Health Equity Best Practices
With the 2027 Star Health Equity Index (HEI) Factor upon us due to 2024 data being used in the baseline, what can plans do to prepare for achievement. It comes down to some common-sense investments to succeed. There is no question that the HEI will be a journey. There are such institutional biases built into the healthcare system and those barriers will not fall overnight. But sensitivity to your members with social risk factors (SRFs) can help you begin to move the needle on health equity.
Here are some of our assembled best practices. We welcome additional insights and comments.
- Determine if you are eligible and for how much of the HEI factor. See an explanation in Part 2 of this blog series. You can also assess your enrollment data for the penetration of dual eligibles, Low Income Subsidy (LIS) and disabled members.
- Examine what the Centers for Medicare and Medicaid Services (CMS) has already done. All plans received from CMS contract-level stratified data on your dual eligible/LIS/disability members that showed how the `contract did against national performance statistics. This stratified data was on over 20 survey, clinical and drug measures. While the statistics will move over time, this is a great way to benchmark your performance against other plans.
- Prepare your data so in all measures you are able to break out the performance of your LIS/DE/Disabled cohort. Plans need to immediately pivot to looking at most measures in two ways – the overall population and then the HEI cohort.
- Educate associates and vendors about HEI and the importance. Many plans already struggle with Star performance. So it is paramount to have everyone in the plan ecosystem understand not only the basics of Star but also the HEI implications. This is not just about associates at the plan proper, but with a myriad of delegated vendors who impact Star generally but could play a pivotal role in success or failure on the HEI.
- Begin to examine ways you can better understand your members impacted by SRFs. Assemble member profiles that include both clinical and social determinant factors from plan and provider data. In addition, seek to incorporate global data that contributes to your understanding of social determinant and health equity impacts. The U.S. Census now allows downloads of census track data. Also look at the Area Depravation Index.
- Ensure social determinant factors become part of our clinical oversight. A majority of health outcomes are tied to other than clinical factors.
- Have a holistic approach to your Star program as well as to the SRF subset. Examining clinical, drug, and member satisfaction measures will all be important to overall success on HEI.
- If you have not done so, undertake mock surveys of your populations. These mock surveys will not only boost overall member satisfaction measure scores, but also provide critical information into the views and problems that your HEI cohort may have.
- If you have one, integrate HEI efforts with your Special Needs Plan (SNP) Model of Care. The overlap in the populations should be major, especially if the SNP is a dual eligible one.
- Make investments in social determinant spending. Such an investment could pay huge dividends. This could include sponsoring community organizations and resources to boost health literacy as well as for transportation, shelter, and food security. Target some of your supplemental benefits to these issues as well.
- Ensure your newsletters and member communications are culturally competent and mention social barriers to health. Communications to members must be sensitive to low health literacy and disability aware, languages other than English, and otherwise be culturally competent.
- Examine your provider network for cultural competency and the ability to react to social barriers. Your providers are key to HEI efforts. Education will be important as well.
- All Star remediation campaigns should be viewed through the lens of social determinants and health equity. Omni-channel outreach and communication is key. What works for a mainstream member population may not be the best way to outreach and remediate care gaps for SRF populations.
Lilac Software is developing cloud-hosted, data aggregation solutions for health plans’ most complex problems. Our Star Performance Management Platform gives unprecedented insight into all aspects of the Medicare Advantage Star program, including forecasting of aggregate scores and revenue, individual measure performance, as well as best practice remediations for all measures. Lilac will seamlessly show how plans are doing on each contract from an all-population perspective as well as for social risk factor (SRF) cohorts.
If you are looking for a solution to the Star complexity and best practices, reach out here to start a conversation with the Lilac team
