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2022 Medicare Advantage Plan Overview, Part Three: Social Determinants

Analysis  |  By Laura Beerman  
   October 25, 2021

"Medicare Advantage plans have a unique and growing opportunity to address the needs of socioeconomically vulnerable populations and improve their health," reports America's Health Insurance Plans.

The expansion of supplemental benefits is just one of the strategies Medicare Advantage (MA) plans are using to address social determinants of health (SDOH). More plans for individuals with low incomes, as well as targeted SDOH investments and initiatives, round out carrier approaches.

On the benefits side, offerings such as meals, transportation, and in-home supports are becoming increasingly common across MA plans, including those with a $0 premium (58% in 2022 compared to 53% in 2021). Many of the largest carriers report, in their press releases or through HealthLeaders sourcing, that they have also expanded the number of Dual-Eligible Special Needs Plans (D-SNP) they offer—and in some cases, linking them to added benefits, such as debit cards to help pay for groceries, utilities, and/or covered over-the-counter items.

These moves are in addition to a growing number of MA plans partnering with agencies in high-need communities. In its May 2021 report, America's Health Insurance Plans (AHIP) highlighted initiatives across MA plans to address social isolation, digital literacy, COVID-19, homelessness, disability, and food insecurity. Some of these initiatives are being incentivized.

Carrier highlights

Part 1 of this HealthLeaders' series targeted MA cost design, while Part 2 highlighted Medicare portfolio strategy. In Part 3, highlighting the three next-largest carriers, Kaiser Permanente enrollment data was provided by the company while Centene (Wellcare) and Cigna data were sourced from the Kaiser Family Foundation (KFF).

Kaiser Permanente

The recurring headline with Kaiser Permanente is the company's quality, with MA plans that are consistently rated five stars, allowing the integrated payer-provider and integrated EHR pioneer to market those plans all year long. Andrew Bindman, MD, executive vice president and CMO states: "From the moment our Medicare health plan members choose Kaiser Permanente for their care and coverage, we work diligently to provide an exceptional, coordinated care experience, and this distinction is a reflection of those efforts."

  • MA enrollment and market share: 1.7 million, 7%.
     
  • Footprint: 8 states and the District of Columbia.
     
  • $0 premium: Number of plans unavailable at time of publication.

In its 2020 annual report, Kaiser highlights "[t]elehealth's breakout moment" and its "fully integrated telehealth capabilities," which include remote monitoring for diabetes and cardiac conditions with data that links directly to the payer-provider's EHR. The company's Social Health Playbook, which includes screening tools and is promoted as replicable across the industry, focuses on home, food, and social connection resources.

Centene

Centene, with 1.1 million MA enrollees, offered an abbreviated press release for its 2022 portfolio emphasizing largely footprint growth and Wellcare, the company it acquired in 2020 and the umbrella name for its now six MA brands. Michael F. Neidorff, chairman, president and CEO, states: "At a time when many seniors are grappling with the effects of COVID-19, we are committed to expanding choice and access to high-quality, affordable Medicare plans that support our members' health and well-being during the pandemic and beyond."

  • MA enrollment and market share: 1.1 million, 4%
     
  • Footprint: 33 states
     
  • $0 premium: Number of plans unavailable at time of publication.

In its financial statements, Centene cites the acquisition as "a key part of our growth as we become one of the nation’s largest sponsors of government health coverage." The company's MA plans have expanded to 327 new counties (a 26% increase) and three additional states (Massachusetts, Nebraska, and Oklahoma) bringing that total to 36 states. Like other carriers, Centene has also increased its PPO offerings, expanding to 10 additional states for 2022.

Cigna

Regarding its 2022 portfolio, Aparna Abburi, President of Cigna Medicare, notes: “Through geographic and product expansion, we’re pleased to be able to provide … customers with the plan that best fits their personal health care needs, including their lifestyle, health and budget. We are committed to making customers’ Medicare options easier to understand and access.” Cigna is the seventh-largest MA company by enrollment in the U.S.

  • MA enrollment and market share: 0.6 million, 2%.
     
  • Footprint: 26 states and the District of Columbia.
     
  • $0 premium: 70% of plans with all markets offering at least one such plan.

Cigna's 2022 MA press release highlights the company's geographic expansion, stable premiums, and three specific benefits: its expanded Part D Senior Savings Program; gift card incentives linked to $0 annual, in-network screenings and physical exams; and a new social connection program in select markets to address customer loneliness and support instrumental activities of daily living (e.g., meals, transportation, chores). The company further highlights its transportation, post-hospital meal delivery, and fitness benefits as well as debit card for allowable expenses for select D-SNP customers. Cigna's 30% year-over-year growth continues its geographic expansion of 80% since 2019 with an emphasis on new states and more PPO options. The company will offer PPOs in 152 new counties in 2022.

A unique position?

Noting that many MA beneficiaries "face more socioeconomic risk factors and are more financially vulnerable compared to the traditional FFS Medicare population," AHIP adds that "Medicare Advantage plans have a unique and growing opportunity to address the needs of socioeconomically vulnerable populations and improve their health. The organization recommends multiple policy changes that will allow MA plans more flexibility to offer SDOH-related supplemental benefits, Star Ratings measures, innovation models, and alternative funding. These recommendations will bear watching as MA plans appear, each year, to up the ante for greater market share.

Laura Beerman is a contributing writer for HealthLeaders.


KEY TAKEAWAYS

Medicare Advantage plans are deploying multiple strategies to address social determinants of health.

These include more supplemental benefits, more dual-eligible special needs plans, and targeted community partnerships.

These strategies, paired with further policy changes, are designed to expand payers' whole-person care capabilities and credibility.


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