The Health Equity Index (HEI) reward in the Medicare Advantage Star ratings program was rebranded in the final rate notice released on Monday.
The Centers for Medicare & Medicaid Services (CMS) has announced plans to update the HEI reward and call it the “Excellent Health Outcomes for All” or EHO4All reward.
The name better captures the goal of ensuring exceptional care for all enrollees, CMS said in the final rate notice.
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EHO4All will be implemented beginning with the 2027 Star ratings. Enrollees included in the metric are those who are dually eligible, receive a low-income subsidy, or are disabled. CMS said that these groups are at risk for poor health outcomes and Star ratings data show gaps in the quality of care for these enrollees. The reward will provide an incentive to improve performance among these members who are at risk for poor outcomes.
However, CMS said it will also provide an incentive to improve performance for all enrollees by removing the current HEI reward factor when the EHO4all reward is implemented. The move is consistent with the goal of achieving excellent health outcomes for all enrollees.
CMS said it is considering adding factors beyond dual eligibility, receipt of low-income subsidy, and disability to the EHO4all reward. One factor under consideration is geography (such as rural or urban). However, any additional factors, including geography, and updates would be handled through rulemaking.