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Thomas KS, Durfey SNM, Gadbois EA, Meyers DJ, Brazier JF, McCreedy EM, Fashaw S, Wetle T. Perspectives of Medicare Advantage Plan Representatives on Addressing Social Determinants of Health in Response to the CHRONIC Care Act. JAMA Network Open. 2019 Jul 3; 2(7):e196923.
Importance: The passage of the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act in 2018 allows Medicare Advantage (MA) plans, which enroll more than one-third of Medicare beneficiaries, greater flexibility to address members'' social determinants of health (SDOH) through supplemental benefits. Objective: To understand MA plan representatives'' perspectives on the importance of addressing members'' SDOH and their responses to the passage of the CHRONIC Care Act. Design, Setting, and Participants: This semistructured qualitative interview study conducted via telephone from July 6, 2018, to November 7, 2018, included participants from 17 MA plans that collectively enrolled more than 13 million MA members ( > 65% of the total MA market). Data analysis was conducted from September 18, 2018, to December 13, 2018. Main Outcomes and Measures: Audio-recorded interviews were transcribed and then analyzed using a modified content analysis approach to identify major themes and subthemes. Results: Thirty-eight participants representing 17 MA plans varying in region, star rating, and size were interviewed. Analysis of interviews revealed 3 key themes. The first theme was that participants increasingly recognize the value of addressing members'' SDOH. The second theme was that participants had different perspectives on whether MA plans should directly address SDOH and how to do so. While some reported that they were taking advantage of the increased flexibility provided by the CHRONIC Care Act to design new benefits or partner with community-based organizations, others indicated that it was outside of their purview to directly address members'' SDOH. The third theme was that participants described complex decision-making around how to provide supplemental benefits, including a need for evidence, return on investment, strong community partnerships, and guidance from the US Centers for Medicare and Medicaid Services. Conclusions and Relevance: These findings suggest that the changes in MA plans'' benefit packages in response to the CHRONIC Care Act and their efforts to address SDOH will vary. Therefore, it is likely that MA enrollees will be differentially affected by the implementation of the CHRONIC Care Act.