To motivate health plans to reduce health disparities, federal and state quality programs have begun to tie health equity to incentive programs. Whether through the proposed Health Equity Index in the Star Ratings Program or the requirement of health equity accreditation through the National Committee of Quality Assurance (NCQA), plans will be measured and rewarded based on how well they reduce health disparities.
Medicare Advantage, Medicaid and Affordable Care Act plans will need to re-orient their care gap closures strategies to account for social determinants of health (SDOH) like income, race, ethnicity, language, gender, sexuality, education and zip code. Generalized outreach will only move the needle so far if plans are not also addressing disparities between different socioeconomic determinants.
The secret to unlocking higher quality scores and year-over-year revenue growth lies in the ability to create comprehensive member records that advise personalized interventions. Being able to drill down to a specific population and community and understand what challenges they face in receiving care will pave the way to more impactful and equitable engagement strategies.
As quality programs develop new ways of assessing performance based on health equity, plans can begin optimizing their quality solution initiatives to address health disparities by incorporating race, ethnicity and language (REL) data into plan performance strategies.
What Does REL Data Mean?
REL data is a self-reported information about a member’s race, ethnicity and preferred spoken and written language.
As a data element, race and ethnicity are collected based on the standardized questions set by the Office of Management and Budget (OMB). These standards require federal agencies and third-party organizations that receive federal funding to include race and ethnicity data into the following minimum categories:
- Hispanic or Latino
- Not Hispanic or Latino
- American Indian or Alaska Native
- Black or African American
- Native Hawaiian or Other Pacific Islander
Affordable Care Act plans are required by the U.S. Department of Health and Human Services (HHS) to report these data elements based on OMB’s minimum standards, but all plans are encouraged to collect more granular data. HHS also require ACA plans to survey members about their primary languages by evaluating how well they speak English and what language they speak at home.
While only one component of a member’s health journey, REL can have a major impact on how a member navigates healthcare systems. Members of different populations and communities may have different experiences with providers, different levels of access to care and different health outcomes. These differences are considered health disparities, and REL data can shine a light on where disparities occur.
Types of Health Disparities
Understanding what types of health disparities member populations encounter daily is the first step to designing programs and interventions that address care gaps. Common health disparities include:
- Health status
- Medication adherence
- Chronic disease management
- Health literacy
- Insurance coverage
- Healthcare costs
- Mortality rates
- Life expectancy
Understanding Why Health Disparities Exist
Health disparities are the result of environmental, social and economic factors that favor one demographic over another. These systemic issues exist outside of a member’s physical and mental well-being, but have a powerful impact on health outcomes.
In an equitable healthcare system, all health plan members should have access to quality care. However, the SDOH contributes to varying experiences within the healthcare system. Due to these systemic advantages or disadvantages, certain demographics will experience better health outcomes compared to others.
For example, members with limited English proficiency have a harder time receiving care in a timely manner, understanding chronic conditions and using plan benefits compared to members with English proficiency. These types of health disparities can be addressed by developing strategies to collect and analyze REL data and action appropriate interventions.
How Can Health Disparities Be Reduced?
Bridging health gaps between demographics requires a baseline understanding about how SDOH overlap with care gaps for specific populations.
To achieve this insight, plans can begin by capturing accurate REL data from members and building out comprehensive records that incorporate member-specific SDOH, care gaps and health risks. Health risk assessments (HRA) are one valuable tool for rapidly collecting this information with standardized questions, especially if they adhere to OMB and HHS requirements.
Pulse Surveys, mock-Consumer Assessments of Healthcare Providers and Systems (CAHPS) and Health Outcome Surveys (HOS) are other useful questionnaires for understanding member experiences. But health plans can also use any interaction with members to ask about their experiences, including interactions with customer service, providers and care coordinators.
Based on the available information, plans should stratify member populations by REL data alongside Healthcare Effectiveness Data and Information Set® measures to identify where SDOH are impacting members in their health journey. This overlap can inform meaningful interventions that empower members to improve health outcomes despite SDOH.
Using REL Data to Make Informed Health Plan Decisions
Addressing health disparities through traditional gap closure and outreach tactics will not achieve the profound change plans and members need to advance health equity. Plans in all markets need to develop sophisticated and flexible tools for managing comprehensive member profiles, quality measure performance and personalized outreach.
There are several digital tools available that support continuous improvements in health outcomes for vulnerable populations, ensuring that plans do not need to put unnecessary pressure on internal teams to build out solutions on their own. Working with the right digital health partner allows health plans to quickly access data-driven solutions that address members’ needs and focus more time on developing meaningful strategies to advance health equity.
When evaluating a digital health vendor, plans should focus on the following qualities:
- Centralized data management: The ability to ingest, analyze and action REL data from a central database is vital to rapidly implementing population- and member-specific interventions. Rather than fragmenting data and tactical insights across multiple platforms, plans should identify one platform to act as the connector between multiple vendors, tools and programs.
- Member-friendly surveys: HRAs, mock-CAHPS, HOS and Pulse Surveys offer insight into the variety of challenges members face in receiving care. Allowing members to easily complete these surveys, while also incentivizing them with meaningful rewards and relevant information, can improve the ability to identify SDOH and develop personalized interventions.
- Digital-first member engagement: Scalable, meaningful engagement relies on the ability to easily and affordable action data to have the strongest impact on member behaviors. Reaching out to members through digital communications like emails, text messages and smart phones apps allows members to easily access healthcare resources, tools and information. For diverse populations that need specific solutions, digital outreach offers the right level of flexibility and scalability.
- Relevant rewards: Mobilizing members to get the care they need is difficult even when SDOH are not a factor, but providing the right motivation and rewards can go a long way to helping members improve healthy behaviors. The right digital vendor can develop scalable and flexible rewards methodologies that allow members to select rewards that meet their needs, while also allowing plans to develop population or SDOH specific incentives.
Start Collecting REL Data Now
At the core of these solutions is the ability to collect REL data and filter it into impactful interventions at a member level.
To ensure you have the right data in hand, equip your quality teams with Healthmine’s digital, NCQA-certified HRA and begin building comprehensive member records. Our HRA allows for the immediate stratification of member risks levels and demographic data to refine outreach lists. When used in conjunction with our member engagement solutions, plans in all markets can rapidly move from data to insights to action, all while empowering members to live their healthiest lives.
Reach out to Healthmine to discover a streamlined process of capturing and actioning REL data. Contact us for a demo.