Earlier this week, CMS released the 2025 MA Advance Notice seeking feedback on potential future changes to the administration of Medicare Advantage. There are significant implications to this year’s advance notice, which are being covered extensively elsewhere. Here, I will confine my reactions to the parts with implications for the future of social care in Medicare Advantage. Of late, CMS has demonstrated a consistent drive to more thoroughly integrate what is widely referred to as social drivers of health (SDoH) – we prefer just social care – into the Medicare Advantage program broadly and, more specifically, into the foundation of the Star Rating process. This latest Advance Notice continues and advances that trend.
In it, CMS notes that they are adding the Social Needs Screening and Intervention Measure developed by The National Committee for Quality (NCQA) as a display measure for 2025 Star Ratings. In addition, NCQA is “exploring the addition of a utilities insecurity screening rate and intervention rate to the Social Needs Screening and Intervention measure for measurement year 2026.” The inability to pay for utilities, including heat, electricity, and communications, is a significant challenge among the Medicare Advantage population. Accordingly, we at BeneLynk applaud this addition and are encouraged by CMS’s commitment to integrating social needs screening and interventions into the Star Rating programs. Medicare Advantage members who face utility payment challenges have many options available to help meet this challenge – from the LIHEAP programs to the federal Lifeline program to hundreds of state and local benefits. As with so many social care barriers, the biggest challenge lies in systematically identifying these barriers and then giving MA members the information needed to access the social programs to overcome barriers.
In the Advance Notice, CMS further notes that NCQA is developing a new measure for screening members for social isolation, loneliness, or inadequate social support and how frequently those members who screened positive received a corresponding intervention. These measures would be reported using the HEDIS Electronic Clinical Data Systems (ECDS). Again, BeneLynk strongly supports the commitment to increase the measurement of and intervention to address a social barrier. Social isolation, loneliness, and inadequate social support can be some of the most difficult challenges to address, but they can also be some of the most important. As Surgeon General Dr. Vivek Murthy said last year when he declared loneliness a public health epidemic, widespread loneliness in the U.S. poses health risks as deadly as smoking 15 cigarettes a day. As pernicious as loneliness and social isolation are, there are impactful programs available that can make meaningful improvements. Offerings from the local Area Agency on Aging or YMCA/YWCA have been shown to significantly improve these challenges. For veterans -- who represent approximately 22% of the Medicare Advantage population and who are three times more likely than the non-veteran population to be socially isolated or lonely -- the Department of Veterans Affairs has unique offerings that should be more widely utilized to bring veterans out of their homes and into the larger veteran community. The resources are there to make a real impact on loneliness and social isolation.
One of the most valuable contributions of the CMS proposed rule is that it provides an outlet for CMS to offer guidance on what it is prioritizing and where it is moving. As has been the case in many CMS communications of late, it is clear that the systematic capture of and intervention to address SDoH barriers is a priority for CMS. It is also clear that in the near future, Medicare Advantage plans will be measured and compensated, in part, by their ability to document and address these social care opportunities.
At BeneLynk, we are proud to help our clients systematically document and address these and other social care challenges. For clients with the Community Lynk+ component of our One Lynk services, we capture social care barriers and in the same conversation, work with the member to develop a plan to meet these challenges using available social care benefits. The results of these engagements are communicated in a manner that is easily understood (e.g., narrative description) and definitively analyzed and measured by CMS/NCQA using LOINC (question), LOIC Answer (response), SNOMED (intervention), and ICD-10 Z-codes.
As CMS continues the push to value and prioritize social care in managed care, it is vital for Medicare Advantage plans to have a robust program in place to not only capture but efficiently and immediately address SDoH barriers. At BeneLynk, we are excited to help our MA clients meet this need and, most importantly, help millions of MA members live their healthiest lives. If you want to learn more, drop us a note at Sales@BeneLynk.com.
About the Author
Sean Libby is the President of BeneLynk, the nation’s leading social care company serving members of government-sponsored health plans, and has been an advocate for older Americans, people with disabilities, veterans, and individuals with low income for over 20 years. At BeneLynk, we are committed to helping managed care plans to deliver superior social care solutions to their members.