Improving Health Equity In Commercial Markets: NCQA

Improving Health Equity in Commercial Markets: Guidance from National Leaders, Part II

National organizations like CMS and the National Committee for Quality Assurance (NCQA) recognize the urgent need to improve health equity. Commercial health plans may want to model some of their health equity strategies on elements of plans from these industry leaders.

NCQA’s Practical Health Equity Roadmaps

Part I of this series on health equity improvement reviewed the Center for Medicare and Medicaid Innovation’s (CMMI’s) plan for improving health equity while expanding the national reach of value-based care. CMMI introduces key principles regarding healthcare data collection, model design, and evaluation that commercial payers could incorporate into their operations.

Much of CMMI’s strategy for improving health equity remains high level and focused on transforming the national healthcare landscape over the next decade. Alternatively, commercial payers looking for more practical guidance may be interested in NCQA’s health equity plans. As an accreditation agency, NCQA is at the forefront of understanding and publicizing features health plans can include that translate into more equitable outcomes.

NCQA’s primary health equity product is the Health Equity Accreditation (HEA), which includes a comprehensive guide for measuring progress towards health equity goals. This complements NCQA’s leadership in quality measurement and value-based care. The suggested activities fall broadly into four categories which are more well-defined, but in some cases, more radical than the guidance offered by CMMI.

1. Go beyond demographic data collection in assessing need

Collecting demographic data allows health plans to identify equity gaps and track an intervention’s impact on health equity (to a degree limited by the granularity of the data).

However, developing impactful health equity strategies and targeting interventions may require much more thorough social determinants of health (SDoH) assessments. This research can unearth obstacles uncovered in demographic data and clarify how interventions relate to population needs. To color in connections between organizational capacity and patient risks, social determinants of health assessments may ask questions such as:

• What population is the organization trying to serve?
• What subset of the population is most likely to benefit from an intervention?
• What are the primary obstacles patients face, and how are these obstacles related to one another?
• What methods will the organization use to reach the population?
• What SDoH factors does the organization want to address (such as housing, food insecurity, addiction, etc.), and which are outside the organization’s purview?

Social determinants of health assessments can be targeted towards specific communities or broader, more general audiences. It’s also important to consider whether insight into developing and targeting interventions can be gleaned by measuring patients’ protective, healthy behaviors in addition to their health risks. Defining the scope and content of an SDoH assessment ultimately hinges on the questions a health plan needs to answer to design impactful, evidence-based strategies for improving health equity. It’s helpful to enact these assessments with objectivity and without assumptions about the correctness of past policy.

2. Share healthcare data across providers and community resources

NCQA promotes sharing patient or member information across organizations without a common employee health record (EHR). Integrating healthcare data provides a more comprehensive portrait of a patient’s medical status and social risks. Two prime vehicles for sharing healthcare data are Health Information Exchanges (HIE) and Community Information Exchanges (CIE).

HIEs allow health care organizations to efficiently exchange patient data across EHRs. CIEs are repositories of information shared by health care and community partners collected through a common data intake process. For instance, community partners may share data on housing and food voucher usage to assist health care organizations in understanding the extent and nature of unmet social needs.

Data transparency works toward improving health equity by allowing partners to deploy their resources more efficiently and precisely. Some CIEs also include resource repositories so that participating organizations can more easily refer patients to partners.

3. Partner with community-based organizations (CBOs)

Many CBOs have been working for decades to address SDoH needs such as housing, transportation, and food insecurity. These organizations have deep community ties but may lack the capacity or resources to address them fully. Health plans can build on this foundation by providing funding and organizational capacity. They might also collaborate with CBOs to develop new programs, initiate value-based contracts to strengthen ongoing partnerships and utilize the infrastructure of community organizations to provide system-wide benefits. An example might be a food security intervention distributed through community centers.

4. Continuously evaluate and refine health equity approach

Because social inequality in health outcomes is a persistent, engrained, and systemic issue, continuous testing and refinement is integral to improving health equity. NCQA advocates a four-step process called Plan-Do-Study-Act. This cycle encourages organizations to develop a clear plan with defined, measurable goals, test interventions on a small scale while documenting issues, analyze results against predictions, and plan new evidence-based approaches to their health equity strategies.

Thoughtfully Choose Your Organization’s Health Equity Strategy

Significant leadership exists from national organizations like CMMI and NCQA about how health plans can take steps toward improving health equity. Despite this extensive guidance it is often difficult for payers or providers to measure their existing health equity performance, identify avenues to increase their number of high-risk patients, design interventions, and collaborate with community groups.

RTI Health Advance has significant expertise in many of the health equity strategies highlighted by CMMI and NCQA. As a healthcare consulting firm situated within a broader research institute, our mission is to improve the human condition. Our knowledgeable staff can design quantitative and qualitative evaluations of SDoH approaches, assess patients’ SDoH barriers, target interventions, stratify outcomes across socioeconomic lines, and collaborate with community organizations to respond to patient needs.

Efforts to transform the efficiency of healthcare delivery and promote health equity continue to merge. Our experts are eager to collaborate with health plans to build, assess, and implement unified health equity strategies that control overall costs while making impactful investments in healthcare for historically under-resourced populations.

Learn more about our health equity services.