Finalized in the 2024 Final Rule, the “Excellent Health Outcomes for All” (EHO4all) reward — formerly the Health Equity Index — will replace the current Reward Factor in the 2027 Star Ratings (based on 2024 and 2025 performance). In implementing the EHO4all, CMS hopes to encourage Medicare Advantage plans to close equity gaps by improving care for members with social risk factors (SRFs). Currently, this group includes:
- Dual-eligible members (members enrolled in both Medicare and Medicaid),
- Those who receive the Low-Income Subsidy (LIS), a federal program that helps pay for prescription drug costs, and
- Individuals who qualify for Medicare due to disability.
Plans can earn additional points toward their overall Star Rating when they demonstrate stronger outcomes among these populations for select measures, driving a health plan’s ability to maintain or improve Star performance.
What Can Your Plan Do to Prepare?
Leverage your data.
Accurate data is crucial for the identification of all LIS, dual-eligible, and disabled members within your health plan. This means understanding who within your population currently meets the definition of having an SRF and who could become newly eligible for dual or LIS benefits, adding to your plan’s EHO4all denominator. By leveraging monthly CMS files or partnering with vendors specializing in dual enrollment and Medicaid retention, plans can pinpoint members who are eligible for these benefits but not yet enrolled, as well as those who may be at risk of losing coverage. This requires a systematic analysis of enrollment records along with demographic, clinical, and socioeconomic data to predict which individuals may qualify for dual or LIS status.
Advocacy efforts to support new dual/LIS enrollment and retention not only improve the accuracy of member identification but also help ensure appropriate risk-adjusted payments. By growing the denominator of members with SRFs, health plans can optimize their EHO4all participation.
Ensure information systems and data sources are collecting/storing important data.
Ensuring that IT systems and data sources consistently capture, collect, and store member-specific demographic information, such as race, ethnicity, language, and sexual identity/orientation, is a critical step toward addressing healthcare disparities and achieving health equity. The systematic collection of this data allows health plans to better understand their member populations, enabling more targeted interventions that can directly improve EHO4all performance and increase the likelihood of earning the reward. CMS is expected to expand the list of social risk factors included in the EHO4all in the coming years. A health plan’s ability to effectively collect and maintain accurate, relevant member data will be essential to scoring well under the EHO4all both now and in the future.
Retain and attract dual members.
Retaining and growing your dual/LIS population is not only a matter of ethical responsibility — but also a strategic imperative. By retaining dual-eligible members, plans can ensure consistent revenue streams, achieve better risk adjustment, and provide a valuable benefit to their members.
Plans that are already performing well should consider campaigns to increase LIS penetration. In addition to supporting EHO4all goals, LIS enrollment drives medication adherence and can lead to higher CAHPS scores.
Plans can also strengthen their efforts to attract new duals and retain their existing population. Medicaid renewal and reapplication services are especially helpful, given the confusing and ever-changing administrative changes. These services, along with other community assistance programs and supplemental benefits, can greatly improve the tenure of these members.
Screen, identify, and provide intervention for social barriers.
It is a well-known fact that LIS and dual-eligible members are more likely to experience severe chronic conditions and face significant barriers to care. The EHO4all is designed to incentivize health plans to reduce these disparities and improve outcomes for vulnerable populations. This can be done by leveraging partnerships with community-based organizations and improving access to benefits and programs that help reduce barriers. Ultimately, a plan’s ability to deliver and demonstrate quality care for its most vulnerable members will be a key driver of success under the EHO4all.
How Can BeneLynk’s One Lynk Solution Improve Your Chances for Receiving the EHO4all Reward?
BeneLynk’s One Lynk solution, a ready-to-implement toolkit for a holistic social care program, allows our clients to prepare for all the above challenges. With our One Lynk solution, plans can expect to:
- Identify members likely to qualify for dual enrollment and LIS. BeneLynk has an advanced eligibility engine that utilizes member demographic information, member risk profiles, and socioeconomic factors to identify members most likely to qualify for these programs. Once dual-eligible members have been identified, our compassionate advocates reach out to gather more information and assist them through the application process.
- Provide structured and compliant social care screenings, gathering important information about your members and the challenges they face. BeneLynk currently focuses much of our efforts on transportation, housing, and food insecurities.
- Our solutions can seamlessly and efficiently map HRSN assessment responses to ICD-10 Z codes, SNOMED, and LOINC. In combination with near real-time reporting offered through Microsoft BI, this gives your plan access to important information about your members when and how you need it.
- Drive Medicaid retention and member satisfaction. Our outreach efforts ensure that members receive timely renewal education and assistance. Our renewal efforts drive Medicaid maintenance, as well as member satisfaction and retention with the plan. When performing annual renewal outreach, we also take the opportunity to evaluate members for additional benefits or a dual-status upgrade (partial to full Medicaid).
- Provide solutions for challenges your members are facing. Once BeneLynk has identified member barriers, we “lead with help” to surface solutions for the challenges your members are immediately facing by facilitating member access to over 300,000 local, state, and federal programs. Since its inception, BeneLynk has assisted over one million members with community program enrollment.
Looking to the Future
The EHO4all will replace the current Reward Factor in the 2027Star Ratings, but the measurement period is already underway — spanning performance years 2024 and 2025. BeneLynk’s ready-to-deploy One Lynk solution helps streamline these efforts, supporting your Star Ratings, enhancing member care, and positioning your plan for long-term success. Choose One Lynk and see the measurable impact a dedicated social care advocate can make — both in your performance metrics and in the lives of your members.