EBook: Advancing Health Equity

Advancing Health Equity with Comprehensive Strategies

The healthcare industry faces mounting pressure to address health equity amid evolving regulations and the rising prevalence of dual-eligible and underserved populations. For health plans, adopting strategies that ensure equitable, whole-person care is no longer optional but a critical imperative. Leveraging advanced technology and data-driven approaches, organizations can address the complexities of health equity while improving compliance and operational efficiency.

Key Challenges in Achieving Health Equity

Health plans must tackle several pivotal challenges to advance health equity successfully:

1. Regulatory Prioritization

Health equity is now tied to measurable outcomes and performance-based metrics through mandates from the Centers for Medicare & Medicaid Services (CMS) and the National Committee for Quality Assurance (NCQA).

2. Dual-Eligible Population Growth

The increase in Dual Eligible Special Needs Plans (D-SNPs) is driving the need for tighter integration though Highly Integrated Dual Eligible (HIDE) and Fully Integrated Dual Eligible (FIDE) plans.

3. Legacy Systems

Manual, outdated systems can no longer sustain the demands of compliance, data collection, and care coordination.

The Shift Toward Whole-Person Care

Health plans must now adopt whole-person care models that integrate medical, behavioral, and social domains to meet regulatory standards and improve health outcomes. This means addressing social determinants of health (SDOH), such as housing, nutrition, and transportation, alongside medical and behavioral health needs. Effective care models require enhanced data collection, cross-departmental collaboration, and partnerships with community-based organizations (CBOs).

Key Goals for Health Plans

To thrive in this new era, health plans should focus on three unified goals:

1. Advancing Health Equity

• Use real-time data and analytics to identify member needs and monitor progress.
• Leverage Enhanced Care Management and Population Health Management to close care gaps and reduce health disparities.

2. Ensuring Compliance with Regulations

• Align with stricter CMS and NCQA health equity standards, demonstrating measurable outcomes and closed-loop referral processes.
• Create transparency and accountability through advanced reporting and tracking systems.

3. Reducing Administrative Burden

• Transition to automated reporting and data collection systems to streamline compliance activities.
• Incorporate AI and automation to reduce inefficiencies and optimize risk stratification.

Best Practices for Advancing Health Equity

High-performing health plans integrate health equity into core functions, leveraging the following strategies to achieve measurable outcomes:

• Personalized Digital Engagement

Early engagement through digital tools ensures proactive intervention and builds trust, particularly for members facing complex barriers.

• Interoperability for Coordination

Seamlessly sharing data across systems, providers, and members enables real-time care coordination and readiness for compliance reporting.

• AI and Automation

These technologies proactively identify high-risk populations, track equity progress, and operationalize interventions, all while easing administrative burdens.

• CBO Partnerships

Collaboration with CBOs ensures members receive the full scope of care and services, such as housing or transportation support.

• Cross-Functional Accountability

Aligning compliance, IT, and care management through shared metrics fosters unified processes and accountability.

Finding the Right Health Equity Technology Partner

A successful health equity strategy requires partnership with technology vendors who possess regulatory expertise, a commitment to innovation, and scalable solutions. Key capabilities to look for include:

• Advanced interoperability and SDOH integrations.
• NCQA-recognized solutions for compliance.
• AI-driven tools for personalized care and operational efficiency.

Closing the Gap in Health Equity

HealthEdge is committed to empowering health plans with scalable, NCQA-recognized solutions that drive equity, compliance, and operational transformation. By realigning strategy around whole-person care and modern technology, health plans can deliver measurable improvements in access, quality, and outcomes while reducing administrative burdens.

Learn more about how HealthEdge helps health plans advance health equity at HealthEdge.com.