Profiling Social Needs Activities in Publicly Traded Medicare Advantage Organizations.

IF 1.8 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Population Health Management Pub Date : 2024-08-27 DOI:10.1089/pop.2024.0045
Khyathi Gadag, Fred Ullrich, Keith J Mueller
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Abstract

The objective was to examine Medical Advantage (MA) organizations' commitment toward addressing social determinants of health (SDOH) through their health-related social benefit offerings, and the perceived impact of providing supplemental benefits associated with SDOH in their plans. Public reporting documents were reviewed from six of the largest MA firms: Humana, UnitedHealthcare, Cigna, Elevance Health, CVS Health, and Centene. Public reports were obtained from each company's website (eg, from the "Investor Relations" page). Quarterly reports for Q1 2023, annual reports for 2022, and proxy statements for 2023 for all companies were examined. Content analysis of the public reports was conducted under three constructs: (1) Growth of MA in the company, (2) SDOH-related activities in the company, and (3) SDOH-related activities in the MA plans of the company. Each of the three constructs was further analyzed for recurring themes and elements. The findings from content analysis suggests that plans are providing tailored benefits that may address the social needs of vulnerable and underserved populations. Companies that offered supplemental benefits and value-based arrangements that addressed social needs reported beneficiary clinical outcomes resulting in cost savings and increased revenue. Health insurance companies identify MA as a significant growth opportunity and a strategically important market for overall membership and revenue growth. Moreover, companies providing innovative social benefits through their MA plans reported witnessing increased value propositions by underserved and vulnerable populations, leading to increased revenue and cost containment.

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剖析公开交易的医疗保险优势组织的社会需求活动。
目的是研究医疗优势(MA)组织通过提供与健康相关的社会福利来解决健康的社会决定因素(SDOH)的承诺,以及在其计划中提供与 SDOH 相关的补充福利的预期影响。我们审查了六家最大的医疗保险公司的公开报告文件:Humana、UnitedHealthcare、Cigna、Elevance Health、CVS Health 和 Centene。公开报告来自各公司的网站(如 "投资者关系 "页面)。对所有公司 2023 年第一季度的季度报告、2022 年的年度报告和 2023 年的代理声明进行了检查。公开报告的内容分析在三个结构下进行:(1)公司中医疗保险的增长,(2)公司中与 SDOH 相关的活动,(3)公司医疗保险计划中与 SDOH 相关的活动。对这三个结构中的每一个结构都进一步分析了重复出现的主题和要素。内容分析结果表明,医疗保险计划正在提供量身定制的福利,以满足弱势和服务不足人群的社会需求。提供满足社会需求的补充福利和基于价值的安排的公司报告了受益人的临床结果,从而节省了成本并增加了收入。医疗保险公司认为,医疗保险是一个重要的增长机会,也是一个对整体会员和收入增长具有重要战略意义的市场。此外,通过医疗保险计划提供创新性社会福利的公司报告称,服务不足和弱势群体的价值主张得到了提高,从而增加了收入并控制了成本。
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来源期刊
Population Health Management
Population Health Management 医学-卫生保健
CiteScore
4.10
自引率
4.00%
发文量
81
审稿时长
6-12 weeks
期刊介绍: Population Health Management provides comprehensive, authoritative strategies for improving the systems and policies that affect health care quality, access, and outcomes, ultimately improving the health of an entire population. The Journal delivers essential research on a broad range of topics including the impact of social, cultural, economic, and environmental factors on health care systems and practices. Population Health Management coverage includes: Clinical case reports and studies on managing major public health conditions Compliance programs Health economics Outcomes assessment Provider incentives Health care reform Resource management Return on investment (ROI) Health care quality Care coordination.
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