Most Medicare Advantage plans now offer a number of supplemental benefits (Dental, vision, OTC, fitness, transportation, etc.) to attract more enrollees and reduce the need for more costly medical services. Despite the explosion of supplemental benefits, the utilization of these benefits remains very low and there is not enough evidence to support the ROI.

When asked, the plans reported significant challenges in conducting a cost-benefit analysis, including:

  • Limited utilization: The utilization of these benefits remains very low, which makes it harder to determine the true value at this point. The benefits are not well-targeted. Often you will see options such as transportation benefits in zip codes where the beneficiaries don’t have such needs.
  • Data availability: Most providers offering supplemental benefits are not sharing data. The lack of encounter and utilization data makes it difficult to conduct a thorough cost-benefit analysis.
  • Lack of standardization: When the data is available from providers, it is often inconsistent. There is a lack of standardization in the way each provider is sharing their data, making it difficult to compare them.
  • Lack of integration: For members availing supplemental benefits, health plans need medical and claims data to determine the ROI. Most health plans don’t have the infrastructure to ingest medical data in a meaningful way.
  • ROI period: Many supplemental benefits such as fitness, meal, and transportation benefits help members over the longer time horizon. In other words, more time is needed to determine the overall impact.

Despite these challenges, the cost-benefit analysis is still an important tool for evaluating the value of Medicare Advantage supplemental benefits. By using a combination of data sources, and considering the specific population and context, it is possible to get a better understanding of the costs and benefits of these services and to make more informed decisions about their use.

Sprite Health provides the technology platform to improve utilization and measure the ROI of supplemental benefits:

  1. Our interoperable data hub unifies and standardizes claims, medical records, and social data from community providers to create a single-member view. This provides the foundation to build the right analytical models.
  2. Our health navigation module improves the utilization of these benefits by meeting members where they are and empowering them with information and guidance on the benefits they need at that point in time. By using data analysis, it creates patterns of utilization and identifies areas where additional education and outreach efforts may be needed.
  3. The integrated care management module makes it easy for providers to understand what benefits are available to their patients and also enables easier coordination with community-based providers.
  4. The system continuously monitors and evaluates the utilization and the impact of the benefits, to identify areas where changes can be made to improve the ROI.
  5. The integrated reporting and live dashboards bring all the pieces together—claims, utilization, benefits operations, program engagement, and member touch points to help health plans better spend their time thinking through the insights and next steps, instead of piecing together information.

If you are a health plan offering supplemental benefits, connect with us to learn how we can help you improve the utilization of these benefits and provide you insights into which one of these benefits is driving lower medical costs.