4 Predictions for Health Plan Operations in 2024

February 8, 2024


Mounting regulatory pressure from federal and state health agencies have set Medicare Advantage plans up for a challenging 2024. From an increased focus on health equity to shifting measure weights in the Star Ratings, plans are being pulled in multiple directions with little clarity about what to prioritize and where to direct resources.

To help plans navigate an evolving industry, three Healthmine’s leaders shared their predictions for 2024 across multiple domains.

Increased Competition Under the Health Equity Index

The latest Health Equity Index (HEI) technical notes from the Centers for Medicare & Medicaid Services (CMS) paint a clearer picture of what this new rewards model means for Star Ratings. The notes included a simulation of the 2024 Star Ratings to demonstrate how reward factors are calculated, how to determine contract performance and where plans should direct their attention.

CMS has also shared contract-level reporting to help plans understand where contract currently rank and how to improve performance. John Willis, Vice President, Consulting & Professional Services, expects plans to increase their focus on health equity using these newfound insights. 

“With plans having received data from CMS to understand their performance, there are lots of opportunities for plans to make the necessary changes to be successful,” said John Willis, Vice President, Consulting & Professional Services.

Dwight Pattison, Executive Advisor, agrees that plans will pursue strong HEI performance to offset the loss of the rewards factors, especially among plans with four and a half to five Star Ratings. However, Pattison also notes that performance targets will change over the next few years as plans try to dominate rankings.

“It is important to realize over the next two years the competitive effort by health plans can basically ensure the performance targets for HEI measures should be higher,” said Pattison.

Unlike the previous Star Ratings reward factor which limited eligibility to plans with four to four and a half Star Ratings, the HEI reward would apply to all plans who meet eligibility requirements. Despite this competition, Pattison encourages plans to develop HEI improvement strategies to have a strong impact on overall performance.

“Focused interventions for ‘sub-populations’ have a great benefit to members with challenges as well as to your overall Star Ratings,” said Pattison.

Healthmine's unified platform helps plans eliminate disparate data to better predict how they'll perform under the HEI. From the same platform, plans can deploy tailored outreach to members who have health disparities, thoughtfully connecting those members to the right support services. 

Higher Investments in Survey Interventions 

Alongside the HEI, our leaders predict that the return of the Medicare Health Outcomes Survey (HOS) measures and changes to the Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures will provide significant challenges for plans.

While only single-weighted in 2024, the HOS measures are new territory for plans that lack experience with this quality area. Unlike other measures, HOS measures evaluate whether a member’s health has improved based on responses to two surveys, each conducted two years apart. Proactively evaluating member health statuses and initiating strategies to improve mental and physical health will be vital for achieving Star Ratings success. This will be an ongoing effort and major priority for plans, as CMS will be making the measures triple-weighted in 2025.

In contrast, CMS will decrease the CAHPS measure weight from quadruple to double-weighted and will add a web-based option for the 2024 survey. The decreased measure weight should not lead plans to discount the importance of member experiences, especially with seniors show more and more interest in digital channels.

“Plans have struggled to improve their response rates for many years,” said Willis. “And with Medicare-eligible beneficiaries becoming more tech savvy, this could change the course for CAHPS in years to come.”

Download Healthmine's CAHPS Playbook, which includes a game plan for addressing CAHPS all year.

More Plans Will Consolidate Spend, Vendors and Outreach

As plans contend with tighter budgets in 2024, Kimberly Swanson, Chief of Staff, predicts that the industry will shift away from point solutions to strategic partners, like Healthmine, that can support multiple lines of business, departments and initiatives. Integrating all member outreach under one platform allows plans to better align risk adjustment and quality strategies to control spend.

“With budget pressures, departments need to come together and maximize their spend on member outreach,” said Swanson. “More coordinated, targeted outreach will help plans avoid abrasion and ineffective outreach.”

Healthmine facilitates health plans focusing on ongoing, digital-first member engagement to reach every member. Digital channels offer more flexible outreach at a lower cost, but it must be implemented as part of a more integrated member experiences.

“Members are increasingly using technology to manage their healthcare,” Swanson said. “They want one place to go to see what they need to stay healthy, how to utilize benefits and get the most out of their plans.”

Expanding outreach to digital channels will also allow plans to conduct more frequent check-ins with members. Regulatory bodies are increasing their focus on developing whole-person views of members, and digital outreach provides plans with more options for evaluating member social, physical and mental health needs.

Plans Will Access New Behavioral Health Resources

Willis predicts that plans will take advantage of CMS’ latest rules for behavioral health services to address the ongoing behavioral health crisis among seniors. It is a difficult challenge to resolve due to a lack of providers.

“Plans have struggled for years to meet the behavioral health needs of their members,” said Willis. “With the approval of new clinical resources, we could see an impact to improved quality for members with behavioral health needs and more timely appointments for members.”

These changes include:

  • Allowing over 400,0000 marriage and family therapists and mental health counselors to enroll as Medicare providers to expand access to behavioral health services.
  • Finalizing payments to community health workers and peer support specialists to address social determinants of health for members who also need behavioral health and substance abuse treatment.
  • Increasing funding to enable members to access intensive outpatient program, which is a type of intermediate level of care that rests between traditional outpatient therapy and hospitalization.
  • Reducing the required level of supervision for behavioral health services to enable behavioral health practitioners in underserved and rural communities to provide care without the need for a doctor or non-physician practitioner being on site.
  • Improving the accuracy of payments for behavioral health services to better reflect the costs to providers.

Reach Your 2024 Goals

This year may bring significant regulatory challenges, but plans do not have to tackle them alone. With the right partner, plans can identify the opportunities to innovate and achieve year-over-year improvements.

Healthmine provides plans with the insights, resources and tools they need to succeed amidst a complex industry climate. Through the first-hand knowledge of our Expert Advisory Services team, health plans can implement immediate and long-term strategies to overcome regulatory changes. Our digital platform equips plans with an array of analytical, survey and engagement tools to help staff launch data-driven campaigns and secure stronger plan performance.

Navigate evolving quality and regulatory challenges with the guidance of Healthmine’s consultants and digital platform. Reach out to us to discuss your 2024 challenges.

Kimberly is a healthcare expert with more than 15 years of experience advising health plans through her robust knowledge of quality improvement solutions. Utilizing her strategic insights into HEDIS scores, NCQA measures, Star Ratings, Health Equity, population health management, and member satisfaction, Kimberly develops innovative strategies for connecting patients to care and improving plan performance for her clients. Kimberly has completed a Foundations of Health Equity Research certification through John Hopkins University.
More Resources from Kimberly Swanson
Dwight Pattison is a consultant with over twenty years of healthcare industry experience focused on quality management, performance improvement, data analytics, and reporting. Fueled by a strong background in Medicare and Medicaid reporting and regulatory compliance, Dwight has directly led MCOs in achieving significant performance improvement results across numerous markets and product lines.
More Resources from Dwight Pattison
John Willis is a quality improvement expert with over 20 years of experience guiding managed care plans to success. Having worked in Stars since its inception, he has a proven track record of building out turn-key strategies that enable Medicare Advantage plans to boost Star Ratings. He has significant experience working with Medicare Advantage, Dual-Eligible Special Needs Plans, Individual Special Needs Plans to improve member experiences and quality scores.
More Resources from John Willis