Health Equity Sessions

Understanding the Health Equity Index for Stars 

What plans need to know

Key takeaways:

The implementation of Tukey outlier deletion criteria caused extreme volatility in 2024 Star Ratings cut points, primarily in the lower (2 and 3 Star) cut points.

CMS’s methodology for the HEI reward maintains an element of industrywide competition as well as enrollment-based eligibility criteria.

Clients should monitor the stratified reporting they receive through HPMS and Acumen Patient Safety to identify performance trends across their member population with defined social risk factors (SRF) – LIS, dual eligible and disabled status.

Shelley Clermont, Executive Director, Government Programs Quality

Arpana Mathur, MD, PBM Executive Medical Director

Linking Data to Health Equity Strategies 

How analytics can help identify the most at-risk members and inform health equity priorities

Key takeaways:

The PBM’s new pharmacoequity tool enhances our clients’ ability to address disparities in care by identifying the most disadvantaged members to prioritize for access, adherence and treatment optimization. Through the assignment of health equity scores, the analytics provide a deeper understanding of what drives a member’s health equity status.

We leverage the analytics to close gaps in care and reduce health disparities across our health care delivery channels and clinical products. 

Clients can use the data to prioritize their own investments in targeted interventions and provider and member engagements. This includes identifying and prioritizing geographic health equity hotspots.

Reach out to your account team to schedule a meeting about pharmacoequity analytics.

Trends and Product Strategies to Drive Improvements in Health Equity 

Understand emerging market trends and data provided by the PBM to help inform your strategies

Key takeaways:

Health equity is a critical pillar of CMS’ quality strategy. It is one of the most important, but challenging, areas of focus for Medicare Advantage Organizations (MAOs).

CMS uses the VBID Model as a critical lever to push health equity, centering it in all stages of the model’s design, operations and evaluation. As a result, participating plans may be better positioned for the Health Equity Index reward.

Plans, particularly D-SNPs, increasingly leverage VBID to target social needs-related supplemental benefits by socioeconomic status, while general MAPD plans tend to target these types of benefits by chronic condition through Special Supplemental Benefits for Chronically Ill (SSBCI).

Clients should supplement their own data with CMS data and the PBM’s data reports to inform and drive health equity investments and strategies. Specific PBM reports are available for VBID, LICS and our OTC Health Flex Card.

To learn more about emerging marketplace trends, the VBID Model or available PBM reports, contact your CVS Account Team to schedule a meeting with the Government Markets Strategic Insights team.

Andy Joliet, Executive Director, Government Markets Strategic Insights and Communications

Rebekah Ocker, Senior Manager, Government Markets Strategic Insights and Communications