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Medicare Advantage Star Ratings: The Health Equity Index (HEI) Reward Factor

The Centers for Medicare & Medicaid Services (CMS) announced a significant change to the Medicare Advantage Star Ratings program. The introduction of the Health Equity Index (HEI) Reward Factor in 2027 emphasizes reducing healthcare disparities among Medicare beneficiaries.

What is the HEI Reward Factor?

The HEI Reward Factor is a new component of the Star Ratings program designed to incentivize Medicare Advantage plans to deliver equitable healthcare. It assesses how well plans serve beneficiaries with social risk factors, such as low income, disability, or dual eligibility for Medicaid.

Why is this Important?

Healthcare disparities are a persistent challenge in the U.S., and Medicare beneficiaries are not exempt. The HEI Reward Factor aims to close these gaps by encouraging plans to:

  • Ensure all enrollees receive access to quality care.

  • Address social determinants of health that can impact health outcomes.

  • Implement culturally competent care practices.

Is Your Organization Prepared?

The implementation date provides time for Medicare Advantage plans to prepare. Here are some steps to consider:

  • Review CMS resources: The CMS website offers guidance and tools to assist plans in understanding and implementing the HEI Reward Factor.

  • Conduct a self-assessment: Evaluate current efforts to address health equity within your plan. Identify areas for improvement and develop strategies to enhance access and quality of care for diverse populations.

  • Develop a data collection and analysis plan: Track performance on HEI metrics and utilize data to refine strategies and demonstrate progress.

The HEI Reward Factor signifies a shift in focus for Medicare Advantage plans. By prioritizing health equity and investing in strategies to address disparities, plans can improve the health outcomes of all beneficiaries while contributing to a more equitable healthcare system.

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