The Centers for Medicare & Medicaid Services (CMS) and the National Committee for Quality Assurance (NCQA) have signaled that their focus on health equity is not going away any time soon. CMS’s Framework for Health Equity focuses healthcare organizations on five priorities. Several of them have direct implications on health plan operations, including the increased need for reliable member data and reporting, and increased access to culturally appropriate services.
“Integrating health equity into quality programs aligns with CMS’s goal to provide effective, efficient and high-quality healthcare for Medicare and Medicaid beneficiaries,” says Mallory Mueller, Vice President of Population Health and Equity at Healthmine. “Health plans have a pivotal role in addressing health equity, improving health outcomes, and ensuring equitable access to high-quality healthcare services for all enrolled members.”
Where Plans Should Start their Health Equity Work
Health plans are tasked with zeroing in on barriers to optimal health. This work will present challenges with resolving health disparities. Here are a few good starting points to build the foundation of health equity work.
- Get NCQA Health Equity Accreditation. This program is offered to assess healthcare organizations' commitment to addressing health disparities and promoting health equity. This accreditation evaluates how well organizations serve diverse patient populations, particularly those facing barriers to accessing quality healthcare due to social, economic or environmental factors.
Several states, including California, Washington D.C., Pennsylvania, South Carolina, Tennessee and Wisconsin, mandate the NCQA Health Equity Accreditation (HEA) as part of their regulatory framework for Medicaid health plans. States like Oregon, North Carolina, Michigan and California are either currently providing or planning to offer incentive payments to health plans that prioritize health equity.
Achieving NCQA Health Equity Accreditation signals to members, providers and stakeholders that a health plan is a leader in promoting health equity and delivering inclusive healthcare services. This can enhance reputation, attract members and differentiate the organization in a competitive healthcare landscape. - Use an NCQA certified Health Risk Assessment. Healthmine has earned three consecutive Wellness and Health Promotion Certification in Health Appraisal awards from NCQA for its HRA for Medicare and Commercial plans, including the most recent re-certification in November 2023. Healthmine’s HRA enables plans to collect information from members on race and ethnicity, language preference, sexual orientation, and gender identity with digital and non-digital surveys. This critically important data enables health plans to act on demographics, barriers to care and self-attested health information, like facilitating preventive screenings.
A significant benefit to Healthmine’s HRA is the auto-ingestion. Digital survey responses are automatically ingested into Healthmine’s plan-facing application in Opportunity Manager. Printed surveys are scanned, and responses are automatically added to Opportunity Manager, without any manual data entry from health plan staff. All HRA scans are uploaded in Opportunity Manager as an added layer of security for data accuracy. - Understand the Health Equity Index (HEI). CMS is replacing the current Reward Factor with the HEI in the 2027 Star Ratings to incentivize health plans to improve care for the most vulnerable patients. To prepare, health plans need to understand their data and their populations to know how the switch will impact revenue. Some plans will not qualify for the HEI and may need to make up for that lost revenue with improved Stars scores.
“The HEI measures are not new,” says Dwight Pattison, Executive Advisor at Healthmine. “They are the Stars measures. What’s great about this is even if you don’t qualify for Health Equity Index [or] even if you’re not sure if you’re going to get the reward, by focusing on these populations that have greater barriers you’re going to improve your rates overall.”
Achieve Health Equity with Healthmine
Navigating NCQA Health Equity Accreditation process and executing on a new health equity strategy can seem overwhelming. Healthmine’s expert advisors have decades of experience in health equity and partnering with NCQA. They can guide your plan through the process to achieve accreditation and implement practices across the organization that work toward success in CMS’ health equity requirements.
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