Skip to main content

The Role of Good Data in Addressing Health Inequities

Health equity is under discussion throughout the industry, as more and more research demonstrates that the prevalence of bias – even structured into healthcare artificial intelligence – is impacting the health of millions of Americans. As is often the case, conversations start with data and how to collect it in directly or indirectly to address disparities in care and outcomes.

The National Committee on Quality Assurance (NCQA) is developing health equity reporting measures under HEDIS, which are likely to be adopted and required by the Centers for Medicare and Medicaid Services (CMS). Other governing bodies may follow suit. One of the first and most basic places to look is at discrepancies between populations in morbidity and mortality by race and ethnicity. These have been documented in the past, but many believe the reporting isn’t as specific as it could be. There are other disease-based Measures that will help tease out other disparities between populations.

This year is not a true reporting year for NCQA, but there’s a lot going on. In 2022, data collection methods allow the capture of race and ethnicity data via two methods. Direct collection of this information may come in from the member during enrollment. Health plans may have indirect means like geographic imputation or other community proxies as a temporary method to create indirect assignment.

Race and ethnicity data is currently available for nearly all Medicare beneficiaries; however less than a quarter of commercial plans have this data for even half their members, so the challenge is significant. With imminent requirements for stratifying quality results by race and ethnicity, developing methods to collect this data is essential.

NCQA has just completed an eight-month collaborative study on how to improve data collection on race and ethnicity with Grantmakers in Health (GIH). NCQA is currently studying five Measures. They want to advance that to 10 Measures in 2023 and 15 measures in 2024. HealthEdge is looking at how HealthRules® Payer and GuidingCare® can help its customers stratify measures by race and ethnicity in combination with direct and indirect collection methods.

Discussions about this and other industry-relevant compliance and regulatory issues are held at monthly focus groups for the benefit of HealthEdge customers. Customers interested in how HealthEdge is responding to the technical challenges associated with these topics should contact their account representatives to join.

Learn more in Maggie Brown’s Regulatory and Compliance Headlines & Highlights update.

About the Author

Maggie Brown has over 30 years of leadership experience in healthcare and insurance marketplace. Maggie transitioned from health plan management roles to implementing core business solutions for numerous health plans around the country. With the enactment of HIPAA, the Balanced Budget Act, and the Medicare Prescription Drug, Improvement and Modernization Act of 2003 she focused on how to ensure a health plan could implement key technology solutions, meeting the needs of their members, while being compliant in a rapidly changing regulatory environment. Maggie has led implementations for government programs at both new and established managed care companies. Maggie holds a Doctor of Religious Arts degree with a major in Pastoral Psychology.