By Leah Dewey, VP of Clinical and Consumer Engagement Operations, Cotiviti
X: @Cotiviti
For decades, achieving health equity has been a focus of many healthcare stakeholders. Since the Department of Health and Human Services formed the Office of Minority Health (OMH) in 1986 and brought this topic into the national spotlight, concrete progress has been made as a result of attention and intention from healthcare and government organizations to develop new approaches and initiatives.
More recently, some health plans have added chief equity officer roles to their leadership boards to lead and enact new programs. Others have launched tailored offerings, like SCAN Health Plan creating a specialized Medicare Advantage plan to meet the LGBTQ+ community’s specific needs. Groups such as the National Committee for Quality Assurance (NCQA) have also committed to addressing these challenges on a more industry-wide level through initiatives including the Health Equity Accreditation Program, which relies on HEDIS® reporting measures to hold health plans accountable for disparities in care.
The growing need to address disparities
Despite these efforts and initiatives, disparities remain prevalent and persistent, going far beyond the inequities that were illuminated by the COVID-19 pandemic. According to a recent CDC report on data from 2020-2021, racial, socioeconomic, and other factors continue to hinder quality care. The report noted that:
- Non-Hispanic Black individuals are at the highest risk of heart disease death
- Hispanic adults are more likely to not receive the care they need due to being uninsured
- People living in extreme poverty (under 200% the federal level) are least likely to go to the dentist
Better understanding the barriers to health that members face is especially important amid the current Medicaid redetermination process, which is expected to lead to the disenrollment of an estimated 8–24 million Americans—with a disproportionate impact on people of color.
As vulnerable individuals are thrust into a confusing process, organizations must remain hyper-focused on addressing the hurdles to care.
Steps to improvement
Understanding each member’s personal situation, including the social determinants of health impacting their ability to engage with care, is critical for improving outcomes—both during the current redetermination process and beyond. Plans can take these steps to provide more equitable, “whole-person” care:
1. Optimize data capture and analytics. The first step of overcoming barriers to care is understanding what they are, which is why plans must start with data. Enrollment data, self-reported data, and provider Z code data related to social determinants of health—combined with information on membership, utilization, and disease prevalence—can all illuminate each member’s situation. With improved data collection, stratification, and analytics, organizations can identify health disparities and drive action plans and health equity initiatives, as well as tailor interventions and care management programs to support quality outcomes.
Refined data practices will also help organizations meet new HEDIS requirements, such as the expansion of Race and Ethnicity Stratification for next year’s HEDIS season and efforts to advance gender inclusivity. NCQA’s work broadening quality measures and enacting new programs are providing critical frameworks to guide the industry on the quest to greater equity and demonstrating the power of health data in driving lasting change.
2. Enhance engagement efforts. Member trust is pivotal for tackling disparities. Without a strong relationship with their plan, a member may refrain from sharing personal information that could be used to better serve them—or may resist additional support being offered. To foster positive connections, empathy and cultural awareness around native language and other considerations are integral, as well as secure multi-channel communication methods aligned with the member’s preferences.
One Pennsylvania Medicaid plan upped its engagement tactics to better reach its population before the redetermination period. The program included rounds of multi-channel proactive outreach (emails, calls, SMS campaigns) as well as telephonic support teams, alerts about key dates, and partnership with community-based organizations. By providing several avenues for contact, the organization executed more than 1 million member outreaches annually to keep them more informed of the coming changes to their coverage, with more than 85% of members rating these interactions as helpful. In outreaches where the member was transferred back to the health plan, 98% of these interactions proved successful, providing members with more opportunities to complete renewal paperwork and deliver information needed to confirm their eligibility.
3. Connect members to community support. Payers are uniquely positioned to improve health equity, but they cannot do so alone. Collaboration with organizations that are closer to where members spend their time is key. Once health plans identify members struggling with food or housing insecurity or other issues, they can connect them to local groups for on-the-ground support—such as housing assistance programs or food banks.
MassHealth, the Massachusetts Medicaid program, launched its Community Partners Program in 2020 and has seen success connecting members to behavioral health and long-term care providers. As of early 2023, the program reduced ER visits by 21%, lowered behavioral health admissions by 30%, and cut risk-adjusted care costs by 20%.
4. Team up with providers. Collaborating with provider organizations is also a powerful approach to closing care gaps. Some plans might develop targeted initiatives with the help of providers in their network, like Healthfirst, a New York-based health plan that developed an initiative with Mount Sinai Health System to address racial disparities in maternal health. The organizations offered high-risk new moms more education, referrals to community resources, ongoing outreach, and financial assistance for transportation—leading to more postpartum visits, which are shown to lead to better outcomes.
Some groups are also weaving health equity directly into care contracts. Blue Cross Blue Shield of Massachusetts, for example, recently penned agreements with four different health systems that offer financial boosts for driving greater health equity—one of the first of its kind in the state and the country.
Leading the charge
Amid current changes to Medicaid eligibility and beyond, health equity must remain a core focus for healthcare industry leaders. Health plans should continue leading the charge by tapping into the power of data and analytics, member engagement, and partnerships with community and provider organizations.
As researchers continue to reveal the far-reaching impacts of SDOH and disparities in care across numerous communities, the healthcare industry can capitalize on this heightened attention and the progress already made to catalyze further change and deliver on the shared goal of ensuring that every member receives the best possible care.