Advancing Health Equity: Strategies for Health Plans Navigating Change, Compliance, and Innovation

As regulatory guidelines evolve and the emphasis on improving healthcare access and outcomes intensifies, health plans that serve Medicaid and D-SNP populations face an urgent mandate to improve access, deliver whole-person care, and meet new compliance standards. And they must achieve this without increasing their administrative burden.

To assist plans in navigating the changing regulations, the Association for Community Affiliated Plans (ACAP) and HealthEdge® partnered to host a webinar: “Advancing Health Equity: Strategies for Health Plans Navigating Change, Compliance, and Innovation.” The panel included Nai Kasick, Principal at Health Management Associates; Dr. Sandhya Gardner, Chief Medical Officer and General Manager of Care Solutions at HealthEdge; Jennifer Vicknair, Senior Director of Regulatory Compliance at HealthEdge; and Jennie Giuliany, Senior Director of Clinical Solutions at HealthEdge.

Together, they shared regulatory updates, market insights, and practical strategies for promoting equitable care and easing the burden of compliance.

What’s Changed: New Medicaid and D-SNP Requirements

Regulatory and policy changes are redefining how Medicaid and Dual-Eligible Special Needs Plans (D-SNPs) operate, emphasizing care coordination, accountability, and support for members’ broader health-related needs. Nai Kasick outlined the shifts accelerating the urgency for action among health plans:

• Medicaid 1115 waivers are reshaping reimbursement by allowing states to fund non-clinical services, such as housing, food, and other holistic assistance, through community-based organizations (CBOs). These CBOs are becoming key partners in whole-person healthcare delivery.
• D-SNP integration requirements are accelerating. By 2026, states like California will require full alignment between Medicaid and Medicare services for dual-eligible members. Plans must prepare for tighter oversight and more complex benefit coordination.
• NCQA and CMS health equity standards are now in force. Plans must collect and report on Social Drivers of Health (SDOH) and Health-Related Social Needs (HRSNs), close the loop on referrals, and demonstrate measurable progress in access, quality, and outcomes.

“Behind every policy is a person,” said Kasick. “Our work must reflect that by aligning systems to meet the real-world needs of members [who, for example, are] navigating pregnancy, grief, and housing instability all at once.” 

Three Goals for Health Plans: Aligning Strategy with Regulatory Reality

As regulatory expectations rise and operational complexity increases, health plans require a clear roadmap for adapting their models, systems, and partnerships. Jennifer Vicknair presented a practical framework based on three strategic goals:

• Advance health equity through whole-person care. Plans must go beyond traditional clinical care to address the behavioral, environmental, and social factors that shape health outcomes. Models like Enhanced Care Management (ECM) and Population Health Management (PHM) offer proven strategies to identify and address care gaps, support populations with high rates of chronic illness, and fulfill emerging mandates designed to improve access to care.
• Ensure compliance with evolving regulations. Oversight from NCQA, CMS, and state agencies is intensifying. Health plans are now required to demonstrate transparent, measurable improvements in care access, outcomes, and coordination, especially for populations who traditionally face barriers. California’s Managed Care Accountability Sets are one example of how performance expectations are being made public and tied to contracts.
• Reduce administrative burden through technology. As data requirements multiply, manual workflows are becoming unsustainable. Automation, artificial intelligence (AI), and advanced analytics can streamline critical tasks like risk stratification, referral tracking, and regulatory reporting. These tools can free care teams to focus on directly supporting members.

“This is about more than checking boxes,” Vicknair emphasized. “It’s about building an infrastructure that supports the kind of care we all believe in.”

Key Takeaways: Real-World Strategies That Work

The panel discussion explored how health plans operationalize equity and compliance in real-world settings. From member engagement to technology infrastructure, panelists shared the tactics and mindsets helping organizations manage change.

• Member engagement drives outcomes. Plans that engage members consistently through digital tools like HealthEdge Wellframe™ see higher satisfaction, better adherence to care plans, and improved retention. “Digital engagement helps us reach members where they are—not just during a crisis,” Dr. Gardner said.
• AI and automation are essential for scale and compliance. Innovative health plans use AIto identify high-risk members, recommend personalized next steps for their care, and automate compliance reporting. “The real power of AI is just beginning,” said Dr. Gardner. “It’s going to reshape how we deliver equitable care.”
• Partnerships with CBOs must be intentional. As community-based organizations take on more responsibility for delivering reimbursable services, plans must support them with training, infrastructure, and collaborative contracting. “CBOs often aren’t familiar with coding, reimbursement, or healthcare processes,” said Vicknair. “We need to meet them where they are.”
• Interoperability is non-negotiable. Integrated platforms that enable seamless data sharing across care teams, health plans, and social service providers are now essential for effective coordination and compliance “Without interoperability, we’ll never fully utilize the SDOH and HRSN data we’re collecting,” Vicknair said.
• Vendor partnerships must go beyond technology. Health plans need partners who understand the realities of compliance and operations. “Look for NCQA-recognized solutions and vendors who collaborate closely to help you meet your goals,” Dr. Gardner advised.
• Cross-functional alignment is critical. The most successful plans are breaking down silos internally. Compliance, IT, and care management teams must work together to design systems and strategies that support equity and efficiency.

The Time to Act Is Now

The panel closed with a clear call to action: the pace of change isn’t slowing, and health plans that delay digital transformation, community partnerships, or compliance readiness will fall behind in efforts to advance health equity and whole-person care.

“Whole-person care isn’t a trend; it’s the direction the industry is headed,” said Giuliany. “And the health plans that invest now will be the ones that thrive.”

To explore the full discussion and gain more insights, watch the webinar on-demand.

Visit HealthEdge.com to learn more about how HealthEdge can help your health plan with digital transformation, compliance, and advancing health equity.