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Social determinants of health (SDoH), such as food insecurity and lack of access to transportation, have profound impacts on patient health and healthcare spending. Food insecurity, defined as the lack of consistent access to enough food for an active, healthy life, is linked to higher rates of chronic diseases like diabetes and hypertension. According to Feeding America, food-insecure individuals incur an average of $1,800 more in medical costs annually than those with adequate food access (Feeding America, 2022). Similarly, transportation barriers can prevent patients from attending medical appointments, leading to delayed care and worsening health outcomes. The National Academies of Sciences, Engineering, and Medicine report that transportation issues result in missed or delayed medical appointments for 3.6 million people each year (National Academies, 2021). For health plans, these SDoH factors not only elevate healthcare spend but also impact patient satisfaction and increase overall risk burden.

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The Centers for Medicare and Medicaid Services (CMS) have recognized the critical role SDoH play in patient health outcomes and healthcare costs. In 2023, CMS extended the Value-Based Insurance Design (VBID) model from 2025 to 2030 and is introducing measures to more fully address health-related social needs of patients. In the third phase of the model, which will begin in 2025, Medicare Advantage Organizations (MAOs) would be required to offer supplemental benefits to address health-related social needs in at least two of three health-related social areas: food, transportation, and housing insecurity and/or living environment (CMS, 2023). This regulatory shift underscores the importance of comprehensive care approaches that go beyond traditional medical services. By addressing social determinants, health plans can reduce unnecessary hospitalizations, improve patient adherence to treatment plans, and enhance overall population health. This proactive stance is expected to lead to better health outcomes and lower healthcare costs, ultimately benefiting both patients and plans.

To effectively address these issues, health plans can take several strategic steps, such as partnering with third-party vendors that specialize in addressing food insecurity through meal planning, food delivery, and food-as-medicine programs. These partnerships can ensure that patients receive nutritious meals tailored to their health conditions, thus improving their overall health and reducing medical costs. Moreover, food delivery services can mitigate the impact of transportation barriers by providing direct access to healthy meals for those unable to travel. By integrating these solutions, health plans can meet CMS mandates, enhance patient satisfaction, and lower their risk burden. Embracing these innovative approaches not only aligns with regulatory requirements but also fosters a healthier, more engaged member population.

Learn how to partner with us to continue helping foster a healthier population by contacting a Michael Best representative.

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Addressing Social Determinants of Health

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