The future of Medicare Advantage: addressing social determinants of health

Published April 29, 2019

Keeping a doctor’s appointment is easy - if you can get there. Eating a nutritious meal is no problem - if you can afford it or are able to cook it while recovering from an illness. These are some of the social determinants of health (SDOH) – access to healthy food, health-related transportation, housing, social support, etc. – that can impact health and well-being just as much as a medical diagnosis. Older adults with complex health needs, like those with a Medicare Advantage health plans, are much more likely to be impacted by SDOH, according to the Commonwealth Fund


Taking the “whole-person” approach to health

Anthem, Inc. and many of its affiliated health plans (Anthem BCBS) seized the opportunity recently given to insurers by the Centers for Medicare & Medicaid Services (CMS) to add new benefits that address SDOH to complement the medical services already covered by Medicare Advantage plans.

According to Martin Esquivel, Vice President of Product Development at Anthem’s Medicare business, Anthem BCBS “is making sure we take a ‘whole-person’ approach to helping our members lead healthier lives. We know that there are other factors that influence someone’s health, such as social support systems or access to health-related transportation and we are creatively trying to address these.”

Anthem BCBS has added benefits for 2019 like home-delivered meals, transportation for medical visits, a personal home helper, assistive devices or time at an adult day center. If a member is recovering from surgery, home-delivered meals are an option that can mean the difference between regaining strength through healthy eating or being readmitted to the hospital. Having help around the house can increase a member’s ability to live independently. And by offering coverage for adult day center services, the health plans hope to decrease the physical and mental health impacts of isolation and loneliness.

Members will find flexibility in new benefits, and can look forward to more options

Medicare Advantage plan members can choose the SDOH-related benefit that’s most appropriate for their situation. They also have the option of working with one of Anthem BCBS’s case managers to help them decide which service is right for them. 

Anthem BCBS’s affiliated health plans are among the first insurers to take advantage of CMS’ new regulations to help consumers be healthier. Interventions like these SDOH-related benefits can help consumers better manage their chronic conditions, stay healthy longer, and keep healthcare costs down.

CMS plans to expand the range of benefits Medicare Advantage plans can offer to include things like modifying a home to accommodate a patient with limited mobility. As Secretary Alex Azar has said, “What it will take is…pushing the boundaries of what we have traditionally thought possible.” And health insurers, like Anthem BCBS, are committed to showing what that looks like. 

Medicare Advantage plans are health plans offered by private health companies that consumers can choose instead of having Original Medicare (also known as Part A and Part B).

Learn why Medicare Advantage members in Rhode Island are getting primary care centers of their own.

Anthem Blue Cross Blue Shield is an independent licensee of the Blue Cross Blue Shield Association, an association of independent, locally owned and operated Blue Cross and Blue Shield companies.