How Medicare Advantage addresses the social drivers of health

February 23, 2024 at 15:08 PM EST

(BPT) - As a health care navigator at UnitedHealthcare, John wears many hats. Some days are spent helping members locate physicians in their area or better understanding their benefits, while others are filled with questions about billing. But providing the support members need often means looking beyond claims or copays to other issues impacting health - ones that aren't always seen as health care issues.

John recalls one member he worked with earlier this year whose largest obstacle was housing. Operating with a disability and on a single income, he struggled to navigate local programs designed to help people like him address housing challenges.

'So I did some research, calling county and local offices to get information that might best fit his needs,' John says.

He soon facilitated a conference call with the member and a neighborhood housing service in Kalamazoo, Michigan, to help him get 'mortgage ready' and into stable housing. At the end of that call, the member told John, 'You made my hero of the day list.'

The impact of social drivers

Nearly 10% of Americans 65 years or older face food insecurity,^[1] and between 2021 and 2022 the poverty rate for older adults increased from 10.7% to 14.1%, reflecting greater overall economic insecurity for American seniors.^[2]

In response, the health care system is paying much closer attention to the overall impact of these social factors.

'For a long time, health care was focused on acute and chronic illnesses, as well as an episodic model for how we manage specific conditions,' said Dr. Alexander Billioux, chief medical officer for UnitedHealthcare Community and State and also responsible for leading the company's population health and social care efforts. 'We're now taking a more holistic view, where we can improve health by thinking about the context in which people live their lives.'

'That,' he said, 'is really where the social care component comes in.'

Dr. Billioux adds that while traditional Medicare is not really set up for identifying social needs or addressing them, managed care - and Medicare Advantage in particular - has that flexibility.

Making meaningful connections to meet social needs

Turning data into action is where UnitedHealthcare has made great strides over the past few years. In 2022 alone, the company screened 4.7 million Medicare Advantage enrollees for social needs using an approach that included health risk assessments; phone calls; in-person visits; and analysis of surveys, claims and administrative data. Of those screened, UnitedHealthcare identified 2 million enrollees with unmet social needs that could be impacting their health.^[3]

But identifying these needs was just the first step. Using individualized outreach tactics-dictated by members' noted preferences-UnitedHealthcare contacted 1 million people who said they wanted help, and from there made 2.3 million social-needs referrals to various national and regional social services programs.

Ultimately, UnitedHealthcare verified that 853,000 Medicare Advantage enrollees were connected to services and supports that addressed a social need. And the result wasn't just a step toward better health, but also meaningful cost savings for these individuals. In 2023, the company is expanding its outreach efforts and expects to screen more than 5.5 million members-driving even more connections to important support services for those in need.

'We're taking those extra steps by telling members these programs exist, as well as contacting, coordinating and advocating,' Billioux says. 'People who have had long exposure to the health system might think that no one is paying attention to these social drivers. So we're working hard to try and change that, because we really are here to help.'

Added John, 'I love having the opportunity to help our members; I want to be that person.'

To learn more about how UnitedHealthcare's holistic medical and social support model is identifying and addressing the needs of millions of people each year, access the research brief on UnitedHealthGroup.com.

^[1] 'Risk Factors Associated with Food Insecurity…' NCBI.gov.

^[2] 'Older Adults Again Experience Increase in Poverty', ncoa.org.

^[3] https://www.unitedhealthgroup.com/content/dam/UHG/PDF/2023/2023-MA-Social-Determinants-Brief.pdf