Buckle your seat belts and get ready for the Health Equity Index

Starting in 2025, the Federal Center for Medicare Services (CMS) will begin their 2-year "look back period" to inform the the new Health Equity Index (HEI), going live in 2027. This new Medicare Advantage performance metric is intended to incentivize improved care and outcomes to at-risk and low income consumers enrolled in private Medicare Advantage plans.

This new metric will measure customer experience scores across the enrolled low income and/or disabled members of a private Medicare Advantage plan. There are currently 11 million Medicare seniors across the country with a household income below 200% of the Federal Poverty Level. CMS wants the private Medicare Advantage carriers to invest in and focus on this population, and they are putting future financial incentive dollars at risk to make it happen.

Why you need to buckle your seat belts

CMS offers significant financial incentives to private Medicare Advantage plans based on consumer experience scores (CAHPS), reductions in the cost of care vs. regional benchmarks and healthcare outcomes (HEDIS). Private Medicare Advantage plans that do not meet the minimum HEI enrollment percentage across their pool of covered lives will be challenged to maintain financial viability starting in 2027 via potential reduction to the carrier's Star Ratings. Once the minimum enrollment percentage is met, carriers, doctors and hospitals will have to roll out new engagement programs and navigation tools to insure the CAHPS and HEDIS scores of this cohort are positive and improve year-over-year.

By launching this new HEI metric, CMS is telling private Medicare Advantage carriers, doctors and hospitals to leverage their substantial financial and organizational resources to engage this often unengaged, uninformed and at risk population, many of whom do not speak English as a first language.

What can you do about it?

If your business participates in private Medicare Advantage - either as a carrier, a healthcare delivery entity, or a vendor - investment now is critical. Having multi-lingual materials and websites is not likely to be sufficient. This is a population that primarily engages person-to-person with the healthcare and social services infrastructure.

Building a market intelligence platform that leverages demographic, data paired with cohort specific engagement tactics, will best position put an organization to reap the benefits of the new HEI program. Buckle up and get started now. 2027 is just around the corner.

This article was written by a human being; no chatbots or AI were used. No permissions are granted for any use of this content to train AI algorithms.

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2itive is a Portland based consultancy founded by Erik Goodfriend, offering a unique combination of market intelligence, knowledge of healthcare payment systems and creative business strategy insights. Feel free to contact us at info@2itive.com