The 2020 Opportunity: Medicare Advantage as a Market for SDOH Innovation

Starting in 2020, Medicare Advantage plans will be allowed to offer supplemental, “non-primarily health-related” benefits to help certain eligible chronically ill patients with unmet social needs. Put simply, this represents a large source of reimbursement for social determinants of health (SDOH) solutions in the high-growth MA market.

While this represents a real opportunity for SDOH innovators, we are at an early stage of the rulemaking process where there are far more questions than answers. The Centers for Medicare and Medicaid Services (CMS) recently issued a draft CY 2020 Call Letter that provides guidance on the new rules.

Making the Sausage: MA + SDOH = SSBCI

There are actually two new, and slightly different updates to the supplemental benefits provision under MA. In 2018, CMS announced they would expand reimbursements starting this year (2019) in the MA program for non-clinical supports that promote the health of chronically ill beneficiaries who meet certain eligibility criteria.

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