CMS has signaled a renewed commitment to health equity with the introduction of the Health Equity Index (HEI), designed to motivate Medicare Advantage (MA) plans to identify and address disparities in care to members with social risk factors such as dual-eligibility, low-income, and disabled populations.   

The new HEI reward provides a unique opportunity for Medicare Advantage organizations to review their health equity strategies and align with the latest and upcoming legislative requirements. The CMS 2024 Final Rule provides a framework to help plans prepare. 

“I think we can all agree that CMS’s strategy to promote health equity and address social determinants of health is long overdue,” said Dina CEO Ashish V. Shah. “It’s great to see some policy focus around it.”

His advice to health plan leaders: prioritize health equity, embrace technology, and improve the member experience.

What is Health Equity?

Until now, there has been much talk about the need to remove the factors that hinder equitable health care access and delivery. To clarify its intent, CMS defined health equity as the attainment of the highest level of health for all people, where everyone has a fair and just opportunity to attain their optimal health regardless of race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, geography, preferred language, or other factors that affect access to care and health outcomes. 

What is the Health Equity Index?

One of the biggest opportunities to advance health equity is with the newly established HEI reward for the Star Ratings system. 

The HEI will replace the existing reward factor for earning Quality Bonus Payment (QBP) incentives. To earn rewards, MA organizations will need to focus on identifying populations with social risk factors and deploying interventions to eliminate barriers to care. The HEI reward is intended to encourage both Medicare Advantage Part C and Part D plans to improve care for members. 

When Does the HEI Go Into Effect?

HEI data will be collected during the 2024 and 2025 measurement periods for the 2027 Star Ratings (2028 payment year). All MA organizations are included in this rule, though only plans meeting the minimum threshold of beneficiaries with social risk factors are eligible for rewards. 

One immediate opportunity is to enroll and better serve beneficiaries with social risk factors, as current performance will impact Star ratings measured when the initiative takes effect.

Health Equity Index Timeline

Below is a timeline of when the HEI will start measuring social risk factor data, when it will impact Star Ratings and when CMS will eliminate the current Reward factor.

HEI data will be collected during the 2024 and 2025 measurement periods for the 2027 Star Ratings (2028 payment year).

Health Equity: Areas of Impact

Maintaining (or increasing) Star Ratings is an important strategy in the competitive MA market, as these ratings directly impact plan revenue. 

According to a simulation, CMS expects about 2% of contracts to gain one-half Star and 13% of contracts to lose one-half Star as a result of replacing the current system with the HEI. CMS expects this change to result in program savings of $670 million for the federal government in 2028, driven by a reduction in rebate dollars.

The actual impact of these rule changes on a given contract will depend on many factors, including risk scores, bid-
to-benchmark ratios, and the disparities in care between members with and without social risk factors, according to a Milliman report. However, the report recommends that all MA organizations evaluate the impact these changes will have on their contracts and consider adjusting their strategies for the 2024 and 2025 measurement years.

“To succeed under this new structure, Medicare Advantage plans will need to understand their vulnerable populations and deliver targeted, high-impact services to close the gaps that impact health equity,” said Shah. 

“In many instances, this means connecting to non-medical home-based partners and tapping into their observations to access really important insights around social, behavioral and functional health status that really can make a massive impact on outcomes.”

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