The Centers for Medicare and Medicaid Services (CMS) has made it clear that health equity is a high priority. Achieving that goal means reducing health disparities and ensuring the opportunity to achieve the “highest level of health for all people.” Among CMS’s new equity-focused initiatives is the Health Equity Index (HEI) reward. Finalized in the 2024 Final Rule, the HEI will replace the current Reward Factor in the 2027 Star Ratings (measuring performance in 2024 and 2025). In implementing the new Health Equity Index reward, CMS hopes to incentivize Medicare Advantage plans to focus on improving health equity among enrollees with social risk factors (SRFs). Currently, the cohort of members with SRFs are members who are dually enrolled, receive the Low-Income Subsidy (LIS), or who became eligible for Medicare due to disability.
- “Dual Eligible or Dual” refers to members eligible or enrolled in Medicare and Medicaid.
- “Low-Income Subsidy” is a federal program that helps pay out-of-pocket drug costs.
The HEI will provide plans with extra points in their overall Star score when they achieve higher equity among these populations for select Star measures, driving a health plan’s ability to maintain or improve its Star ratings.
What Can Your Plan Do to Prepare?
Leverage your data.
Data is crucial for the identification of all LIS/dual and disabled members within your health plan. This means understanding who within your population currently meets the definition of SRF, but also understanding who could be newly enrolled in dual/LIS benefits and therefore be added to the denominator. Using the information from your monthly files from CMS or employing vendors that specialize in dual enrollment and Medicaid retention, organizations can identify those members who are eligible for dual or LIS benefits, but not yet enrolled, or those who need help maintaining their Medicaid/LIS benefits. This approach involves systematically analyzing enrollment records and other pertinent information (such as member demographic information, member condition profile, and other socioeconomic factors) to predict which individuals might qualify for LIS and dual eligibility. New dual/LIS advocacy not only enhances the accuracy of beneficiary identification but also ensures that you are getting paid accurately for the risk of your members. By growing the denominator of members with SRFs health plans can optimize their Health Equity Index participation.
Ensure information systems and data sources are collecting/storing data.
Ensuring that IT systems and data sources consistently capture, collect, and store member-specific demographic data, including race, ethnicity, language, and sexual identity/orientation, is a critical step toward addressing healthcare disparities and attaining health equity. By systematically gathering this information, health plans can gain a deeper understanding of their member populations, which is essential for tailoring interventions that can positively impact your plan’s HEI score and your chances of receiving the HEI reward. CMS will likely expand its list of social risk factors that will be included in the Health Equity Index in the years to come. We anticipate members with SDoH barriers generally being categorized as having SRFs. Successfully collecting and storing pertinent member information will be paramount for a health plan's ability to score highly on the HEI in the future.
Retain/attract dual members.
Retaining and increasing your dual/LIS members is not only a matter of ethical responsibility but also a strategic imperative. By retaining dual eligible members, plans can ensure consistent revenue streams, achieve better risk adjustment, and provide a valuable benefit to your members.
Plans that are performing well should consider a campaign to increase LIS penetration. Not only will it contribute to the HEI, but LIS is a great way to increase medication adherence and improve CAHPS. Of course, plans can also work to attract more duals and help maintain their existing population. Medicaid renewal and reapplication services are especially helpful this year given the confusing and ever-changing COVID unwind. These services along with other community assistance programs and supplemental benefits can greatly improve the tenure of these members.
Screen, identify, and provide intervention for SDoH barriers.
It is a well-known fact that LIS/dual members are more likely to have severe chronic health conditions and barriers that prevent them from receiving ideal care. The HEI is intended to incentivize plans to reduce/remove inequities faced by these vulnerable populations. This can be done by leveraging partnerships with community-based organizations and improving access to benefits and programs that help reduce barriers. Overall, your plan's success could very well depend on your ability to demonstrate quality care to your most vulnerable populations.
How Can BeneLynk’s One Lynk Solution Improve Your Chances for Receiving the HEI Reward?
BeneLynk’s One Lynk solution is a ready-to-implement toolkit for a holistic social care program, allowing our clients to prepare for all the above challenges. With our One Lynk solution, your health plan can expect to:
- Identify members likely to qualify for dual enrollment and LIS. BeneLynk has an advanced eligibility engine that utilizes member demographic information, member risk profiles, and socioeconomic factors to identify members most likely to qualify for these programs. Once dual-eligible members have been identified, our compassionate advocates reach out to gather more information and assist them through the application process.
- Provide structured and compliant social care screenings, gathering important information about your members and the challenges they face. Current regulations require the use of a standardized tool such as PRAPARE which includes a wide range of topics. BeneLynk currently focuses much of our efforts on transportation, housing, and food insecurities.
- Our solutions can seamlessly and efficiently map SDoH assessment responses to ICD-10 Z codes, SNOMED, and LOINC. In combination with near real-time reporting offered through Microsoft BI, this gives your plan access to important information about your members how and when you need it.
- Drive Medicaid retention and member satisfaction. Our outreach efforts ensure that members receive timely renewal education and assistance. Our renewal efforts drive Medicaid maintenance, as well as member satisfaction and retention with the plan. When performing annual renewal outreach, we also take the opportunity to evaluate members for additional benefits or a dual-status upgrade (partial to full Medicaid).
- Provide solutions for challenges your members are facing. Once BeneLynk has identified member barriers, we “lead with help” to surface solutions for the challenges your members are immediately facing by facilitating member access to over 300,000 local, state, and federal programs. Since its inception, BeneLynk has assisted over one million members with community program enrollment, including enrollment into Medicaid and LIS.
Looking to the Future
Although the HEI reward will not replace the current Reward Factor until the 2027 Star Ratings, health plans should begin proactively preparing. The dual/LIS measurement period will begin in 2024 and 2025. Data collection will play a large role in your plan’s future success in achieving the HEI reward as CMS is expected to add other social risk factors to upcoming measurement years including race, ethnicity, and language (REL) and sexual orientation and gender identity (SOGI).
BeneLynk’s ready-to-implement toolkit, One Lynk, can streamline your HEI efforts, improve your Star ratings, and ultimately enhance the care of your members. Be proactive – choose our One Lynk solution and learn what a difference a social care advocate can have on your plan’s performance and, ultimately, in the lives of your members.