People dually eligible for Medicare and Medicaid often experience more complex health issues and worse health outcomes than people eligible only for Medicare. These health disparities are often related to factors outside the health care system—including access to nutritious food, transportation, secure housing, social inclusion, and other social determinants of health (SDOH). To address SDOH, health plans serving dually eligible individuals may develop partnerships with community-based organizations (CBOs) to provide additional services, such as meal delivery, social engagement activities, and non-medical transportation.
Resources for Integrated Care, in collaboration with The SCAN Foundation, has developed a brief on key considerations for health plans interested in working with CBOs to address the social needs of their dually eligible members.
 U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. (2016). Social Risk Factors and Performance Under Medicare’s Value-Based Purchasing Programs. Retrieved from https://aspe.hhs.gov/system/files/pdf/253971/ASPESESRTCfull.pdf
 Artiga, S. & Hinton, E. (2018). Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity. Kaiser Family Foundation. Retrieved from https://www.kff.org/racial-equity-and-health-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/