In April 2023, the Centers for Medicare and Medicaid Services (CMS) introduced a significant update to the Star Ratings program: the Health Equity Index (HEI). This initiative, set to impact the 2027 Star Ratings, highlights CMS’s commitment to enhancing care for beneficiaries with social risk factors (SRFs), such as dual eligibility for Medicare and Medicaid, low-income status, and disability. One crucial aspect of improving health equity is addressing food and nutrition care. Here’s how Medicare Advantage Organizations (MAOs) can prepare for the HEI by focusing on personalized food and nutrition care.
Understanding the Health Equity Index
The HEI is designed to reward Medicare Advantage plans that effectively serve members with SRFs. CMS aims to bridge the health equity gap by incentivizing plans that excel in providing high-quality care to vulnerable populations. The HEI will use data from 2024 and 2025 to determine Star Ratings in 2027. To qualify for rewards, contracts must have a portion of beneficiaries with social risk factors higher than the median or at least one-half of the median.
Key Components of the HEI
- Enrollment Thresholds: Contracts with a higher percentage of members with SRFs are eligible for HEI rewards. These SRFs include low-income subsidy (LIS), dually eligible (DE) members, and those who qualify for Medicare due to disability.
- Quality Measures: The HEI will assess performance on select quality measures for vulnerable populations. Plans must compare their quality scores for members with SRFs against national averages to determine HEI scores.
- Impact on Star Ratings: The HEI replaces the current rewards system in Star Ratings, with CMS expecting significant shifts. Approximately 2% of contracts might gain one-half Star, while 13% could lose one-half Star, resulting in substantial program savings for the federal government.
Preparing for the HEI with Personalized Food and Nutrition Care
Assess and Improve Enrollment
MAOs should start by identifying opportunities to enroll and better serve beneficiaries with SRFs, focusing on those who face food insecurity. This proactive approach will be crucial as current performance impacts future Star Ratings. Key actions include:
- Identify SRF Members: Ensure accurate data validation to capture members enrolled for at least a month.
- Expand Enrollment Efforts: Focus on enrolling eligible members in income-based programs, Medicaid, MSP, and LIS.
Enhance Data Collection and Analysis
Robust data collection and analysis are fundamental to succeeding under the HEI. Plans should prioritize the following:
- Centralize Member Records: Consolidate member data into comprehensive records, including enrollment and claims data, to understand members’ health journeys and identify care gaps related to nutrition.
- Bridge Data Gaps: Address incomplete or outdated records using data validation software, member experience surveys, and health risk assessments (HRAs) to capture information on food security.
- Leverage Technology: Adopt digital tools that use various data sources to identify at-risk members. High-value data visualizations and customizable dashboards can help prioritize outreach and interventions.
Implement Targeted Food and Nutrition Interventions
Once data is centralized and analyzed, MAOs should develop targeted interventions to address the specific nutritional needs of members with SRFs:
- Personalize Outreach: Use person-centric strategies like motivational interviewing to build trust with members. Equip outreach clinicians with detailed data to engage members effectively about their nutrition needs.
- Provide Continuous Support: Interventions should be ongoing, not one-time efforts. Regular follow-up ensures members continue to receive the support they need to maintain proper nutrition and adhere to their care plans.
- Utilize Community Resources: Connect members with grocery delivery services and nutrition education programs to address food insecurity and impact diet-related diseases, drive behavioral change, and improve their overall health.
Future Considerations
While the initial focus of the HEI is on LIS, DE, and disabled members, CMS may expand to include other social risk factors such as race and ethnicity, limited English proficiency, and mental health. MAOs should prepare for these potential changes by:
- Expanding Data Collection: Collect and analyze data on a broader range of social determinants, including detailed information on food security, to anticipate future HEI criteria.
- Continuing Education and Training: Regularly train staff on the importance of health equity and effective strategies for addressing nutritional needs.
Conclusion
The introduction of the Health Equity Index marks a significant shift in how Medicare Advantage plans will be evaluated and rewarded. By prioritizing the enrollment of members with social risk factors, enhancing data collection and analysis, implementing targeted food and nutrition interventions, and building strategic partnerships, MAOs can not only improve their Star Ratings but also contribute to reducing health disparities. As the healthcare landscape continues to evolve, staying ahead of these changes will be crucial for the success of Medicare Advantage plans and the health of the communities they serve. By focusing on personalized food and nutrition care, MAOs can make a tangible impact on the well-being of their most vulnerable members.
