There are a lot of changes underway – and even more speculation –with the new administration. Quality leaders are questioning the future of health equity initiatives that gained momentum during the prior administration and how a potential pivot away from the Health Equity Index (HEI) would impact their programming. These program requirements across Medicare, Medicaid, marketplace and commercial plans may be updated along with other potential changes in quality measurements.
However, until new guidance is finalized, health plans should continue to focus on important quality improvement efforts that help connect more members to high-quality care. Due to uncertainty in the scope and timing of changes, you do not want to lose out on valuable time during the year where you can be reaching members, closing care gaps and improving member satisfaction.
Below, we’re highlighting what changes are and are not confirmed, and how plans can move forward while they wait for more from the new administration.
Confirmed changes from NCQA
Changes have already come from the National Committee for Quality Assurance (NCQA) effective February 12, 2025. These changes include adjusting scores to Not Applicable (NA) or score without some minimums for standards and elements containing diversity, equity and inclusion (DEI) and/or gender identity requirements for accreditation, including:
- Health Equity Accreditation
- Health Equity Accreditation Plus
- Accreditation of Case Management for Long-Term Services and Supports Programs
- Accreditation and Certification in Wellness and Health Promotion
What’s next for the Health Equity Index
The HEI was fully codified in 2023 and is finalized for implementation for Star Rating 2027, but some plans are tentatively anticipating a delay or a change with implementation. We’ve heard from many plans that are considering pausing health equity related initiatives while we wait for final word on if the new administration will move forward with the HEI, modify it or eliminate requirements altogether. However, pausing these efforts does not help overall quality improvement performance and the well-being of your membership.
Whether there is a health equity program or not, engaging with all members, meeting them where they are and addressing social determinants of health (SDOH) is the best way to help improve quality outcomes and will improve your performance on quality measures that remain in effect.
Where to maintain focus amidst uncertainty
Health plans must continue to prioritize comprehensive and coordinated engagement tailored to each member, which is inclusive of understanding a member’s barriers to care and offering relevant interventions to help the member close quality and risk gaps.
Continue engaging members based on their communication preferences like preferred language, outreach method and working in the community to support the needs of the member. If you don’t have a process or platform in place to do this level of outreach, start partnering with internal stakeholders to figure out what’s needed to implement this type of engagement strategy.
A commitment to continued engagement will support the improvement of the overall measures. Even if not being measured separately based on demographics or SDOH, targeting members based on their individual needs will help make sure members have access to care and better health outcomes. This is how plans will see incremental improvement in Star Ratings, Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores, Healthcare Effectiveness Data and Information Set (HEDIS) scores and Net Promoter Scores (NPS), Health Outcomes Survey (HOS) scores, while also increasing risk code capture and reducing emergency utilization costs.
A commitment to continued engagement will support the improvement of the overall measures. Even if not being measured separately based on demographics or SDOH, targeting members based on their individual needs will help make sure members have access to care and better health outcomes. This is how plans will see incremental improvement in Star Ratings, Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores, Healthcare Effectiveness Data and Information Set (HEDIS) scores and Net Promoter Scores (NPS), Health Outcomes Survey (HOS) scores, while also increasing risk code capture and reducing emergency utilization costs.
Steps you can take right now
With so much unpredictability in the direction of health equity programs, stay focused on what you can influence in the short term that also builds the foundation for strong future performance, regardless of regulatory changes. Here are three steps you can take immediately.
Segment your populations
Stratifying populations by certain demographics can further help target the best approach to engaging the membership and keep away from the generic outreach approach that no longer works. Characteristics that will remain important to stratify populations by are:
- Race
- Ethnicity
- Language
- Gender
- Location
- Education
- Financial needs
- Housing needs
- Food insecurity
- Disability
Tailor outreach
Once stratified, it is key to use the information to help further understand member needs through customized communications and intensity of engagement. Messages, imagery and calls-to-action should be adjusted based on the individual’s demographic data to drive the highest rate of gap closure and member satisfaction.
Find a flexible, knowledgeable partner
Having the right partner in place is crucial to success in a rapidly changing environment. Healthmine has expertise on how to best engage members to reach their best health outcomes. Our behavioral scientists, communications strategists and consultants work together to recommend engagement activities supported by research and real-life use of engagement activities and outcomes. We will work with you on a one-on-one basis during periods of unpredictability to provide short-term and long-term recommendations based on your historical data and anticipated changes, establishing and maintaining your plan as a high performer, with strong quality scores and happy, healthy members that feel supported.
We can get started right away in stratifying and engaging your population using targeted best practices. Reach out to Ana Berridge, Executive Advisor, at Ana.Berridge@healthmine.com.
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