To continue the understanding of CMS’s emphasis on health equity within the 2024 Final Rule, Part 2 of this blog series delves deeper into compliance efforts required by health plans to maintain or elevate Star Ratings while ensuring compliance with the new ruling. In Part 1, How to Use the Health Equity Index: Closing the Gap with Proven Outcomes, we examined CMS’s stance on health equity and its first two priorities regarding the use of SDOH data to submit results in closing health equity gaps.
Now, we’ll uncover the final three priorities shared by CMS and explore how to generate tangible, achievable outcomes. Leveraging SDOH data remains pivotal for driving substantive results and ensuring compliance. And, it underscores the necessity for tailored member engagement strategies that foster empathetic and member-first interactions with vulnerable populations. 86Borders offers proven strategies to stay compliant, advance health equity, and effectively engage disparate members through SDOH data utilization—thereby meeting and exceeding CMS standards.
Priority 3: Build capacity of healthcare organizations and the workforce to reduce health and healthcare disparities.
Incentivizing plans encourages and requires them to enhance the capacity of their technology, services, outreach, and outcomes. CMS uses financial incentives to further invest in such resources. All of which ensure the highest quality of care and services provided and bridge the gap in equity for disadvantaged members of the healthcare population.
In addition, Medicare Advantage contracts require more attention to the ruling. The Reward Factor, an existing reward previously for Medicare Advantage plans that score 4 or more Stars, will be replaced by the Health Equity Index (HEI) Reward. With no Star threshold criteria to qualify, HEI will be applied to all contracts meeting the Social Risk Factors (SRF) enrollment threshold. So now a contract with 2.5 Stars will receive the same reward as a contract with 4 Stars, since they both met SRF enrollment standards. The reward is then added to the UN-ROUNDED Star ratings overall score, and HEI rewards can round a previous rating to the nearest half Star.
Priority 4: Advance language access, health literacy, and the provision of culturally tailored services.
Ensuring health equity among all member populations requires the inclusion of underserved communities and conducting additional and tailored outreach. Members of those communities lack a certain level of education, and also face language barriers, income insecurities, and more standing in the way of their healthcare.
Within each plan, region, and socioeconomic subset of these members, specifically tailored outreach and engagement are vital to consistency and communication with their health plan. Here are some of 86Borders proven outreach strategies:
- Create personalized and empathetic relationships with a single care coordinator on behalf of all outreach from their plan.
- Speak to each member in their preferred language, communication preference (phone, email, text), and during times that work best for them.
- Understand hesitation and resistance to receiving honest answers to sensitive SDOH screening questions.
- Ensure each member receives a breakdown of all available benefits and how to access and use them, presented at their individual level of understanding.
Priority 5: Increase all forms of accessibility to healthcare services and coverage.
To produce outcomes that show equal or better care interventions for at-risk members within a contract, health plans must differentiate their approach for specific populations. The methods, strategies, outreach, and care interventions required for vulnerable member populations are different from other plans, such as employer group plans.
Using collected and standardized SDOH data for each member within disparate groups allows plans to use effective engagement strategies to connect members with available resources needed to close gaps in care.
For example, sending an address or scheduling an appointment for a corresponding need is not enough to yield proven outcomes needed from this ruling. Sharing a list of community or faith-based organizations nearby to meet corresponding insecurities is insufficient as well. To prove actionable health equity efforts required by CMS, health plans must go above and beyond traditional efforts to close gaps in care. Investment in technology to leverage SDOH data and interaction notes gleaned from engaging with vulnerable populations is critical.
Regulatory to Reality: How plans can produce proven success
At first glance, the CMS 2024 Final Rule may overwhelm health plans and their leaders. Producing proven results based on minimal SDOH data for at-risk and hard-to-engage members of vulnerable populations seems daunting—especially when measured against other contracts. However, our team at 86Borders are experts in Member Relationship Management and tailored member engagement.
We have used member-first engagement strategies to close the circle on required covered care. For example, when partnering with a health plan to engage Medicaid members and conduct proper SDOH screenings, our team achieved successful documented results. With the subset of members who have not seen their primary care physician (PCP) in more than 13 months, we produced:
- 57% conversion rate from inactive to active members
- Comprehensive SDOH data collection for the plan’s reporting
Efforts to engage a plan’s Medicaid Patient Centered Medical Home (PCMH) Program produced proven outcomes:
- 247% increase of intended PCP appointments
- 19% reduction in inpatient/ER utilization
- 101% reduction in the plan total cost of care (TCOC)
In addition, engagement of Medicaid and D-SNP populations to provide benefits education, utilization, and SDOH screenings yielded:
- 60% engagement rate
- Improvement in overall member satisfaction and quality scores
In conclusion, an empathetic, member-first approach to interaction with vulnerable populations based on SDOH data can and HAS produced proven outcomes in health plans’ efforts to close the gap in health equity for contracts with members facing social risk factors.