Accrediting group adds health equity metrics to quality data

The National Committee for Quality Assurance is adding metrics to the Healthcare Effective Data and Information Set to track how well insurers address health disparities.

The update adds some race and ethnicity breakdowns, revises gender labels for people who are pregnant and includes social needs screening within 2023 measures for health plans.

The revisions fold equity goals into quality assessments and will help health plans identify disparities among their member populations, said assistant vice president Sepheen Byron, the group’s assistant vice president. The changes also build on a multi-year plan to collect race and ethnicity data with health outcomes, which is starting to be a requirement for insurers seeking certain accreditations and Medicaid contracts.
“We are taking a staged approach because there needs to be infrastructure built up,” Byron said. “There needs to be trust that’s built up in terms of engaging members and patients and there needs to be incentives into things like value-based payment to really be able to achieve health equity.”
The organization tracks healthcare quality performance and serves as the accrediting body for more than 1,100 insurers. The organization’s quality analytics tool, HEDIS, collects data from health plans covering approximately 203 million people across the U.S.

Race and ethnicity breakdowns are being added to eight HEDIS measures that committee researchers identified as potentially having the greatest disparities, including childhood and adult immunizations, asthma, emergency department visits for substance use disorder, opioid prescribing and treatment, well-child visits and breast cancer screening. The organization added race and ethnicity stratifications to five measures last year, including colorectal cancer screening, high blood pressure management, hemoglobin controls for patients with diabetes, prenatal and postpartum care, and child well care visits.

The group also plans to track insurers’ efforts to screen their members’ needs for food, housing and transportation, and how those needs are filled once identified.

Among other revisions, the group is collecting data on pediatric oral health evaluations and use of topical fluoride; benzodiazepine prescription practices among adults older than 67; and preventing emergency department visits for older adults with hypoglycemia.

In a move to measure gender-affirming care, the accrediting organization is removing a limitation on pregnancy and birthing data that only accounts for female patients. It also retired five measures, including annual dental visits, flu vaccinations and pneumococcal vaccination for older adults.

The new metrics come as the committee rolls out a new health equity accreditation that governmental bodies are considering mandating for Medicaid and Marketplace plans. The program focuses on eliminating health disparities by increasing data collection efforts surrounding race, ethnicity, gender and social determinants of health. It also mandates insurers deploy language services and ensure the diversity of their clinical networks matches that of their patient base.

“It’s a combination of nudging people along, celebrating people who are early adopters and innovators and then, at the end, pushing the rest forward,” Byron said. “When it comes to implementing big policy changes, that’s really just the way it has to be. The goal is to move everyone along, for us to all move forward to equitable care.”