Health plans understand the importance of reducing disparities in the care their members receive. However, with competing priorities that drive revenue, it may be difficult to find the funding to invest in health equity. But with the right positioning, health equity can remain a top priority.
For those advocating for health equity initiatives in the budget, frame the return on investment for health equity initiatives to adopt the same approach as the Centers for Medicare & Medicaid Services (CMS). Use Star Ratings as the accountability structure and the catalyst for change.
Medicare Advantage plans who do not invest now will be at a competitive loss with future Star Ratings and quality bonus payments. Plans should be seeking to:
- Understand why vulnerable populations are not engaged in their health care through analytics, predictive modeling, and member sentiment.
- Solve the underlying issues creating health disparities through innovative product design and programs.
- Effectively remove barriers to care and provide members with the support they need to promote long-term healthy outcomes.
CMS will replace the Reward Factor with the Health Equity Index (HEI) in the 2027 Star Ratings. CMS released two years of risk stratified HEDIS and CAHPS data for Limited Income Subsidy and disabled members. These moves from CMS indicate that plans must do better at connecting vulnerable populations to quality care from providers and health plans.
CMS is intentionally using health equity to drive the competition for coveted quality bonus payments. Those who do not quickly adapt will be on the losing side, making it more difficult to offer competitive benefits to grow and retain membership.
To start investing in the highest impact areas:
- Scrutinize the risk-stratification tables from CMS and supplement with all data sources you may have to better understand where members are experience inequities.
- Create quality improvement projects for lower performing measures to get the right members the care they need in the vital last months of the year.
- Model out HEI impact in your Stars dashboards and review with leadership to outline the return on investment for a path to health equity.
- Rapidly expand and enhance member data collection, especially in race, ethnicity, and language.
- Modernize your Health Risk Assessment (HRA) strategy to reach every member through their preferred communication channel preference, add questions on Social Risk Factors and send pulse HRAs throughout the year to quickly check-in with members, direct them to the care they need and quickly resolve issues.
Healthmine’s expert consultants have decades of experience in Star Ratings, Medicare Advantage and health equity, and can provide recommendations for plans seeking the right path forward in implementing health equity strategies. Connect with Kimberly Swanson to find out more.