U.S. government health insurance programs have seen significant shifts in 2023; next year will be no different. Complications continue from the Medicaid continuous enrollment unwinding, and Medicare Advantage Star Ratings are undergoing substantial changes in 2024. These shifts put increased pressure on health plans that serve both populations, such as Dual Eligible Special Needs Plans (D-SNPs). Supporting D-SNP members through the ongoing Medicaid redetermination and reevaluating Star Rating strategies will be critical to achieving desired health outcomes and quality ratings.
The member population of D-SNPs is multiplying year-over-year, jumping a staggering 22% between 2021 and 2022 alone. That growth shines a necessary spotlight on supporting these members, where over 75% live below the Federal Poverty Level, have multiple chronic conditions, face complex social determinants of health (SDOH), and are ultimately the hardest for health plans to reach and engage.
Now, more than ever, health plans play a huge role in addressing the barriers that have historically hindered the care for these populations, as doing so is crucial for enhancing the quality of care and outcomes for D-SNP members. This year's Medicaid redetermination and upcoming Star Ratings changes—especially the introduction of the Health Equity Index—reinforce the urgency for plans to make immediate changes that will best support their D-SNP members.
We are breaking down the implications of these program shifts and what plans can do to set themselves and their members up for success.
Over 1.5 million Medicaid recipients have already been unenrolled after the unwinding of continuous enrollment began in April—half of which are still actually eligible for Medicaid. Some sources estimate that up to 24 million people could be left without coverage throughout the Medicaid redetermination process.
According to the Centers for Medicare and Medicaid Services (CMS), D-SNPs are required to:
These requirements should greatly mitigate the risk of unnecessary member churn.
However, this is not without its own unique set of challenges, made even more difficult by the social risk factors a majority of D-SNP members face, such as:
These factors make it much harder for health plans to ensure they have the most up-to-date contact and social screening information.
A significant pain point for health plans is outreach. A common sentiment is, "I would just like to be able to reach my members." For D-SNP members facing numerous social risk factors, prioritizing their health care often comes after meeting their immediate needs—putting food on the table, ensuring shelter, ensuring their loved ones are cared for, etc. How can health plans cut through the noise of everyday pressures to successfully get in contact with these members? How can members become motivated to want to participate?
By shifting the goal from outreach to forging a relationship, health plans have a better chance of engaging with their members. D-SNP members are more likely to have negative associations with their health plans, like discrimination and costly medical bills, so they are avoidant and less likely to respond to outreach.
Trust is built over time, but health plans can establish relationships through frequent, positive member touchpoints. This familiarity makes things like behavior nudges, interaction with educational materials, social needs screening, and updating information much more manageable. Another element that helps build trust is personalization.
Effective member outreach is not one-size-fits-all. D-SNP plans are primarily established to care for people with complex needs such as disabilities, financial restraints, and multiple chronic conditions.
At a minimum, plans can provide outreach in multiple languages through multiple mediums (calls, SMS, and e-mail). However, incorporating behavioral science and machine learning capabilities can be a game changer in individualized outreach.
By marrying these components into a simple and accessible platform, D-SNPs can craft a member journey sensitive to each member's needs and behaviors while optimizing outreach timing, messaging, and follow-through.
Incentives (when used properly) can be a powerful tool for encouraging engagement and offsetting the effects of SDOH.
When members receive rewards to help accommodate their needs, it empowers them to participate and chips away at the barriers to care that members face. This makes room for members to move thinking about health from the back-burner, to front and center.
The CY 2024 Medicare Advantage and Part D Final Rule changes are causing a big stir for all Medicare Advantage plans, including D-SNPs, with modifications to measure weighting, member experience measures, and the introduction of the Health Equity Index (more on this game-changer below).
There are three notable changes, aside from the Health Equity Index, that are especially important for D-SNPs:
The CY 2023 Final Rule established that beginning in January 2024, all types of SNPs must include questions about housing, food insecurity, and transportation in their HRA forms. The addition of these questions reflects a further commitment to addressing health equity, however the sensitivity of these questions makes it all the more important to establish a trusting relationship with SNP members.
Another output from the CY 2023 Final Rule, D-SNPs with exclusively aligned enrollment can hold a D-SNP only contract. As part of CMS's push to encourage health equity, D-SNPs must now report their member outcomes separately. Therefore, considerations for effectively outreaching and engaging D-SNP members will be crucial for improvement and quality measures.
Because D-SNP populations are far more likely to fall under marginalized demographics, making sure resources are inclusive and accessible will significantly impact future Star Ratings. D-SNP related documents including Individualized Care Plans (ICPs) must be translated upon request and thereafter. The repercussions of these efforts will also affect a health plan's Health Equity Index.
For 2027 Star Ratings, CMS will officially replace the Reward Factor with the Health Equity Index (HEI). This change aims to incentivize plans to reduce health disparities for their members and push for the highest health standards across all populations.
While the addition of the HEI is part of the 2027 Star Ratings, the data used to determine the first Index will be collected starting in 2024. Most D-SNP members are in the underserved populations considered in deciding the Health Equity Index. D-SNPs will need to ensure their members are actively participating in their health plans by the beginning of 2024, or else the requirements for the HEI will not be met.
Engaging D-SNP members can make or break Star Ratings success based on how well a health plan can tackle social determinants of health to increase accessibility, leading to better health outcomes.
The shift in focus and changes discussed above reinforce how all areas of member care connect. Health plans with an actionable and impactful way to remove barriers to care and encourage active participation are better equipped to move the needle on the Health Equity Index and their Star Ratings.
The integral piece is encouraging daily healthy behaviors by empowering and assisting members in removing social and psychological barriers to health.
Wellth has proven to effectively outreach and maintain engagement for our partners' hardest-to-reach populations, by using behavioral economics and machine learning AI to provide daily, personalized support while empowering them to take control of their health.
Wellth's whole-person approach to supporting care management is built on the foundation that addressing barriers to care and improving health outcomes are intrinsically linked. By completing daily healthy behaviors, like eating a healthy meal or monitoring their blood pressure, Wellth members receive flexible rewards that they can spend on their areas of need.
The Wellth Rewards have a few different functions:
"I love the Wellth app because it allows me to become accountable for my health and well-being! Last month I spent my total rewards on produce alone, which I normally could not afford! I eat healthier, therefore, I am healthier. Thank you for helping me lead a better life!"
-Tecca, Wellth D-SNP Member
As the habits build, members and health plans quickly see the benefits of continued engagement. Through streaks and affirmations, members can see themselves reaching health milestones like improved daily health readings and celebrating milestones like 100 successful check-ins. For our customers, these daily habits lead to key improvements that boost outcomes, Star Ratings and provide impactful cost savings. On average, our customers have seen the following:
Wellth is designed to help members, particularly those with complex care needs like D-SNP members, with an easy-to-use, behavior-driven platform designed to tackle the behavioral and circumstantial barriers head-on.
The continuous enrollment unwinding and the shifts in Star Ratings provide an opportunity for D-SNPs to restrategize and optimize their outreach and engagement initiatives. Doing so will not only set health plans up for success, but will ensure they are meeting the needs of each one of their members.
These challenges are an opportunity to employ a steadfast and reliable program that establishes D-SNP member engagement and builds on that momentum to close critical care gaps and improve the lives of their most vulnerable members.
Wellth is helping our partners address their hardest-to-reach members with a whole-person approach to member care that improves health outcomes, removes barriers, and paves the way for continued success and longer, healthier lives.
How can we help you address the complexities on the horizon for your D-SNP populations and help break down barriers to care?