The Medicare Advantage market is poised for a shift with the introduction of the Health Equity Index (HEI) into the CMS Stars Rating system. This significant change, taking effect in 2027, is designed to incentivize recognizing and eliminating health disparities by reallocating billions in bonus payments among insurers. This significant change, taking effect in 2027, is designed to incentivize recognizing and eliminating health disparities by reallocating billions in bonus payments among insurers. As we explore this evolution, it becomes crucial to grasp the broader implications and opportunities for health equity and the quality of care within the Medicare Advantage ecosystem.
With this new CMS Stars Ratings measurement, the message is clear that CMS is committed to innovation meant to drive equitable or even better clinical outcomes for members who face social determinants of health (SDoH) that may cause barriers to care. Health plans must be prepared to harness SDoH data, skillfully use the information to drive care initiatives, and ultimately improve health outcomes for all. At Zyter|TruCare, we’re leading the charge in this new era, providing health plans with innovative solutions designed to navigate these changes with agility and insight. Our comprehensive suite of tools, bolstered by our strategic partnership with findhelp and our advanced Health Information Exchange capabilities, exemplifies our dedication to closing care gaps and elevating CMS Stars Ratings, underscored by a deep commitment to health equity.
Bridging Care Gaps with Our findhelp Partnership and Comprehensive Solutions
Our partnership with findhelp and the introduction of TruCare® Home and Community Services™ exemplify our commitment to integrating clinical healthcare with comprehensive well-being. This alliance and solution suite place advanced tools in the hands of healthcare navigators, facilitating a smooth transition between managing clinical needs and addressing broader SDoH challenges. Enhanced by a unified sign-on experience and a tailored ‘case notes’ feature, this integration provides a deep view of the referral journey, merging health considerations with essential life factors.
TruCare® Home and Community Services™, an add-on module to our award-winning population health platform, is specifically designed to address the long-term care needs of individuals with chronic health conditions or disabilities. This module exemplifies innovation in healthcare coordination, enabling care coordinators and agency providers to deliver patient-centered care that promotes independence and quality of life. Central to this solution is facilitating Medicaid and Medicare waiver programs under Home and Community-Based Services 1915(c), enhancing accessibility and advancing health equity through comprehensive service management and customizable, patient-driven care plans.
This module also brings to the forefront several distinctive features aimed at optimizing care delivery:
- Facilitation of Essential Services: From daily living assistance to personal care and meal preparation, we streamline services that enhance participants’ quality of life in their homes or communities, thereby maintaining their dignity and independence.
- Innovative Care Coordination Tools: Our platform enriches care coordination with functionalities for program enrollment tracking, service request management, and individual service plan development, ensuring each member’s current needs and goals are met efficiently.
- Configurable Assessments and Automated Workflows: Tailored assessments and automated tasks within any workflow facilitate timely responses and consistent operations, embodying our commitment to operational excellence and patient satisfaction.
- Comprehensive Documentation & Communication: Through structured notes, template-driven letters, and member-specific PDF generation, our solution ensures accurate and thorough documentation, facilitating seamless internal and external communication.
- findhelp Integration: Direct access to local programs through findhelp integration within our software suite establishes a seamless healthcare system, supporting enhanced assessments, care plans, and the identification of community support, thereby enriching the continuum of care.
Zyter|TruCare’s suite of solutions empowers health plans to leverage SDoH data effectively, with a partnership with findhelp and Health Information Exchange capabilities playing a central role by:
- Collecting and Integrating SDoH Data: Our platforms, integrated with findhelp and enhanced by TruCare® Home and Community Services™, enable comprehensive SDoH data collection, providing a complete understanding of member challenges and facilitating targeted interventions.
- Demonstrating Progress in Health Disparities: Our advanced analytics and reporting tools allow health plans to measure their effectiveness in mitigating health disparities, showcasing their progress in the health equity component of the Stars Ratings.
- Enhancing Engagement and Intervention Strategies: We offer tools to develop targeted engagement strategies and interventions, addressing the needs of underserved populations to contribute to improved health outcomes and higher Stars Ratings.
Forward-Looking: Championing Health Equity
Introducing HEI into the CMS Stars Ratings system signifies a significant shift towards acknowledging and incentivizing efforts to combat health disparities. Zyter|TruCare provides health plans with the necessary tools and expertise to excel in this evolving environment, promoting a healthcare ecosystem where health equity and quality care are paramount.
By integrating SDoH into healthcare strategies, alongside our strategic partnerships and comprehensive solution suite, we support health plans in boosting their Stars Ratings and advancing toward a more equitable and inclusive healthcare system.
