Congress remains in session on Capitol Hill this coming week. Sixty years ago this week, on September 28, 1959, the Federal Employees Health Benefits Program was enacted into law.
This coming week is National Health IT Week. The themes are Supporting Healthy Communities and driving transformation of our health and wellness ecosystem to promote better health outcomes and health equity.
The Robert Wood Johnson Foundation has updated its Culture of Health Action Framework which it introduced in 2015.
Since 2015, what do the data tell us about our progress in creating a Culture of Health in America? We are seeing small but positive changes in the appreciation of the social determinants of health and the need for broader community health investments. However, there has been less movement in many of the structural and systems-level factors that critically influence health, well-being and equity.
In that regard, Fierce Healthcare reports
The Centers for Medicare & Medicaid Services (CMS) recently finalized new flexibilities to allow MA plan sponsors to offer nontraditional benefits that target the social determinants of health such as air quality tools, transportation and meals for the 2020 plan year. CMS broadened those options beginning in the 2019 plan year.
Researchers at the Urban Institute conducted a series of interviews with MA insurers, health insurance experts and social services providers that highlighted several barriers to embracing benefits that target the social determinants of health: funding challenges and struggles in targeting the right beneficiaries. * * *
As CMS did not allocate additional funding for these benefits, health plans are stuck with limited financial resources to try supplemental benefits, the report noted. To pay for supplemental benefits, MA plan sponsors must pull from rebates CMS pays out to make up the difference between an insurers’ bid and the national benchmark, if the bid is below that marker.
However, these rebates are often small, averaging about $107 per member per month in 2015, according to the study. Additionally, insurers pull from these funds for other efforts to lower cost-sharing or to cover benefits such as dental and vision care or gym memberships, which are popular with beneficiaries.
Quite a conundrum.