New NCQA Race and Ethnicity Network One of Many Efforts to Improve Health Equity Data

From accrediting organizations to payers, stakeholders seek often-illusive intel on healthcare's most vulnerable populations.

The National Committee for Quality Assurance (NCQA) has announced its new Race and Ethnicity Stratification Learning Network — “a free, interactive, online tool that offers data and best practices to help health plans improve how they collect race and ethnicity data on their enrollees” with the ultimate goal to “advance health equity through measurement.”

A spokesperson for NCQA stated that the Network provides a first-time look into health plan performance variation trends based on race and ethnicity, and best practices for plans to collect, measure, and report health equity data. The trend data originates from 20 million enrollees of 14 health plans that reported select HEDIS measures results stratified by race and ethnicity.

In a press release for the announcement, the NCQA’s Dr. Eric Schneider — EVP of the organization’s Quality Measurement and Research Group — stated: “Organizations are devoting substantial resources to support health equity, and many are eager to learn how to collect and leverage data to narrow health disparities.”

In an exclusive quote for HealthLeaders, Keirsha Thompson, MSW — NCQA Manager, Performance Measurement of NCQA — added: “What’s exciting about this is that no one has ever seen these data in one place before, and it’s inspiring that the information can be used to support quality improvement to data and help reduce health disparities.”

Thompson adds: “Network findings reflect over 100 contracts across Commercial, Medicaid, Medicare, and Exchange insurance plans. We want health plans to use the Network to feel empowered and know that they can make tangible changes to improve the data they rely on and ultimately work toward narrowing health disparities for their member populations.”

The NCQA is a private, nonprofit organization that accredits, certifies, and recognizes the performance of multiple stakeholder groups including health plans and physician practices. The organization’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the healthcare industry’s most widely used measurement tool.

Just over 10% participation

The 14 health plans and 20 million members reporting race and ethnicity-stratified data for five HEDIS measures is a start. But there is still a long way to go for race and ethnicity data collection to become part of how healthcare does business.

More than 190 million members are represented by plans that report HEDIS overall. Those that report stratified data represent just 10%.

Heath plans have sought to improve their race and ethnicity data collection for years, a chronically difficult task. People of different races and ethnic groups can feel that this data will be used against them by a healthcare system that they already distrust — one that underserves them and even contributes to their poorer health outcomes.

Attacking the problem from multiple angles

Multiple efforts are underway — through data and measurement — to create a healthcare system that at the very least provides equal care for everyone, with the highest aim of producing equal outcomes.

In addition to its new learning network, the NCQA introduced new Health Equity Accreditation (HEA) and HEA Plus programs in recent years — also focused on HEDIS race and ethnicity reporting and adding standards for “organizational diversity, equity, inclusion and reducing bias” as well as data collection for sexual orientation, and gender identity (SOGI). 

Payers have launched their own efforts, including plans in the Blue Cross Blue Shield Association (BCBSA). The BCBSA has launched a National Health Equity Strategy, in part to grow self-reported patient data that is more granular and regularly updated on race, ethnicity, and language (REL) as well as social needs and SOGI.  

Blues plans are embedding these efforts in their Alternative Quality Contracts (AQC), one of the first — and it could be argued more successful — commercial value-based reimbursement models in the U.S.

In a prior exclusive with HealthLeaders, BCBS-MA CMO Sandhya Rao noted that "data gaps and the lack of race data have been a challenge for years." The plan is now nearly 18 months into an equity initiative that incentives physicians to close care gaps and uses HEDIS data to identify the most critical disparities among members who are Asian, Black, and Hispanic.

All payers must participate

In addition to commercial payers, CMS is doubling down on health equity as a component of not only data collection and measurement but payer and provider reimbursement.

Encouraging and incentivizing health equity have been a part of every annual CMS rule governing Medicare, Medicare Advantage, Medicaid, and ACA plan operations and payment.

The agency’s annual proposed marketplace rule (Notice of Benefit and Payment Parameters) seeks to improve disparities through expanded access and coverage and builds on last year’s rule which had specific proposals for health equity-related data collection and standardization.

In its annual Medicare hospital inpatient prospective payment system (IPPS) rule, CMS has proposed 15 new health equity categories that would impact fiscal year 2024 hospital payments. The agency also wants to add social drivers of health (SDOH) factors to three ICD-10-CM diagnosis codes that would incorporate homelessness as a complication or comorbidity.