A Past President’s Reflection: Why Value-Added Benefits Matter

By: Shannon Dowler, MD, CPE, FAAFP

Dr. Shannon Dowler is a past NCAFP president and current member of the American Academy of Family Physicians Board of Directors. From 2019-24, she served as the Chief Medical Officer of North Carolina Medicaid. Her long-time experience as a family physician and policy leader includes advancing rural primary care, access to care, and sexual health.

When I joined the NC Dept. of Health and Human Services (NCDHHS) as the Chief Medical Officer of Medicaid in 2019, it was with the intention that if we had to move to Managed Medicaid, then at least I would help guide the direction. I looked for silver linings in the early days, and one thing I was able to latch onto was the ability of Managed Care plans to provide specific benefits to members that a traditional Medicaid program could not. These are known as “value-added benefits” (VABs). These VABs are offerings that serve to improve the health of members and range from covering the cost of a GED, paying to expunge a legal record, covering an electric bill, providing a breast pump, or supplying a visa card to help patients achieve their preventive health goals, like a mammogram.

Compared to other states, North Carolina’s design for Managed Card gives plans a very narrow lane to compete for members. Medicaid Members have the ability and right to choose their health plan. In a competitive market, finding creative ways to serve members is paramount, and VABs are one wat members can differentiate between plans.

Some skeptics might say, “the plans don’t want to provide them because of the cost,” and I disagree. In our unique market, any money spent on VABs is a great investment for the plans in three distinct ways:

1. It offsets their Medical Loss Ratio.
2. Offering the “best” benefits makes the plans competitive.
3. These offerings build trust and confidence in their brand, so that members are more likely to engage in care management and other supports that improve their health.

These findings are consistent with other states: despite plans having positive and beneficial benefits, most members never access VABs. Unlike medications or durable medical equipment, receiving VABs is not in the hands of the prescriber; rather, members must call or click on a link to get most benefits.

Through my work with Nurture NC, a state-wide maternal and infant health collaborative, we are driving awareness of VABs in partnership with the standard plans through awareness efforts that include social media campaigns, one-pagers, wall charts for offices, and patient brochures to let health care teams and lay audiences understand these benefits and to increase their utilization. At a time when heating, food, and housing costs are stretching household budgets, providing these supports and resources has never been more important.

Please go to www.nurturencnow.org, where we maintain up-to-date perinatal VAB;s under the Resources tab. And watch out for more comprehensive materials for your office! While you don’t “prescribe” these benefits, your care teams can help families access these much-needed supports. Importantly, if you have recent experiences where members cannot access the benefits or VABs fail to serve their intended purpose, we hope you and your patients will be “secret shoppers.” Contact us through the website and share your experience, so that we can help the plans optimize this important — but often missed — benefit!