A recurrent theme in managed care is the importance of understanding not just the member’s medical conditions, but the broader factors impacting the member’s lifelong health. A member’s social determinants of health (SDoH) drive up to 80% of health status. Often the phrase “social determinants of health” serves as another way of saying low-income. However, at BeneLynk we think of the social determinants of health more broadly as an individual’s life story – both past and present. Sometimes, an individual’s story involves service in the United States military: a defining life experience. Military service is a meaningful part of a Veteran’s identity, a piece of their healthcare puzzle, and a keystone to a wide variety of benefits available through the Department of Veterans Affairs (VA) and other sources. This context impacts the way that members access healthcare and, more importantly, how to engage them in meaningful discussion.
Identifying Veteran Populations
According to data from the U.S. Census Bureau, approximately 22% of Medicare Advantage (MA) members are Veterans of the United States Armed Forces. These members have had a unique life experience – one that can increase the prevalence of a wide variety of medical and behavioral health conditions. Currently, the majority of MA plans have no systematic understanding of who, within their population, are Veterans. The ability to identify, engage, and communicate with both the Veteran members and their VA facility requires a unique understanding and comprehensive, systematic approach.
Understanding Veteran Healthcare at the VA
The Veterans Health Administration is America’s largest integrated health care system providing care at 1,293 health care facilities (including 171 medical centers and 1,112 outpatient care sites of varying complexity) and serving 9 million enrolled Veterans each year. According to the Journal of the American Medical Association, of the 29 million Medicare Advantage members, 8.3% were enrolled in Veterans Health coverage through the Department of Veterans Affairs. Over 60% of this population accesses VA healthcare each year. In other words, 5% of the Medicare Advantage population receives some or all of their care at a VA facility each year.
The Challenge: Care Coordination Between the VA and MA
For many Veterans, the VA provides care at little to no cost. Many Veterans begin using the VA upon separation from the military and build a long-standing relationship with providers there. When these Veterans become Medicare eligible, many choose to follow the guidance of both CMS and the VA in maintaining both coverages. Since there is no coordination of benefits between the VA and Medicare, VA care is invisible to Medicare Advantage plans. This invisible care prevents MA plans from documenting all of the member’s medical conditions. These members often look like healthy non-users, but their lack of engagement might impact retention, participation in care management initiatives to improve their health, and your ability to accurately capture HEDIS measurements. This gap can adversely impact Star Measures and prevent MA plans from accurately reflecting the appropriate risk score for these members. Finally, it prevents MA plans from performing their fundamental mission of providing excellent, coordinated, medical care to Medicare recipients.
The Value of Understanding All Member Care
As our healthcare delivery model continues to evolve, we learn more about the importance of understanding the whole patient. Medicare members who have served our country have access to a wide array of healthcare and other benefit programs — most notably services from the Department of Veterans Affairs. Finding this population, getting them to engage with your plan, and building a communication bridge is the first step in delivering optimal healthcare to our nation’s Veterans.
Veterans Helping Veterans
At BeneLynk, we conduct outreach to identify Veterans through live-agent conversations with advocates located entirely within the United States. We recruit heavily within the Veteran and military spouse communities. In addition to knowing that this is an excellent labor pool from which to draw, we have found that shared life experience leads to a strong connection and builds trust between our advocates and members.
BeneLynk recognizes Veteran status as an important social determinant of health. We provide services to help MA plans identify, communicate with, and better serve their Veteran members. We go the extra mile by retrieving documentation of VA care directly from the VA. From there, we can link members with a wide array of Veteran-specific benefit programs to help them meet any challenges they may be facing. We are committed to serving Veterans and helping MA plans find and connect their Veteran population with the benefits they deserve.
The editorial staff had no role in this post's creation.