CMS’s Health Equity Index demands that plans use social determinants data to reduce care disparities through impactful operational changes. Lauren Barca shares valuable steps to take now in her recent Health Payer Specialist article.
As part of The Centers for Medicare and Medicaid Services’ (CMS) 2024 Final Rule, health plans are tasked with improving health equity outcomes for their most vulnerable populations. The Health Equity Index (HEI), within the rule, targets Medicare Advantage contracts that fit the social risk factor (SRF) specifications – members of low income, DSNP, or disabled eligibility.
While the reward factor starts in 2027, CMS will use social determinants of health (SDOH) data health plans collect in 2024 and 2025 to determine ratings. Therefore, efforts taken now to reduce inequitable care amongst vulnerable populations become the foundation to measure Star outcomes in 2027 and beyond.
CMS’s new rule puts health equity front and center. If you SDOH data isn’t in shape, now’s the time to fix it.
Take these Four SDOH Data Steps Now
The determining factor for success under this framework is how health plans use SDOH data and act upon it now—in 2024 and 2025. CMS is looking for documentation of improved outcomes for members with social-risk factors. Here are four steps to consider.
- Collect quality data on members that qualify for social risk factors
- Incorporate large data sets and insights to tailor member interventions and screenings
- Identify common themes and gaps within populations and group member subsets by applicable and locatable themes
- Align programs and tailor member interventions to address racial disparities according to data insights obtained
Lean Into Personalized Member Engagement
To meet HEI requirements, health plans need to stop relying on generic outreach. Real results require real connections with members—no robocalls allowed. Here are five new strategies to consider.
- Expand member data collection, reporting and analysis to pinpoint risk factors and conduct proper interventions.
- Find and connect with SRF qualifying members through advanced data sources and personalized engagement.
- Build upon initial trust to foster tailored communication based on sensitive member data and communication needs.
- Resolve SDOH needs in full, delivering on each member’s most prominent and unique concerns.
- Document successful completion of closed SDOH gaps.
Read the full article here for a detailed guide to health equity index success. Membership to Health Payer Specialist is required.