We’re living in an era that empowers active seniors. Gone are the days where sitting around an elder’s home and watching daytime television was a mainstay. Today’s seniors want to live their sunset years to the fullest — to be active, social, and independent. Countless surveys illustrate their desire to spend time with family, live in walkable neighborhoods, and wholeheartedly engage with their communities.
But they can’t accomplish these goals without support. To live long, healthy, and active lives, seniors need health plans that take their unique care needs into consideration — that look beyond their age and take their lifestyle, environment, and socioeconomics into account.
In other words, today’s retirees need health plans that address their social determinants of health.
What Are the Social Determinants of Health, and Why Do They Matter?
The social determinants of health (SDOH) is an umbrella term that encompasses all of the environmental factors and conditions that contribute to — or detract from — a person’s long-term wellbeing. As one writer for Healthy People describes, “Social determinants of health are conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”
Factors to consider might include a person’s access to public transport, healthy food, affordable housing, public safety, social services, medical care, education, and technology. Other conditions are societal — such as exposure to discrimination or pollution.
Here’s a quick hypothetical for illustration. Two women, Jane and Mary, are both 62 years old and reasonably healthy — but their social circumstances are very different. Jane is white, middle-class, and lives in a home that she owns. Her grocery store is only a quick walk away, and she has easy access to community services and engagement programs.
Mary, a working-class Black woman, faces a different situation. She rents a home in a neighborhood that is relatively safe but not particularly walkable. The nearest grocery store is a long and inconvenient bus ride away, and the only food options within easy walking distance are fast-food restaurants. Moreover, a growing trend of racism in her community has caused her intense stress as she navigates her community. Unlike Jane, she doesn’t have many local engagement programs — and might not feel comfortable accessing them even if she did.
Taken together, it becomes clear that despite their shared age and base health, Jane and Mary face very different pressures. It’s substantially easier for Jane to maintain her health, given her easy access to healthy food and resources. Mary, in contrast, faces an enormous amount of socially imposed stress, does not have ready access to healthy food, and cannot engage the resources Jane takes for granted. Unequal infrastructure and social circumstances place significant barriers in Mary’s efforts to maintain her wellbeing and thus leave her more vulnerable to adverse health events.
As researchers for a 2016 study wrote in PLOS ONE:
Overwhelmingly, studies find that non-medical factors including social, behavioral, and environmental determinants of health consistently play a substantially larger role than medical factors. Similar patterns hold for specific health outcomes, including burdensome, high-cost diseases such as heart disease, stroke, and diabetes.
Research suggests that social factors such as poverty, racism, and scarce resources account for up to 55 percent of health outcomes, contribute to increased emergency department utilization rates, and lead to higher care costs.
Given all of this, it’s abundantly clear that seniors won’t benefit equally from a one-size-fits-all health plan; they need a more inclusive and supportive approach.
Developing a More Thoughtful Approach to Senior Healthcare
It is within payers’ interests to develop health plan offerings that take enrollees’ SDOH into account. Doing so could significantly improve enrollee health, limit avoidable health events, and reduce the need for costly care. Moreover, research has demonstrated that engaging in interventions outside the usual bounds of “healthcare” (e.g., nutrition support, care coordination, community programming) can have “a positive impact in terms of health improvements or health care spending reductions.”
In light of such research, the Centers for Medicare and Medicaid (CMS) have begun exploring means to reform and improve their policies and practices to promote health equity. Medicare Advantage (MA), is leading this trend — one recent survey conducted by the Kaiser Family Foundation found that 91 percent of responding MA plans “reported activities to address social determinants of health.”
What, then, might these actions consist of? Every plan’s first step should be to critically evaluate their offerings and assess what they are (and aren’t) doing to facilitate equitable care. It’s important to note that this doesn’t mean providing a single solution to everyone. Instead, plan designers should consider the SDOH challenges faced by target populations when formulating new products and find new ways to close care gaps and eliminate access disparities.
Part of this process is, of course, understanding the community the plan serves. No two regions have precisely the same culture or challenges. Developing a nuanced, high-level understanding of local enrollee populations and their unique care needs is crucial for creating tailored and equitable healthcare solutions.
Researchers for the American Academy of Family Physicians frame this initial process as an investigation. As they wrote in a 2018 report on health equity: “What barriers do your patients face to living a healthy life? What resources do your patients have access to in their community? Demographic, environmental, and public health data can illuminate issues that your patients may not even know they face.”
By crafting customized, thoughtful Medicare Advantage products that genuinely understand seniors’ circumstances and care needs, health plans can bolster health equity, improve enrollee experiences, and boost their bottom line. Doing so is both a business and moral imperative — all seniors should be able to look forward to their sunset years, knowing that their health plan has their back.