Insurers may soon be accountable for the health equity promises they make.
In recent years, insurance organizations and professional groups have committed to programs that address social determinants of health and promote diversity, equity and inclusion.
Now, such initiatives could become the baseline.
Government entities are considering making the National Committee for Quality Assurance’s Health Equity Accreditation mandatory for Medicaid and marketplace plans, which would require insurers administering them to comply with new standards meant to eliminate disparities in the communities they serve.
Some states have already moved to enact the requirement, but insurers have pushed back against a federal mandate for marketplace issuers. They cite costly operational changes, overly broad guidance and unproven effectiveness as reasons to hold off from making accreditation a federal requirement.
Consumer advocacy groups and public entities, meanwhile, say the mandatory accreditation process is necessary to revamp practices that perpetuate inequality within the healthcare industry.
“The NCQA standards are ambitious, and I think we need some ambition here,” said Christine Monahan, assistant research professor and faculty member at the Center on Health Insurance Reforms at Georgetown University. “Health disparities are a real problem, and we need to be pushing insurers to take more action to solve them.”
An updated accreditation
NCQA launched the Health Equity Accreditation in November 2021 as an expansion of its 12-year-old Distinction in Multicultural Healthcare program, which sought to standardize some data collection and language services among insurers and healthcare providers.
The updated curriculum aims to address health disparities by overhauling certain operations, data collection and network adequacy. It creates guidelines for collecting data on race, ethnicity, language, gender identity and sexual orientation with a goal of better understanding unequal outcomes among plan beneficiaries.
It also requires insurers to employ workers who demographically represent member communities and offer language services to communicate with members who don’t speak English. Additionally, it tasks insurers with measuring the cultural competence of their clinical networks.
“It’s looking to see if there is a match between membership in the plan and the practitioner network to be able to meet the needs of different members, and can (insurers) expand efforts being made to diversify provider networks,” Monahan said.
According to a letter to the Centers for Medicare and Medicaid Services from the insurance trade group AHIP, data collected by insurers to identify health disparities is limited and unstandardized, especially regarding race and ethnicity information. The accreditation’s data collection requirements may therefore present a tangible opportunity to provide more equitable care, Monahan said.
“The biggest challenge to this health equity issue is just getting the right data,” said Anne Winter, senior managing director at the business advisory firm FTI Consulting. “It’s been imprecise, and so now the NCQA is (moving) to implement a screening requirement.”
Mississippi, Pennsylvania, Rhode Island, South Carolina, Tennessee and Wisconsin required the previous Multicultural Healthcare Distinction for Medicaid plans and will have the option to convert to the new version when that expires, an NCQA spokesperson said. Delaware and California have announced mandatory HEA accreditation for their Medicaid plans by 2024 and 2026, respectively. California will require the HEA accreditation for participation in its marketplace by 2026, as will Washington, D.C., which has yet to set a deadline.
The California Department of Health Care Services said it chose to mandate the accreditation to improve the quality of its plans and increase oversight of health outcomes.
“DHCS is looking at how to improve health equity across all populations, and believes NCQA’s health equity accreditation requirement will contribute to DHCS’ mission to reduce health disparities and achieve better health outcomes for all Medi-Cal beneficiaries,” a spokesperson said.