In Part One of this blog series, I laid out the first two priorities for health plans to consider as they work toward full compliance with the recently renamed Health Equity Index (HEI) which requires expanded collection, reporting, and analysis of standardized SDOH data by health plans. Once SDOH data is collected, health plans must also analyze the causes of health disparities, address inequities, and close member healthcare gaps.
Part Two of this blog series lays out three additional priorities to bolster Star Ratings and other quality outcomes once a solid SDOH data platform is established.
- Build capacity of healthcare organizations and the workforce to reduce health and healthcare disparities.
- Advance language access, health literacy, and the provision of culturally tailored services.
- Increase all forms of accessibility to healthcare services and coverage.
Collecting SDOH data is essential for driving real progress in health outcomes. To make meaningful change, health plans must be able to act on this data by removing barriers that impact care. Yet gathering and operationalizing SDOH data remains a challenge. Building trust through tailored member engagement strategies is critical, particularly for vulnerable populations. Here are the next three priorities for health plan executives to consider.
Priority 3: Build capacity to reduce health and healthcare disparities.
CMS uses financial incentives within EHO4all to reduce health and healthcare disparities. Health plans are incentivized to invest in technology, services, outreach, and outcomes to achieve this goal: bridge the gap in equity for disadvantaged members of the health plan’s population.
In addition, Medicare Advantage contracts require more attention to the ruling. The Reward Factor, previously an existing reward for Medicare Advantage plans that score 4 or more Stars, will be replaced by the EHO4all Reward. With no Star threshold criteria to qualify, EHO4all will be applied to all contracts that meet 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 unrounded Star ratings overall score, and 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 excellent outcomes among all member populations requires the inclusion of underserved communities and additional tailored outreach. Members of these communities lack a certain level of education, face language barriers, experience income insecurities, and face more barriers to care.
Within each plan, region, and socioeconomic subset of these members, tailored outreach is vital to achieve consistency and deliver proper communications. Here are some 86Borders proven outreach strategies to consider:
- Create personalized and empathetic relationships with a single care coordinator on behalf of all plan outreach.
- Speak to each member in their preferred language and communication preference (phone, email, text) 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 document success.
With the above four strategies in place, health plans are fully prepared to make services available and achieve better outcomes with their at-risk members. The EHO4all focus on standardized SDOH data for each member emphasizes the need to increase access to care, connect members with available resources, and effectively close care gaps.
However, the next steps for health plans (methods, strategies, outreach, and care interventions) are different from those used in other contracts such as employer group plans. Simply sending an address or scheduling an appointment for a corresponding need is not enough from this ruling. Additional steps must be taken.
To prove actionable health equity efforts required by CMS, health plans must go above and beyond traditional efforts to close gaps in care through longer-term member engagement, conversations, and follow-up. Technology to document, track, and assess member interactions will be a valuable tool for EHO4all compliance.
Regulatory to Reality: Compliance is worth the effort.
At first glance, the CMS rebranding to the EHO4all program may overwhelm health plans and their leaders. Producing better outcomes based on minimal SDOH data for at-risk and hard-to-engage members of vulnerable populations is difficult—especially when measured against other contracts.
However, success can be achieved, and the long-term benefits outweigh short-term demands. 86Borders’ 15 years of experience with at-risk members proves that personalized, human-to-human connections work, and will help health plans comply with the new EHO4all rules.
For example, when partnering with a health plan to engage non-active Medicaid members* and conduct proper SDOH screenings, our team successfully:
- Converted 57% from inactive to active members
- Collected comprehensive SDOH data for the plan’s EHO4all reports
Efforts to engage a plan’s Medicaid Patient Centered Medical Home (PCMH) Program produced similar outcomes:
- Increased intended PCP appointments by 247%
- Reduced inpatient/ER utilization by 19%
- Cut total cost of care (TCOC) by 101%
Finally, engagement of Medicaid and D-SNP populations to provide benefits education, utilization, and SDOH screenings yielded a 60% engagement rate and grew overall member satisfaction and quality scores.
86Borders’ 15 years of experience working with at-risk members proves that personalized, human-to-human connections work, and will help health plans comply with the new EHO4all rules.
To learn more about our services, click here »