The Acid Test: Health Tech's Value For MA Plans

While the Stars rating system is nothing new it is evolving and demands even more consideration. The Health Equity Index (HEI) will replace Medicare's current Star Ratings reward factor, impacting ratings and quality bonus payments from 2027. As healthcare tech vendors enter the value-based care market, promising improved performance and financial returns, plans face challenges in quantifying these benefits as not only adequate tools to reduce the disparities of access & care as well as evaluating the ROI against their paper thin margins.?

The opportunities provided by the litany of new technologies and services are clear; however, it can be difficult for health tech to make the leap from the anecdotal to the empirical. Trusting that taking on a new investment will yield positive returns to HEI/STARS can be a tough pill to swallow for those that hold the purse strings at the MA plan. Given the plan is already balancing the health & welfare of the population while tip toeing a razor thin profit margin of 3.3%, trust is not a word they'll going to rest on. So, how does the health tech deem their offering essential to the needs of their MA plan targets?

Plans want to be approached with a simple & verifiable value prop that clearly ties directly back to the measures by which they're aiming to do business = operating in the the black + brag worthy ratings. The health tech partner holds the key here in the simple form of analytics.? The message of a beneficiary journey touting an optimized outcome & happy member must be backed up with empirical evidence that translates into the ROI.? Your tool is going to reduce falls? Then your value prop must include a delta on measure C12 - Reducing The Risk of Falls. You have a new revolutionary offering for beneficiary engagement? Great - what measures are you tying to? C21 - Customer Service? C18 - Follow up after ED Visit? (CMS '24 Star Ratings Tech Notes)

Economic evaluation of the offering based on real world evidence is the triangulation that not only heralds the value of health tech as essential, it also validates the financial value of the partnership. ?Third party tools or evaluations through resources such as Charisma Health Solutions legitimize health tech's POC & value proposition from the theoretical to the conclusive.

So, what’s the “cut to the chase” for health tech? ?It comes down to three points when working with your plan partners:

-????????????? How does this product affect margin, reduce costs, increase reimbursements and on and on? ?Don’t describe it - “Show me the money” (who by the way I met last weekend – fyi: he doesn’t like it when you say that to him)

-????????????? How does this product increase the plan score(s)?? Give it to them measure by measure.? The changes that de-emphasize the operational/non-care related activities can have a marked affect on many plans.

-????????????? Don’t aggregate your value – each plan is unique.? From the populations they serve, the geo/regional attributes, the providers…. Set expectations that are specific to that plan's make up.