Healing health disparities is often discussed as a continuous goal in the patient-provider sphere. But it’s increasingly clear that health plans also have a significant role to play in helping narrow gaps in care.
As of February 2023, nearly 31.2 million people are enrolled in a Medicare Advantage (MA) plan. That’s roughly half of all Medicare beneficiaries. Serving such a large and diverse population, payors are uniquely positioned and have a responsibility to help address long-standing inequities in healthcare access and care beyond the walls of the hospital.
Furthermore, CMS recently announced more robust health equity standards for MA plans. That means a renewed commitment to ensuring payors are laser-focused on expanding access to high-quality care — and reimbursements will doubtlessly be tied to these new expectations.
As payors increasingly prioritize health equity, collecting accurate social determinants of health (SDOH) data will be critically important. So will taking things a step further to bridge gaps in care. And innovative digital health platforms are poised to help them do both.
What to know about CMS’s 2024 health equity index reward
CMS published its 2024 Medicare Advantage and Part D Final Rule in April 2023. Among several updates — including new marketing requirements, prior authorization reforms, and changes to provider directories — one notable milestone was the announcement of the health equity index (HEI) reward.
The HEI reward is intended to further incentivize Parts C and D plans to improve care for enrollees with social risk factors (SRFs), and to support CMS efforts to ensure positive health outcomes for all beneficiaries. CMS will choose a set of existing measures and compare outcomes in populations with SRFs to those without, and reward health plans that narrow inequities.
The reward will take effect for 2027 Star Ratings, and will be based on 2024 and 2025 MA plan performance.
1. Leverage text messaging to collect SDOH data and identify barriers to care
CMS maintains that self-reported information remains the gold standard for sociodemographic and SDOH data. But what is the best way to actually collect this information from members?
Some health plans use portals and email to engage members, but studies show most people don’t prefer using portals to begin with. On top of that, at-risk beneficiaries may lack internet access or data plans. Payors often resort to direct mail to overcome the digital divide, but it isn't a reliable method for data collection nor a channel for two-way communication.
Boasting a 99% open rate, texting is incredibly effective for sending communication. Beyond the high open rates, text messaging is highly accessible and built into every mobile phone on the market — from flip phones to smartphones.
So how can SMS help health plans collect important SDOH data? Novel intelligent care enablement technology proactively engages members with text-based prompts and surveys to collect sociodemographic and SDOH information, and to determine what barriers members face when trying to get care.
2. Use digital healthcare tools to send members personalized resources for accessing the care they need
Collecting data is a critical first step for identifying which individuals have social risk factors and what barriers they face to achieving their highest level of health. Food insecurity, housing instability, and transportation inaccessibility have all been shown to negatively impact health outcomes. But once health plans collect this SDOH data, how do they actually use it to address disparities?
Care managers are excellent at helping individuals navigate care, but they often face challenges in getting in contact with members. Most people don’t answer the phone if they don’t recognize who’s calling, and the majority of payors reach out to members through telephone.
Digital healthcare platforms can automate member outreach, collect data from members, and even leverage AI and natural language processing (NLP) to connect members to relevant resources without a care manager picking up the phone. For instance, if a member completes an SDOH survey and food insecurity is identified as a risk factor, an advanced digital health solution can intelligently surface a resource with local food bank information.
This type of automation can be used to share relevant information related to housing, transportation, and health plan benefits that members may not realize they had access to. Digital health will never replace care managers, community health workers, or social workers, but it can meaningfully improve the number of members they reach and ultimately impact.
3. Proactively support member experience with preventive care reminders
Healthcare in the U.S. is pricey. We outspend nations with comparable economies both at individual and systemic levels. One of the costliest aspects of health is chronic care management.
At-risk communities encounter chronic conditions more than other groups. Communities and individuals who have been historically underserved as defined by education, income, race and ethnicity, age, and other factors have been shown to experience significantly higher rates of chronic illness. One study found higher education levels to be directly associated with lower prevalence of hypertension, diabetes, and cardiovascular disease.
It’s widely accepted that improving preventive care can help stave off chronic conditions. Routine screenings and checkups give clinicians the opportunity to partner with members early on and help reduce the risk of negative health outcomes. And for individuals with existing chronic conditions, making the right interventions at the right time can help preempt acute care episodes and secondary or tertiary illnesses.
Forward-thinking digital health tools actively remind members about their preventive care options and help equip them with the right resources when they need them. In addition, advanced technologies educate members with tailored information about why getting preventive care is important for them, helping advance health literacy and empowering people to feel more confident about managing their conditions.
Innovative health plans have the opportunity to lead the industry in solving how to address health disparities. While there is no single solution that meets the multifaceted nature of systemic inequities, digital health can help by identifying at-risk individuals, understanding their needs, and meeting them where they are.
Ready to see how intelligent care enablement technology can improve health equity for your members? Speak with one of our experts!