Last week, I had the opportunity to listen to health equity leaders talk about measuring health equity in their Medicaid programs. They wanted to better understand the current adoption of health equity quality measures. For example, how extensively do other states stratify quality measures by race and ethnicity? Is there an agreed upon, core set of health equity measures readily available? If so, how many states use it? Or are states in a less formal, less standardized phase of the process?
As luck would have it, NCQA recently released results from a national scan of state contracts and interviews with several Medicaid programs trying to answer these questions. What did they find? Here is the white paper if you want to take an in-depth look, but in a nutshell, NCQA found there is a significant and increasing amount of activity around measuring equity although little alignment around formal, standardized measures. A growing number of Medicaid programs are moving toward explicit equity measurement for their managed care programs, such as requiring NCQA’s Multicultural Health- care Distinction. In addition to measuring disparities, many states are scrutinizing their internal policies and structural components, like contracts, to identify and make equity-focused improvements.
Two leaders in health equity – Pennsylvania and California – shared their strategies. Both states have made the strategic decision to be more explicit, intentional, and directional about what health plans must do in terms of closing equity gaps in quality of care. Both have built greater transparency of health plan performance into their strategy as well. For example, Pennsylvania convenes plans quarterly to show each plan’s performance on priority quality measures and talk about effective quality interventions. Both have linked payment incentives to reporting and/or closing the equity gap. In Pennsylvania, they’ve already seen that plans who were early adopters of NCQA’s Multicultural Healthcare accreditation had better quality rates.
California has been publishing a health disparities report since 2016 that stratifies quality measures by race and ethnicity, primary language, age and gender. The state is exploring ways to include geography, sexual orientation and gender identity, and disability. Medi-Cal health plans are also required to conduct a performance improvement project on an identified and significant health disparity among their member population. In terms of structural changes, California is revamping how plans partner with community-based organizations as it launches California Advancing and Innovating Medi-Cal (CalAIM) benefits, such as Enhanced Care Management and Community Supports, and is requiring closer collaborations with schools and local public health departments. This is more meaningful because it centers on the needs of health plan members and the community. California is also embarking on a multi-year strategic planning process to co-design a health equity roadmap with members, stakeholders and community members.
So what’s next? States will continue to learn from each other and from their communities as they drive toward measuring, identifying and closing equity gaps. They’ll look to organizations like NCQA to illustrate how and where performance rates are changing. And NAMD will continue to elevate their leadership and innovation so that other insurers can also learn from and follow Medicaid’s lead.