Managed Healthcare Executive May 31, 2024
One of the changes that CMS has added is a Health Equity Index (HEI) reward to its Stars program. The agency will use HEI data collected this year and next to calculate 2027 Star Ratings, so plans must capture member data on every measure included in the HEI.
Multiple changes by CMS to calculate risk adjustment factor (RAF) and quality of care scores are forcing health plan leaders to significantly revise their plans or risk lower reimbursements from government-sponsored programs.
Some of the risk model and Star Ratings changes for those programs (Medicare, Marketplace and Medicaid) and others are still being fine-tuned so the direct financial impact cannot yet be accurately predicted. One thing, however, is clear: Health plans should...
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