We're living in a time of transformative change in healthcare, with a renewed focus on ensuring equitable access to quality services for all. The Centers for Medicare & Medicaid Services (CMS) has taken a significant step forward by introducing the Health Equity Index (HEI) reward, a groundbreaking initiative poised to reshape the landscape of Medicare plan ratings.
Understanding the CMS Health Equity Index
The CMS's prioritization of advancing health equity represents a paradigm shift in evaluating the effectiveness of Medicare plans. While the CMS Star Ratings have long emphasized clinical outcomes and patient satisfaction, the HEI introduces a crucial dimension—ensuring that healthcare is accessible and effective for all, regardless of socio-economic background, ethnicity, or language spoken.
In April 2023, CMS finalized a new rule for the Star Ratings program, introducing a HEI reward to replace the current Reward Factor that impacts Quality Bonus Payments for high-performing plans.
Under this new rule, Part C and Part D will be rewarded for improving care for members with social risk factors. Although the rule takes effect in the 2027 plan year, payers should not wait to start improving outcomes for members. The metrics used to calculate the HEI reward will be based on data from the 2024 and 2025 plan years. Therefore, payers should implement strategies to improve outcomes for underserved individuals as soon as possible.
Language Access as a Pillar of Health Equity
One of the key pillars supporting health equity is language access. As a language services provider, we recognize the significance of breaking down language barriers in healthcare communication. Imagine navigating the complexities of a healthcare system when the information is presented in a language you don't fully understand. It's a daunting challenge that millions of Americans face, leading to potential misunderstandings, missed appointments, and suboptimal health outcomes.
By prioritizing language access, Medicare plans can proactively address disparities and foster a more inclusive healthcare experience. Providing information in multiple languages, offering interpreter services, and ensuring that communication is culturally competent are essential steps toward creating an environment where every member can fully engage with their healthcare journey.
The Impact on Star Ratings
So, how does language access tie into the CMS star ratings and the new HEI reward? The connection is more direct than you might think. Plans that actively invest in language access demonstrate a commitment to breaking down barriers and fostering an environment where everyone can make informed decisions about their health.
Improved communication leads to increased patient understanding, which, in turn, enhances compliance with treatment plans, medication adherence, and preventive care measures. Plans that excel in these areas are likely to see improved health outcomes among their members, a factor that can positively influence their star ratings.
Moreover, the HEI explicitly recognizes the importance of addressing disparities among diverse populations. Plans that implement robust language access programs are well-positioned to demonstrate their commitment to inclusivity, thereby earning potentially higher ratings in the health equity category.
To learn more about how the HEI reward will be calculated, please watch this presentation from the 2023 CMS Health Equity Conference.
Embracing the Future Together
As we navigate the evolving landscape of healthcare, it's heartening to see a commitment to health equity taking center stage. Language access isn't just a checkbox on a compliance form; it's a catalyst for positive change in healthcare outcomes. As the CMS HEI becomes a cornerstone of plan evaluations, language services play a pivotal role in helping plans not only meet but exceed the expectations for equitable care.
Let's embrace this journey toward a more inclusive and equitable healthcare future, where everyone can access the care they need and deserve, no matter what language they speak.
Want to learn more about CMS Star Ratings and how language access can help improve ratings? Download our guide below.
