researchers Take Aim at Bias in AI and Big Data

The rise of artificial intelligence (AI) and machine learning within health care — from clinical decision-making tools to population health stratification efforts — is loaded with potential, but experts warn that embedded data flaws can heighten health disparities and stanch the promise of an equitable playing field for consumers.

As AI-fueled devices and algorithms gain in popularity and practical use, regulators are increasingly taking notice. Multiple agencies, including HHS, the FDA and the Office of the National Coordinator for Health Information Technology (ONC) are quickly adopting regulatory frameworks to address health equity within big data.

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Medicaid MCOs Brace for Return of Churn, Other Challenges

As a condition of receiving enhanced federal funds during the COVID-19 public health emergency (PHE), states were required to take certain steps to ensure continuous Medicaid and CHIP coverage for most enrollees, leading to a nearly 18% jump in Medicaid enrollment. But with the latest PHE extension set to expire on Jan. 16, states will no longer receive such funds and will therefore no longer be required to maintain continuous coverage, although CMS has given them 12 months after the month in which the PHE ends to complete eligibility redeterminations. As a result, supporting states’ reverification efforts and ensuring that eligible members stay on the rolls or have a viable landing spot will be critical to Medicaid managed care organizations this year, industry experts tell AIS Health, a division of MMIT.

Ahead of 2023 Rate Setting, BMA Issues End-of-Year Wish List

As CMS gets ready to set Medicare Advantage rates for the 2023 calendar year, the Better Medicare Alliance in a Dec. 6 letter urged Administrator Chiquita Brooks-LaSure to take several actions to address social determinants of health (SDOH) and close the gap on longstanding racial disparities. The research and advocacy group supports more than 170 ally organizations that include several major MA insurers. Among its recommendations, BMA asked that CMS:

Non-Emergent 911 Calls Offer Intervention Opportunity

Not every person who calls 911 needs to be transported to a hospital for emergency treatment. But people who make those phone calls do need some kind of health care; they just don’t know how to access the services they need.

With that in mind, the health insurer CareOregon recently made a $2.5 million investment in a new Portland Fire & Rescue (PF&R) initiative to connect community members with the care they need. The Community Health Assess & Treat (CHAT) program will take a proactive approach to assessing and meeting the needs of members of Oregon Health Plan, the state’s Medicaid program.

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Medicare Advantage Insurers Step Up SNP Offerings for 2022, Particularly for Duals

As Medicare Advantage enrollment soars and the number of individual MA plans available across the U.S. reaches a new high for 2022, the MA Special Needs Plan market is also seeing continued growth. According to estimates from Clear View Solutions, LLC, there will be 926 plans available next year that were offered in 2021, compared with 766 plans that carried over from 2020 to 2021 (see infographic). Dual Eligible SNPs (D-SNPs), in particular, will rise from 477 plans offered in 2020 and 2021 to 569 plans available this year and next, according to the consulting firm’s analysis of the 2022 SNP Landscape files from CMS.

MVP Health Care Taps Into ‘Underserved’ Market With D-SNP

Schenectady, N.Y.-based MVP Health Care has long served Medicare beneficiaries in New York and Vermont with Medicare Advantage and Medicare Savings Account plans. It is also a contractor for the New York State Medicaid program, caters to employers, and offers individual and family plans on and off the Affordable Care Act exchanges. For 2022, the not-for-profit insurer is launching a Dual Eligible Special Needs Plan (D-SNP) through a joint venture with Belong Health, a new company that was co-founded by former Cigna Corp. executive J. Patrick Foley and specializes in helping regional payers launch MA and SNP products.