posted by Rashi Venkataraman, AHIP Executive Director, Prevention & Population Health
on June 6, 2019
“Our background and experience are really as a social service agency,” noted Eve Gelb, Senior Vice President of Healthcare Services for SCAN Health Plan. “We got into health insurance when we were chosen to take part in the federal Social HMO pilot. So, addressing the social determinants of health has always been the primary focus for us as we serve not only our plan members, but seniors in the community at large.”
The not-for-profit health plan was founded in 1977 in Long Beach, Calif., where it has a long history of providing comprehensive benefits to meet the needs of its more than 200,000 Medicare beneficiaries through Special Needs Plans (SNPs) and Medicare Advantage (MA).
The health plan has invested heavily in care management services to help members navigate their benefits, especially those dually enrolled in both Medicaid and Medicare (D-SNP). Within 90 days of enrolling in the plan, each D-SNP member receives a welcome call from a SCAN care manager, who provides education and support, assists with care coordination, and completes a health risk assessment. This screening helps identify social and health care needs and informs the overall plan of care.
In addition to information related to a member’s functional status, physical health, cognitive status, and chronic conditions, the health risk assessment focuses on social, cultural, and environmental factors. For example:
These social determinants help the care manager understand what barriers to good health the member may have and what challenges they may face in getting needed care and services.
Using a standardized assessment for all newly enrolled members gives SCAN a whole-person view of its members, so solutions can be tailored to their unique needs. For example, the health plan recognized that fall prevention was a need for some of its members, so it designed and began offering the Home Advantage benefit in 2019. Members with this benefit receive in-home visits from an occupational therapist who designs a safety plan for the member and works with local contractors to procure any necessary home modifications.
Being able to target the right programs to the right people is key.
“Knowing the needs and life goals of our members helps facilitate meaningful interventions,” said Gelb. “Screening like this takes time, but if it helps us to better target our interventions and ultimately improve health outcomes, then it’s the right thing for us to do.”