FutureFocus October 24, 2018: Medicare Advantage and the IMPACT Act: Social Risk Factors Best Practice

Lisa Remington

This week’s FutureFocus insight is a window into your future. All payers are focusing on social risk factors. Strong market signals are brewing.  Social risk factors become a readmission penalty in 2019, the IMPACT Act is required to conduct studies on socioeconomic status, and Medicare Advantage Plans are incorporating supplemental benefits to address social determinants. Social risk factors will become a common quality measure across the continuum. Get a head of the curve to learn what this means for your organization.

Lisa Remington, President, Remington Health Strategy Group

By: Lisa Remington, President Remington Health Strategy Group, Publisher, The Remington Report

How are providers and health plans serving Medicare beneficiaries working to improve health outcomes for beneficiaries, especially those with social risk factors?

Did you know: Section 2(d) of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 calls for the Secretary of Health and Human Services (HHS), acting through the Assistant Secretary for Planning and Evaluation (ASPE), to conduct a study evaluating the effect of individuals’ socioeconomic status (SES) on quality measures and measures of resource use under the Medicare program.

The Department of Health and Human Services has issued a request for information on how health care providers and health plans are working to improve care for Medicare patients with social risk factors. Comments are due by Nov. 16. The responses to the RFI will be used in a report required by the Improving Medicare Post-Acute Care Transformation Act of 2014 on issues related to social risk in Medicare's value-based payment programs. The report will be completed by October 2019.

Why is this important to your organization?

  1. Beginning in 2019, social risk factors and hospital readmission penalties: The 21st Century Cures Act required that CMS develop a methodology for the Hospital Readmissions Reduction Program (HRRP) for the dual-eligible. These beneficiaries are eligible for both Medicare and Medicaid. CMS will incorporate the socioeconomic status of dual-eligible patients toward readmission penalties.
  1. In April, CMS issued a final rule giving Medicare Advantage plans additional flexibility in determining supplemental benefits to include items and services to address social determinants of health (SDOH).
  1. More than 80 percent of payors are integrating social determinants of health (SDOH) into their benefit program according to a Pulse survey earlier this year. Organizations are taking steps to leverage community programs and resources, integrate medical data with financial census and geographical data, and training doctors to identify social indicators.
  1. In 2017, 19 states required Medicaid MCOs to screen beneficiaries for social needs and/or provide enrollees with referrals to social services and six states required MCOs to provide care coordination services to enrollees moving out of incarceration, with additional states planning to implement such requirements in 2018.

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