Closing the Gap: National Minority Health Month

From disease rates to maternal outcomes to overall life expectancy, significant disparities in healthcare outcomes for under-resourced populations continue to persist in the U.S. healthcare system. Not only are minority groups generally more likely to be uninsured than white individuals, they achieve worse outcomes due to long-standing racism, bias, mistreatment, and lack of access to appropriate resources.

This April, designated National Minority Health Month by the U.S. Department of Health and Human Services, health plans can take meaningful steps toward improving health equity by standardizing their collection of race and ethnicity data to determine where they can make the greatest impact. As our monthly Closing the Gap series continues, we also focus on how plans can deploy highly targeted, culturally relevant member engagement campaigns to reach members at the right time with the right message, enabling them to close persistent care gaps and improve quality scores in a scalable, repeatable way.

Preparing for expansion of HEDIS^® race and ethnicity stratification

First introduced in Measurement Year (MY) 2022 for five measures, the National Committee for Quality Assurance (NCQA) expanded its Race and Ethnicity Stratification (RES) program for MY 2023 to include an additional eight measures. For MY 2024, NCQA has proposed adding another five measures to the RES program, bringing the total to 18. As the organization notes, “stratifying HEDIS measures by race and ethnicity is intended to further understanding of racial and ethnic disparities in care and to hold health plans accountable to address such disparities, with the goal of achieving equitable health care and outcomes.” The Centers for Medicare & Medicaid Services has also prioritized health equity, recently proposing a “Universal Foundation” of quality measures that would better track disparities in care.

Of course, before health plans can stratify measure results by race and ethnicity, they need to have collected this data on their members—a challenging task that can be hampered by lack of data access, standardization, and member engagement barriers. To assist in this effort, NCQA recently interviewed several health plans about their approach, with interviewees noting their primary sources for obtaining race and ethnicity data were:

• Enrollment data received from government and employer sponsors
• Interactions with plan members (e.g., call centers, care management, web portals)
• Clinical sources (e.g., integrated delivery systems)
• Imputation based on name and place of residence

The NCQA report goes on to make three key recommendations:

1. Define use cases for collecting, documenting, using, and sharing race and ethnicity data. For patients to feel comfortable sharing this information with payers and providers—and to be confident it won’t be used to discriminate against them—plans must fully define how this data will be used to combat inequity and improve care outcomes.
2. Consider interoperability standards when developing plans to support the collection and sharing of race and ethnicity data. Without interoperability between healthcare systems in place, race and ethnicity data can remain siloed and ultimately not support your health equity efforts.
3. Improve imputation methods when self-reported data is unavailable. While the report notes that self-reported race and ethnicity data is broadly considered to be the gold standard, it acknowledges that health plans will likely never be able to achieve fully self-reported data. Therefore, plans should look at rigorously tested methods such as Bayesian Improved Surname Geocoding to fill in the gaps while creating guardrails for how imputed race and ethnicity data will be used.

Improving member and provider engagement to advance equity

Targeted member outreach is the bedrock of improving self-reported race and ethnicity data for health plans—but requires a thoughtful, systematic, and highly tailored approach to be successful. Plans should look to:

1. Deploy multi-channel communications. Even within the same demographic groups, some members will prefer to respond to a quick text message, others will be more likely to trust a phone call from an agent, and still others will prefer to log into a secure web portal to share data with their health plan. Plans can’t afford to invest in only one approach. Solutions such as Cotiviti’s Eliza^® enable plans to capture self-reported data through health risk assessments (HRAs) and other outreach campaigns through a wide variety of channels. With clear messaging, plans can introduce the importance of collecting the data and explaining how it will be used to advance health equity.
2. Communicate with cultural awareness and empathy. Hiring call center agents who speak the same languages as your members is an obvious starting point, but building trust with all the communities served by your plan goes well beyond simply adapting to language barriers. From enrollment to disenrollment, plans must understand the unique cultures of the members they serve. A message that resonates with English-speaking communities may fall flat or worse, actually offend your members if simply translated into Spanish, Chinese, or Tagalog without hiring people from those backgrounds to help you understand your members’ unique cultures.
3. Build partnerships with local businesses and community organizations. It’s one thing to send a text message or email and hope the member pays attention to it—it’s quite another to get out into the community to physically meet members where they are. From partnerships with laundromats to grocery stores, health plans are finding unique and innovative ways to not only close care gaps but also demonstrate empathy and build trust with their members.

When engaging providers, plans should also work with their networks to encourage adoption of improved coding, including the use of Z codes to capture social determinants of health (SDOH) factors that impact care outcomes. Once race, ethnicity, and SDOH data are sourced, use them not only to meet HEDIS reporting requirements but to fuel action plans and health equity initiatives year-round. As plans start to build their data analyses, the insights gained from these combined efforts can be used to tailor interventions and address disparities as they are identified.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).