Targeting high-need beneficiaries in Medicare advantage: Opportunities to address medical and social needs

Issue: Serving Medicare beneficiaries with complex health care needs requires understanding both the medical and social factors that may affect their health.

Goal: Describe the prevalence and characteristics of high-need individuals enrolled in the Medicare Advantage program.

Methods: Analysis of the 2015 Medicare Health Outcomes Survey.

Key Findings: Thirty-seven percent of enrollees in large Medicare Advantage plans have high needs, requiring both medical and social services. Individuals with high needs are more likely to report having limited financial resources, low levels of education, social isolation, and poor health.

Conclusion: Federal policymakers should consider allowing Medicare Advantage plans to identify high-need beneficiaries based on their medical and social risk factors, rather than just medical diagnoses. Doing so would enable plans to deliver better-targeted services that meet their members’ needs and facilitate implementation of the CHRONIC Care Act provision that allows plans to offer nonhealth supplemental benefits.