Medicare Advantage Plans Need Robust Health Equity Strategy


The new health equity index will impact Medicare Advantage Star Ratings. Helping members enroll in public assistance programs is more important than ever.

Lindsay Knable and Anna de Paula Hanika

4 min read

Medicare Advantage plans are entering a new chapter for Star Ratings. Beginning this year, plan performance will impact a new health equity index (HEI) that will replace the current reward factor in the Star Ratings program. Data from measurement year 2024 and 2025 will impact Star ratings in 2027.

The HEI is designed to reward MA plans that meet two criteria. First, having a high percentage of MA enrollees with social risk factors (SRF), defined as those enrolled in the income-based programs Medicaid, Medicare Savings Program (MSP), or the Extra Help / Low Income Subsidy (LIS) program, as well as those who qualify for Medicare due to disability. Second, delivering strong relative Stars measure performance on this population. The new HEI is part of a broader effort by the federal government to use payment as a mechanism for spurring action on closing the health equity gap.

Building and sustaining an impactful strategy for HEI requires enterprise-wide coordination. MA plans need to adopt a health equity focus at nearly every level of their operations — from data collection to analytics and ongoing efforts to eliminate barriers to health equity. A critical, and largely underutilized resource, is leveraging the set of income-based programs available to over 50% of Medicare members. But MA plans may not have the internal capabilities to assess the entire landscape of public assistance programs for their members.

Since its founding in 2019, Uno Health has been on the frontlines helping financially vulnerable seniors enroll in these federal and state income-based programs, including both the HEI qualifying programs — Medicaid, MSP and LIS — as well as those that support paying for utilities, prescriptions, and food. Oliver Wyman’s Lindsay Knable recently spoke with Uno Health CEO and Cofounder Anna de Paula Hanika about ways insurers can take a more comprehensive approach to addressing health equity.

de Paula Hanika was the 2023 recipient of Oliver Wyman’s Tom Main Health Innovation Mentorship, a program that pairs innovators with senior members of Oliver Wyman’s Health and Life Sciences practice to help map out a growth strategy for their company.

Knable: What is Uno’s perspective on the health equity index and what it means broadly for MA plans?

de Paula Hanika: CMS has implemented a lot of changes in Medicare Advantage Stars over the past couple of years. The addition of the HEI is probably one of the biggest shifts. It reflects a continued focus by CMS on supporting lower-income Medicare beneficiaries and bridging the health equity divide.

Knable: What hurdles do plans face when it comes to factoring the HEI into their processes?

de Paula Hanika: There are two key components to the HEI — reaching the reward membership threshold and understanding how your membership is performing against your peers.

There are a few critical steps plans should take. First, they need to determine where their membership sits against the partial and full thresholds on a given Medicare contract. In other words, what percentage of members fall within the SRF categories? Those whose SRF members make up equal to or greater than the contract-level median SRF enrollment for all contracts can earn up to 0.4, which is added to their unrounded Star rating. Those that have 50% or more of the contract level median can earn up to 0.2. The challenge is that a number of members meet the criteria for one or more of the income-based programs, but they won’t show up in the HEI until they are actually enrolled.

Once they have that assessment, plans can map out efforts to measure and address the health equity gap that they need to close. An area that Uno is particularly focused on is helping low-income members enroll in the comprehensive set of income-based programs that address social determinants of health. We’ve found that nearly 50% of Medicare beneficiaries are missing out on opportunities to benefit from low-income assistance programs because they aren’t enrolled.

Knable: Let’s dig deeper on how plans can help their members get enrolled in these income-based programs. Are there strategies you’ve seen work particularly well?

de Paula Hanika: You want to implement a solution that can scale outreach, engagement, and end-to-end eligibility determination and enrollment. Navigating eligibility rules and enrollment processes are among the biggest challenges. That’s where partners like Uno can help in developing a comprehensive, technology-enabled solution that can be deployed enterprise wide. It’s essential that plans create a seamless process for getting members enrolled in these programs. The administrative and operational burdens are immense and costs can add up quickly with point solutions if there isn’t reliable technology support. Having a partner manage those aspects allow plans and their employees to stay focused on core member services, such as accessing care and clinical support.

Some tactics that drive positive results include training and equipping all member-facing staff with eligibility screening tools. Plans can also integrate eligibility and application status data into their core internal systems so anyone at the plan can track and support a given member’s enrollment process. Digital tools and communication channels are a big help, too. That includes sending text messages and emails and then making it easy for members to upload their supporting documents and data digitally, for example through a portal. There’s a myth that all seniors are technophobes. In some cases, we’ve seen digital tools overall yielding a return rate that’s three-times higher than non-digital efforts. A faster-growing segment is seniors willing to complete portions of their applications online. We’ve seen nearly one-third of seniors embrace the technology this way. Insurers that don’t have a strategy to target these individuals risk missing them entirely. They also miss an opportunity to reduce reliance on telephonic outreach and potential member abrasion.

Knable: What kind of results are you seeing when members enroll in these assistance programs?

de Paula Hanika: There are immediate benefits to members. On average, members save $4,500 a year by enrolling in Medicaid or LIS and other income-based assistance programs like SNAP, utility assistance and phoneline assistance. For many, that’s more than the difference between having to choose to pay for groceries or the medications.

From a plan perspective, we’ve also seen the positive impact on Star ratings that having more members enrolled in these programs can drive. And it’s a strong member retention tool: a comprehensive program enrollment can reduce churn rates among Dual Special Needs Plan populations by as much as 10%, further enhancing the value of these programs.

  • Lindsay Knable and
  • Anna de Paula Hanika