In 2022 CMS continues to look more closely than ever at social determinants of health (SDOH), health equity and community-based frameworks to ensure the consumer voice is heard in managed care. As such they recently released a proposal introducing several new potential measurement concepts and methodological enhancement initiatives to ensure that health plans are improving the member experience while delivering on health equity measures. 

More specifically with the significant success of member advisory councils for Medicare-Medicaid and PACE plans, CMS is now extending the requirement of member advisory committees to D-SNP plans starting in 2023. These new committee members will now be representative of the D-SNP population, providing input around how to best improve access to covered services and health equity for the underserved.

Other proposed Medicare Advantage-focused health equity measures include introducing a Health Equity Index that will enhance the measurement of care management and a SDOH screening intended to ensure that plans are identifying and addressing non-clinical barriers to care.

Are Health Plans Ready?

While more progressive health plans have already started to roll out various strategies to engage their members in initiatives to address SDOH barriers, others will need to begin moving quickly to adapt. For example:

  • Health plans will need to double down and more formally build out SDOH capabilities – such as putting SDOH-specific teams in place and brokering larger partnerships with community-based organizations to build hyper-local presence.
  • The potential introduction of the Health Equity Index – a measurement of how quality scores are distributed across different population segments – means plans will have to fine tune how they target, deliver, and measure interventions across their membership to ensure equitable distribution of efforts.
  • Adding in a SDOH screening component will drive new health plan initiatives to engage members in underserved communities to drive these assessments, but several cultural and logistical issues will remain challenging for many health plans. 

Wider Circle Is Ready to Help

Wider Circle is an established SDOH and health equity-focused community health organization that has gained demonstrable traction helping Medicare Advantage, dual-eligible and Medicaid plans address critical needs and gaps in care among the hardest to reach, most vulnerable populations.

Working with Wider Circle means forward-thinking health plans can gain a better understanding of:

1) Best practices for health plan member engagement to drive CMS’ proposed SDOH assessments

2) Why it’s important for culturally competent boots-on-ground teams to enter and build trust with health plan member communities (which will ultimately enhance completion of SDOH assessments)

3) How to better engage health plan members in defining, designing, participating in, and assessing their care systems moving forward

Our team understands the importance of using culturally competent, hyper-local teams to build trust in health plan member communities to ultimately support plan efforts to enhance completion of SDOH assessments. We also have a deep knowledge of how plans can better engage with members to define, design, participate in and assess their care systems moving forward, making us a valuable partner as payors look to develop the necessary foundation for navigating these new proposed changes. As of today, our organization has built 1800 groups across 320 communities in five languages, engaging over 20,000 plan members. In the months ahead we are excited to join forces with today’s most forward-thinking health plans to help them prepare for these new proposed rules. 

Want to learn more? Read our latest white paper about the impact of a community-based intervention on utilization, risk adjustment factor scores, and member retention.

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About the author: Moshe Pinto, CEO, Wider Circle