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Veteran Status: An Under-Recognized Social Determinant of Health in Medicare Advantage

A recurrent theme in the Managed Care Industry is the importance of understanding not just the member’s health status, but the broader factors impacting the member’s lifelong health and healthcare. A member’s “social determinants of health” are an increasing focus for managed care plans, as the MCOs recognize that socio-economic status and historical access to care impact current healthcare needs. In the Medicare Advantage (MA) world a broad and persistent gap in information available to MA plans remains. According to data from the US Census Bureau, approximately 23% of Medicare Advantage members are veterans of the Unites States Armed Forces. These members have had unique life experiences and are subject to different prevalence of a wide variety of medical and behavioral health conditions. Currently, the majority of Medicare Advantage plans have no systematic understanding of who within their population are veterans. The ability to identify, engage, and communicate with both the veteran members and their VA facility requires a unique understanding and comprehensive, systematic approach.

Further, according to the Journal of the American Medical Association, 8.3% of the overall Medicare Advantage population were enrolled in Veterans Health coverage through the Department of Veterans Affairs (VA). And over 60% of this population accesses VA healthcare in a given year. In other words, 5% of a Medicare Advantage population receives some care at a VA facility each year. However, since there is no coordination of benefits between the VA and Medicare, this care is invisible to Medicare Advantage plans. So 5% of all Medicare Advantage members receive medical care that is not systematically communicated to the plan!

This invisible care prevents MA plans from documenting all the medical condition that members have. It hinders the ability to meet the requirements of HEDIS measurements and can adversely impact Star Measures. Finally, it prevents MA plans from performing their fundamental mission of providing excellent, coordinated medical care to Medicare recipients. As our healthcare delivery model continues to evolve, we learn more and more about the importance of understanding the whole patient. Medicare members who have served our country have access to a wide array of healthcare and other benefit programs, most notably services from the Department of Veterans Affairs. Finding this population and building a communication bridge is the first step in delivering optimal healthcare to our nation’s veterans!

BeneLynk provides services to help Medicare Advantage plans identify, communicate with, and understand the veterans in their population. We recognize veteran status as an important social determinant of health. Learn more about us at

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