As health plans prepare to tackle the many regulatory and market challenges on the horizon in 2023, health equity stands as one of the most complex and vital issues facing the industry.
Federal and state regulatory bodies have highlighted the need to prioritize equitable access to care for vulnerable and diverse populations over the next few years, but achieving this goal requires a significant data lift to understand health disparities at a member-level. Among the social determinants of health (SDOH) that impact member health outcomes, life expectancies and chronic condition management, health plans will need to capture data around race, ethnicity and language (REL) to set the stage for future health equity initiatives.
New SDOH Reporting Standards on the Horizon
The Centers for Medicare and Medicaid Services (CMS) have outlined a Framework for Health Equity to help health plans develop strategies that ensure all individuals have equitable access to healthcare services. A key component of these guidelines is the importance of developing a richer understanding of how individual populations contend with SDOH and implementing interventions to reduce health disparities for underserved members. How health plans and government programs report this data will play a major role in the future of plan performance.
To meet the demand for more inclusive reporting standards, the National Committee for Quality Assurance (NCQA) will implement a new HEDIS® measure in 2023 that catalogues members’ social risk factors. The Social Need Screening and Intervention (SNS) measures will require health plans to screen members for unmet social needs related to food, housing and transportation and provide a corresponding intervention within 30 days of a screening.
Alongside the SNS measure, federal and state programs have proposed codifying health equity into quality improvement initiatives. In the 2023 Advance Notice, CMS proposed replacing the Reward Factor with the Health Equity Index within the Star Ratings program to incentivize Medicare Advantage plans to address disparities in health care. Several states like California are mandating Medicaid and Affordable Care Act plans obtained NCQA-certified Health Equity Accreditation and demonstrate their ability to assess and reduce health disparities in member populations.
Aligning plan performance efforts with these new regulatory standards sets the stage for more effective quality improvement initiatives. Investing in health equity allows health plans to refine their member engagement strategies with more personalized and meaningful interventions to drive stronger and sustainable quality scores.
To ensure health plans have the right resources to address heath disparities and improve health outcomes for diverse populations, Healthmine identified the must-have data collection and stratification tools for advancing health equity.
Capturing REL and Social Risk Factor Data
Understanding how ethnicity and health intersect to create disparities at a community- and member-level requires a comprehensive review of several factors, including:
- Medical history
- Mental health
- Physical activity
- Diet and nutrition
- Gender identity
- Sexual orientation
- Language preference
- Barriers to care
One of the most widely accepted instruments for capturing this information is a health risk assessment (HRA). HRAs are short health and wellness surveys that ask members to voluntarily share their medical history in a non-intrusive and judgement-free manner. When implemented correctly, HRAs can capture valuable member data and allow plans to create roadmaps for improving health outcomes.
While HRAs primary focus on physical and mental health, augmenting assessments with questions that capture REL, sexual orientation and gender identity (SOGI) and SDOH data. This information enables health plans to develop comprehensive member records to inform the appropriate interventions.
A well-designed HRA should use:
- A member-friendly format that empowers members to complete surveys in a timely manner
- Questions on REL, SOGI and SDOH
- A digital-first format that allows members to submit responses through web portals and mobile apps
- The option to complete a paper survey for members with limited internet access
- Relevant rewards to encourage higher completion rates
Processing and Understanding Health Disparities
Converting REL data into real-world interventions relies on the ability to rapidly process, analyze and stratify HRA responses. Incorporating HRA data into a centralized database allows plans to actively monitor responses and surface insights into health disparities without having to rely on complex spreadsheet manipulation.
Leveraging digital HRAs further streamlines this process by cutting out unnecessary and time-consuming labor associated with manually inputting HRA results. Instead, plans can access results in real-time when they take a digital-first approach to HRA administration.
Whether a plan uses an in-house platform for reviewing HRA results or a third-party vendor, the ability to create and filter member outreach lists based on member responses is vital for creating meaningful interventions. Categorizing member populations by REL data, care gaps, location and SDOH enables plans to surface insights into why health disparities exist between different demographics, the types of health disparities members face and how health disparities can be reduced. Based on these insights, plans can develop outreach lists to inform targeted engagement campaigns.
Implement Targeted Health Equity Campaigns
Based on the insights captured in HRAs and with readily available outreach lists in hands, plans can implement personalized and data-driven interventions that reduce health disparities for underserved populations.
For example, plans may determine that members with limited English proficiency who live in rural areas have difficulties renewing prescriptions due to a lack of pharmacists with the appropriate language skills, resulting in low medication adherence rates. To better serve disenfranchised populations, care teams can work with translators and bilingual staff to reach out to members in their preferred language and through their preferred channels to help them sign up for home delivery prescriptions and 90-day refills. Directly engaging with these members may also facilitate further conversations about barriers to care and allow plans to improve member experiences.
Integrating members’ demographics, languages and social risk factors into member engagement strategies in this manner enables plans to deliver holistic care in a more targeted manner for undeserved ethnic and racial groups than generalized campaigns. High-touch and personalized outreach is the exact type of innovative solutions government bodies are pushing plans to utilize to advance health equity.
Reducing health disparities with targeted engagement campaigns requires the ability to:
- Engage members through their preferred channel, including email, text messages, in-app notifications, mailers and phone calls
- Communicate in a language and at a reading level that they can understand
- Personalize outreach based on a member’s demographic, health conditions and needs
- Monitor and report compliance rates, member feedback and quality measure performance
Access an All-in-One Solution
Moving from SDOH and REL data collection to launching equitable engagement campaigns relies on several complex tools and solutions acting in conjunction. Splintering this process between multiple vendors risks impacting operational efficiencies, raising costs and limiting strategic capabilities.
Healthmine’s digital suite of solutions streamlines this entire process and empowers plans to implement sophisticated health equity initiatives. We have partnered with health plans in all markets to develop comprehensive quality improvement campaigns that convert responses captured in our NCQA-certified digital HRA into population-specific initiatives. Quality teams have leveraged our solutions to connect populations to care and continuously monitor campaign performance all from a single platform.
Equip your quality and care teams with member-centric solutions designed to surface insights into the everyday challenges your members face and initiate population-specific strategies to advance health equity.
Healthmine is the leading member engagement and rewards solution focused on empowering people to take the right actions to improve their health.
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