500x315 Health Plan Index
Food insecurity is always a SDOH for health plan members, but in the pandemic environment, the situation has worsened.
Nov 9, 2020

Social Determinants Outweigh Even COVID-19 As A Top Challenge For Health Plans

Broad Industry Survey Reveals Food Insecurity Now The Top Concern

(RESTON, Va. – Nov. 9, 2020) – Altruista Health today released survey results on the current top challenges and concerns of health plan leaders and how they are preparing for 2021. The annual Altruista Health Payer Index Survey Report reveals that payers’ top challenge is “managing and predicting Social Determinants of Health (SDOH)” among members. They report this challenge outweighs even their overall response to COVID-19. Several of the 177 survey respondents said the true depth of SDOH needs is unknown and that many providers do not code for SDOH.

“We have good information about people who have already ‘fallen off the cliff,’ but don’t have as many indicators about who is close to falling or how many there are,” one respondent wrote.

Social determinants of health have been a top concern for plans for some time, but the mix of needs has changed under recent conditions, according to 58 percent of respondents. When asked to select the SDOH that most impact their populations in general, respondents selected transportation, food insecurity and housing. In recent months, however, food has become the top issue.

Cross-Section of Plans Rank Top Challenges

The Altruista Health 2020 Annual Payer Index Survey was fielded in August using independently curated lists of health plan leaders as well the membership rolls of three health plan associations. Seventy-two percent of participants serve in director-level roles or higher within their organizations.* The survey included questions about both pre-pandemic and current pandemic conditions.

Plans were asked to rank their challenges from a list of prominent industry issues. Following SDOH, plans rated the following in order of challenge: the “21st Century Cures Act as is applies to interoperability” the “overall response to COVID-19,” “impacts to their plan’s business operations” in the current environment, and the “disruption to member rolls because of economic issues.”

Confidence Meeting Other Challenges

Ninety-five percent of respondents expressed some degree of confidence their plans would be able to meet new regulatory requirements governing interoperability. Nearly half said “time” was the biggest obstacle to doing so.

“COVID-19 has forced health plans to become much more reactive,” said Munish Khaneja, MD, MPH, FACP, Altruista Chief Medical Officer and Lead for Clinical Innovation. “The next set of deadlines is always top of mind. From talking with people in the industry, I don’t think there’s a lot of focus on how the CURES Act fits into a health plan’s long-term strategy, although the leadership is definitely concerned about the deadlines the regulatory agencies have set.”

Respondents also expressed confidence that even with the overall challenge of COVID-19, ranked as the third most challenging issue, they feel they are prepared for a next wave. Sixty-one percent said they are prepared, with another 37 percent reporting they are “planning now.”

Disruptions To Care And Enrollment

In other pandemic-related questions, survey respondents noted lapses and delays in care like “a notable decrease in vaccinations” and patients “not seeking care for emergency events like stroke.” Open-ended questions revealed that plan leaders believe it’s too soon to assess longer-term impact to health outcomes.

In other membership trends, plans noted significant movement to Medicaid. Other research supports that these rolls are swelling, in part because members are not being disenrolled under the public health emergency regulations. Nearly half of plans said they will expand outreach and education during open enrollment because of the current environment.

The Landscape Ahead

Health plans were asked to make predictions about the future of telehealth/telemedicine, care management and utilization management. There was strong agreement there is constant evolution toward value-based care. The pandemic has given sudden traction to telehealth/telemedicine that opens opportunities.

“This is a disruptive time and plans should seize the opportunity to be creative, especially during the post-election lame-duck session, no matter who is in office in January,” said Mike McKitterick, RN, Altruista’s Executive Vice President of Clinical Services. “I can’t imagine government waivers around telehealth going away right now or in the foreseeable future, so this is a good time for health plans to get creative and demonstrate the value of these technologies.”

Respondents indicated care management and utilization management are always evolving and will continue to become “smarter” and more efficient as targeting, management and automation improve.


About Altruista Health

Altruista Health delivers care management and population health management solutions that support value-based and person-centered care models. Its GuidingCare® technology platform integrates care management, care coordination and quality improvement programs through a suite of sophisticated yet easy-to-use web applications. GuidingCare is the largest and most widely adopted platform of its kind in the United States. Founded in 2007 and headquartered in the Washington, D.C. area, Altruista Health has grown into a recognized industry leader, and was named twice as one of the Top Population Health Management Companies to Know by Becker’s Healthcare. Health plans and healthcare providers use GuidingCare to transform their processes, reduce avoidable expenses and improve patient health outcomes.

*About the Survey

The Altruista Health Payer Index Survey was conducted in August 2020 and emailed to an independently curated list of plans, as well as the member plans of the Association for Community Affiliated Plans (ACAP), the Alliance of Community Health Plans (ACHP) and the SNP Alliance. Sixty-five percent of respondents work in plans serving 100K members or more. Among 177 respondents, 72 percent are in director-level roles or higher, with 57 percent of respondents in clinical quality/compliance or operational roles. There was well-distributed geographical representation among respondents across the contiguous United States. Plan types represented among respondent organizations included commercial (large group, small group, individual), Medicare Advantage, Marketplace, Medicaid, D-SNP or MMP and MLTSS.


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