4 Ways to Prepare for the CMS Health Equity Index

Changes to Medicare Advantage (MA) Star Ratings and the impact on health equity

MA Star Ratings are designed to measure and report on the quality of care across numerous clinical and experience metrics and give patients helpful information to consider when choosing a Medicare health or prescription drug plan. The Star Ratings also incentivize plans to continuously improve, as a higher rating signals a higher quality plan and carries significant financial impacts.

New MA Star Ratings signal that CMS is increasing its focus on health equity. For example, including a new health equity index (HEI) in the Star Ratings, designed to reduce disparities by identifying socioeconomic vulnerabilities, will incentivize health plans to improve care for members with certain social risk factors. Reward payments for the CMS HEI will be made in 2027 using data from the 2024 and 2025 measurement years. If health plans want to benefit from HEI incentives, now is the time to begin making changes.

Measuring What Matters: Health Equity

Everyone deserves equal access to quality healthcare services. Unfortunately, millions of Americans routinely face health disparities due in part to race, income, location, gender, or other social factors. Addressing these factors through a health equity lens can help organizations address inequities holistically. Changes to the Star Ratings indicate that CMS is building accountability by investing its money (and its stars) where its mouth is.

With an increased emphasis on health equity and added difficulty in obtaining high Star Ratings, here are 4 things health plans can do to prepare for 2024 and beyond.

1. Collect demographic data.
   First, take the time to understand how your plan will be measured and make sure your internal data evaluation practices are in place. The goal is to improve the overall health of your patients, so be sure you are collecting actionable data that can be used to make decisions year after year. Demographic data is a critical place to start. Establishing data management programs to collect information from a variety of sources, such as self-reported, publicly available, purchasable, and non-traditional partnerships, can help fill in missing data and paint a more holistic picture of your community. Collecting race, ethnicity, and language (REaL) and sexual orientation and gender identity (SOGI) data will develop a better understanding of your members. Disaggregating data can also help create short and long-term interventions tailored to individuals and unique sub-populations.You can then use this data to understand where you should direct resources and offer accessible care options

2. Meet your members where they are.
   Consider the factors that may impact healthcare utilization, like social determinants of health, social and community context, and trust in the healthcare system. Meeting your members where they are is an important healthcare quality improvement initiative. Rather than expecting your members to travel to a traditional brick-and-mortar healthcare facility, think creatively about how to provide necessary services to historically underserved populations. Partnering with established community-based organizations or Federally Qualified Health Centers (FQHCs), participating in local health fairs, or contracting with facilities closer to where your patients live are great ways to build relationships and trust.

3. Build better pharmacy coordination.
   Pharmacy-based clinical measures are assessed for the entire calendar year. Improve your care coordination with an integrated Rx program so that your organization can seamlessly follow up with your members to ensure medication adherence and refills throughout the year and troubleshoot if they need financial support or require medical attention. To get started, ask the right questions to evaluate your current pharmacy performance. Which specific medications are being prescribed the most? Where are members obtaining their medications from? Do you already have a way of measuring medication adherence? Do members have access to pharmacy technicians to support any concerns? Is it difficult for members to pay for medications—how would you know?

4. Continuous engagement with your members.
   Treat every interaction with your members as an opportunity to know more about them. Verify REaL information and ensure the members have health plan language-specific resources for each member. Ask members if they live alone, need transportation, or have a social support system. If they are new to your plan, use a welcome call to ask and learn about their needs. Understanding member’s comfort with your plan’s benefits and access to care will go a long way toward establishing trust and building a relationship. Continue to have conversations and assist with care coordination throughout the year. This is especially important for members with multiple comorbidities who require follow-up care, those who have been delaying care, or those who should be refilling their medications later in the year. Remember, this is a two-way conversation. Share information, listen to what your members have to say, and have infrastructure in place to tailor care to meet their needs.

Is your health plan ready to prioritize health equity?

The next three years will see even more changes in the MA Star Ratings as CMS works to prioritize health equity and access to quality care. To meet the needs of your members and participate in incentive payments, look at your data, remain agile, and develop action plans to establish short and long-term interventions tailored to your population.

If these recommendations are helpful and you’d like to learn more about developing healthcare plans and programming to improve your Star Ratings, we’d love to hear from you. Our experienced health equity consultants can help you and your organization gain invaluable expertise to support your projects in all the right ways and achieve the right results right away.