How Medicare Advantage plans use data for supplemental benefits decision-making

Area of Science:

• Health Services Research
• Health Policy
• Social Determinants of Health

Background:

• Health care payers are increasingly addressing social risk factors.
• The Bipartisan Budget Act of 2018 enables Medicare Advantage (MA) plans to offer non-health-related supplemental benefits.

Purpose of the Study:

• To explore the decision-making processes of MA plans regarding new social risk factor benefits.
• To understand how MA plans utilize data to inform the expansion of supplemental benefits.

Main Methods:

• Qualitative analysis of semistructured interviews with MA plan leadership.
• Combined data from 2 studies involving 63 representatives from 29 MA plans.

Main Results:

• MA plans use diverse data sources for benefit targeting.
• Evidence gaps impede the expansion or introduction of new supplemental benefits.
• Some plans conduct internal research and quality improvement to enhance benefit effectiveness.

Conclusions:

• MA plans face challenges in data collection, generation, and analysis for social risk benefits.
• Interoperability of data sources and shared learning are crucial.
• Narrowing evidence gaps is essential for designing effective social care interventions.