Learn about the innovative strategies special needs plans (SNPs) can leverage to support individuals with significant, complex social needs while advancing health equity.

SNPs are in a unique position to address social needs as well as drive health equity and social justice through a strategic model of care. Most Medicare Advantage (MA) plans provide benefits related to fitness, dental, vision, and hearing. But far less provide benefits that meet deeper social needs such as meals benefits, transportation, bathroom safety, and in-home and caregiver support, which is where SNPs really shine, according to Eve Gelb, senior vice president for member and community health, SCAN Health Plan, who presented at RISE’s virtual Special Needs Plan Leadership Summit in June.

During the presentation, Gelb shared the key elements of a SNPs’ model of care that enable it to address social needs programs and drive health equity and social justice.

1. Collect the right data, in the right way

Data collection is critical to understand the needs of a population and adapt your model of care, explained Gelb, who recommended plans use Health Risk Assessments (HRAs) to collect not only SDoH information but Race Ethnicity and Language (REAL) and Sexual Orientation Gender identity (SOG) data as well.

While there is an abundance of accessible clinical data, Gelb recommended plans prioritize data around self-efficacy, social situation, and function and cognition.

Most importantly, when collecting data from individuals, be sure to collect it in a way they are willing to share. Gelb recommended plans ensure they always give members a ‘prefer not to answer’ option as well as an option of who they want to share their data with.

2. Conduct intensive complex care management

Intensive care management is a large part of what many SNPs do to support social needs. In addition to medical needs complex care management, SNPs have an opportunity to provide intensive in-person complex care management by leveraging resources such as social workers, community health workers (CHWs), nurses, and pharmacy technicians to address intense social needs.

“It’s not just about a referral to a community resource but the actual work that’s required to meet the need,” said Gelb, noting the hands-on approach can look different based on the individual’s need. “It’s about resolving evictions, going to family court with these folks, really supporting people experiencing elder abuse to get to safe environments, not just making an APS [Adult Protective Services] referral.”

3. Provide linguistically and culturally appropriate transitions of care

Once SNP members are ready to engage with more intensive services, plans can offer benefits such as in-home care as well as in-person linguistically and culturally appropriate care transition, typically through a CHW, to support a transition of care and then develop rapport and engage with the member, explained Gelb.

CHWs serve as linguistically and culturally competent resources who understands the needs a population faces and how to create a culturally relevant treatment plan. The role of the CHW “really supports engagement with a health system that is not designed to meet the cultural and social needs of the folks we work with.”

4. Remove barriers and drive change

Since SNPs typically serve underserved populations, the plans are frequently left to address outcomes driven by “past failures” of the health system, said Gelb.

She recommended plans remove this barrier by acknowledging those past failures, such as unethical care and institutionalized and structuralized racism, and providing trustworthy staff to earn the trust of members and commit to actively antiracist and just health care. Plans can then drive change by establishing purposeful frameworks focused on health equity.

The RISE Population Health Summit

Plans should also direct the same kind of focus toward their workforce, she said, by decreasing institutionalized racism and ensuring they have good benefits. “If we don’t care for the population who serves our members, who are representative of our members, then we can’t address the needs of our members,” she said.

“Regardless of the step along the model of care, SNPs have really been integrating social needs into the model of care in a way that is not just about the benefits but it’s about the resources,” said Gelb, crediting SCAN Health Plan’s care model for the plan’s ability to address health equity head-on.

5. Forge community-based partnerships

Community-based partnerships are important for everyone involved–health care providers, payers, and the community-based organizations (CBOs), explained Marisa Scala-Foley, director, aging and disability business institute, National Association of Area Agencies on Aging, who presented alongside Gelb.

For health care providers and payers the partnership provides an emphasis on the integration of health care and social services, increases recognition of the importance of services that address SDoH and community living services for health outcomes, and contributes to the drive toward value-based care. The partnership also provides CBOs with an opportunity to increase the recognition of the value they can bring to health care partners in improving health outcomes and quality of life, engage individuals, their families, and communities on what matters to them, as well as obtain sustainable revenue sources.

To gauge the current status of CBO and health care partnerships the last few years, the Aging and Disability Business Institute conducted three Requests for Information surveys between 2017 and 2020, which Scala-Foley shared results from during the presentation.

A few of the insights she shared include:

  • The number of CBOs that participate in contracts with care entities has steadily increased year over year since 2017.
  • The five most common services CBOs are providing under contract include ongoing case management/care coordination/service coordination, evidence-based programs, nutrition programs, transitions from hospital to home, and home care.
  • The three most common health care payer partners for CBOs with contracts include Medicaid managed care plans, state Medicaid plans that are not a pass through via a managed-care organization, and commercial or employer-sponsored health insurance plans.
  • The three most common health care provider partners for CBOs with contracts include hospitals or health systems, Veterans Administration Medical Centers, and accountable c organizations/health homes.

As for best practices in successful partnerships between CBOs and health care entities, Scala-Foley emphasized the value in finding the right partners with a shared vision, mission, and language; openness and flexibility; culture change in both sectors with buy-in at all levels; integrated, efficient workflows; adequate infrastructure; and clearly defined and open data-sharing protocols.