Health plans are adjusting to an aging population, accounting for growing rates of chronic illness combined with a high degree of social isolation and a strong desire to age in place. Set against a backdrop of a disappointing rate adjustment for 2025 and rising expectations for STAR ratings, health plans leaders must think creatively to successfully navigate an increasingly challenging environment.
But in many ways, the challenge is simple and well known: how do we create efficient, scalable ways to address the upstream drivers of health?
Loneliness, food insecurity, and transportation constitute the tip of the iceberg for at-risk populations, with data from the Pew Research Center and the University of Michigan shedding light on the pervasive nature of these challenges: 27% of adults aged 60 and older live alone, while 1 in 3 adults between the ages of 60 and 80 report feelings of isolation.
In a recent interview, Best Buy Health’s Chief Medical Officer, Ben Zaniello MD, MPH, discussed the ways in which social care represents a paradigm shift towards a more holistic approach to healthcare and how it can bring needed benefits to health plans.The retailer's Health business, grown primarily through acquisition since 2018, combines both curated and proprietary technology solutions with configurable services for healthcare organizations and consumers. Many of those services are delivered through in-house Caring Centers, which serve as support hubs, staffed by more than a thousand agents, including health coaches and licensed social workers. When a member experiences any situation that they need help with, they can press a button on their phone or PERS device to speak directly with an agent who will address their concerns, connecting them with local resources like food banks, transportation, and utility assistance. This combination of technology and human connection enables an accessible and scalable support structure.
The Growing Importance of Social Care in Regulatory Frameworks and Health Plan Success
Driving much of the growth of social care is the evolving regulatory landscape. Updates to STAR requirements and CMS’s Health Equity Index underscore the imperative of addressing disparities and ensuring unbiased assessments. Within this context, social care transcends being a mere “nice to have,” playing a vital role in supporting a health plans’ core needs.
Dr. Zaniello states, “The reason why social care is important to the health plan is that ultimately a health plan is responsible for the total cost of care. Their financial reimbursement, whether it’s their quality metrics or otherwise, is driven by how successful the care is.”
By addressing social determinants and fostering comprehensive support through technology, social care initiatives contribute to reducing high-cost utilization and promoting equity.
Leveraging Technology, Data, and Social Care for Equitable Access
While remote monitoring and other assistive technologies offer ways to better support members and reduce high-cost utilization, health plans must account for how their initiative will reach across the digital divide.
To this end, Dr. Zaniello emphasizes the importance of bringing the continuum of care directly into the home and including flexible tactics for supporting digital literacy. Additionally, utilization data underscores the pivotal role of social care in preventing high-cost utilization patterns, such as unnecessary emergency room visits, by addressing underlying social needs and providing timely interventions.
By connecting individuals with community resources such as housing assistance or transportation services, social care initiatives mitigate health disparities and can alleviate strain on healthcare systems. These services can improve clinical outcomes and contribute to STAR ratings and member satisfaction
Striking the Right Balance
“Health plans must figure out how to navigate the population health and social dynamics of the next decade. Our health systems already have capacity crises and both our fee for service and value equations must look upstream,” says Dr. Zaniello. “As we look across the continuum of care, the need for and benefits of addressing the drivers of health are clear. And meeting that need requires health plans to think locally and design for scale.” Striking that balance of scalable yet local capabilities, combining technology and human connection, is at the core of how Best Buy Health serves members and communities.