Insurers wrestle with proposed market rule
Insurers at the forefront of the accreditation process talk about its operational requirements, particularly around data collection, and the programming changes it may entail.
CalOptima, an Orange County insurer that provides coverage through Medi-Cal and serves 150,000 dual-eligible members, is working to obtain health equity accreditation and has hired an outside consultant to help to line up.
Marie Jeannis, executive director of quality management and population health, said one of the organization’s main focuses will be its data collection efforts. CalOptima already collects data based on ethnicity, race, age, location and gender, which has helped it identify disparities in Orange County.
To expand on this, she said she would partner with community organizations to collect data on the education, income, housing, food and water quality members receive.
“We may not be able to change the social determinants of health, but what we can do is ensure that each of our members receives the support they need in a culturally appropriate environment (while respecting ) their individual needs,” says Jeannis.
CalOptima is also expanding its internal coding to be more accurate when collecting patient data. For example, the changes will allow it to recognize multiracial people or people who identify as gender non-conforming.
“It’s really about the individual and how they identify themselves, so we want to make sure we’re getting that kind of information at that detailed level to be able to answer that,” Jeannis said.
Health Net, a Centene company that insures about 3 million people in California through Medi-Cal, Medicare and exchange plans, renewed its multicultural healthcare distinction for all service offerings in 2021. It is bolstering its operations to obtain the HEA before the deadline.
Download the Modern Healthcare app to stay informed when industry news is breaking.
Laetitia Barrad, director of program accreditation at health insurer Health Net, said much of the work will be expanding its data collection infrastructure to include more categories, including sexual orientation and gender identity. The need will be particularly great in Health Net’s market plans, where these efforts have historically been less robust.
The IT team also determines the best way to store the data while maintaining privacy, she said.
Once collected, the data feeds into the insurer’s disparities dashboard, which shapes targeted health interventions. For example, Health Net offers a black doula program to improve maternal health outcomes for women of color and offers breast cancer screening in Russian-speaking communities where participation is low.
Additionally, Barrad said the company must implement ways to track internal workforce diversity and hiring trends to ensure its employees reflect the communities it serves. This also applies to its clinical networks, where it faces barriers to collecting data on workplace diversity.
“We’ve noticed that vendors aren’t as keen on providing this information, so that’s something we’re working on with our vendor network team to try and get more information,” Barrad said.
It is also participating in a pilot program with the NCQA for an enhanced version of accreditation for health equity, which emphasizes community engagement through partnerships with local resources and nonprofit organizations. lucrative.
“I think it’s very efficient,” Barrad said of the whole accreditation process. “I think it requires a holistic view of your organization and your operations. You look at the social needs of individuals, the social risks of communities, and then you look at how you close those gaps. And then, how do you keep it going?