Humana announced Wednesday a new program that reimburses health systems for referring Medicare Advantage members to social services such as food banks and affordable housing.
The program, called the social determinants of health value-based program, aligns with the Trump administration's push for commercial payers to address social determinants of health in the Medicare population. Last April, the CMS unveiled new policies that allow MA plans to cover meal deliveries, transportation and home cleaning services.
New Orleans-based Ochsner Health is the first system to participate in Humana's program, which started March 1. Additional payment is offered when providers screen Medicare Advantage members for social determinants of health, document the assessment and then connect the member to appropriate resources in the community or at Humana. Health systems must do all three to receive the added reimbursement. For example, if a patient screens positive for food insecurity, the health system has to document they referred the patient to a local food bank or Humana's home food delivery services.
By offering a reimbursement option, Humana is addressing a frequent argument from health systems leaders that the current fee-for-service payment structure is a barrier to tackling patient social risk factors.
Other major for-profit commercial health plans are also interested in addressing social determinants of health, although it commonly occurs in the Medicaid managed care space. Healthy Blue, an Anthem managed care provider based in Louisiana, reimburses primary care physicians, OB-GYNs and behavioral health professionals for screening Medicaid beneficiaries for food insecurity and then referring them to local food banks. More than 1,640 providers opted into the program, according to an Anthem spokesman.
Unlike for-profit payers, many not-for-profit health plans already reimburse for social service screenings and referrals in the Medicare Advantage space, said Ceci Connolly, CEO of the Alliance of Community Health Plans. Financial incentives are aligned for these health plans to reimburse for such services because they are usually integrated with a health system or closely partner with one.
"Our community-based health plans have been doing this work long before it had a jazzy name or was a sexy topic," she said.
Humana approached Ochsner to participate in the new program given their interest in tackling social determinants of health, said Oraida Roman, vice president of value-based strategies at Humana, in an email.
As of January 2020, Ochsner has 38,835 Humana Medicare Advantage patients. This is the first contract Ochsner is participating in with a payer that will reimburse the system for screening patients for social determinants of health.
"We're pleased to deepen our value-based work with Humana in identifying and addressing critical drivers of poor health that occur outside of the doctor's office," said Dr. Philip Oravetz, chief population health officer at Ochsner Health, in a prepared statement. "This new program considers the impact of important factors that affect the well-being of our patients. It's an exciting development as we continue to adapt our approach to care to meet the comprehensive and diverse needs of the communities we serve."
Humana plans to expand the program to include other providers in the U.S. although there isn't currently a timeline for when that will happen, Roman said. Humana has about 2.4 million individual Medicare Advantage members who are treated by about 62,000 primary care physicians in value-based payment relationships with the payer.
Reimbursement for health systems will be determined by tracking member screenings, assessment findings, and external and internal referrals.
Humana will analyze the results from the screenings and use the data to help make strategic decisions in the future about how to address social needs, said Caraline Coats, vice president of population health strategy, in an email.
The program doesn't have involve any downside risk taking for providers.
"What we believe will happen through the program is that by addressing social determinants of health, health outcomes will be positively impacted, and that would mean greater compensation for the provider," Roman said.
