Health

Insurers struggle with proposed market rule

Local implementation

Insurers, at the forefront of the accreditation process, are talking about its operational requirements, especially with regard to data collection, and the programming changes it could bring about.

CalOptima, an Orange County insurer that provides coverage through Medi-Cal and serves 150,000 dual-entitled members, is working towards health equity accreditation and has hired an outside consultant to help with the reconciliation.

Marie Giannis, executive director of quality and public health management, said one of the organization’s main activities will be data collection. CalOptima already collects data based on ethnicity, race, age, location, and gender, which has helped identify disparities in Orange County.

To expand on this, she said she will partner with community organizations to collect data on the education, income, housing, food and water quality participants receive.

“We may not be able to change the social determinants of health, but we can move to ensure that each of our members receives the support they need in a culturally appropriate environment (while) respecting their individual needs.” Ginnis said.

CalOptima is also expanding internal coding to improve the accuracy of patient data collection. For example, changes will allow it to recognize members of different races or people who identify as gender non-conforming.

“It’s really about the person and how they identify themselves, so we want to make sure we’re getting this type of information at such a detailed level that we can refer to it,” Ginnis said.

Health Net, a Centene company that insures about 3 million people in California through Medi-Cal, Medicare, and exchange programs, has renewed its Multicultural Healthcare Distinction status for all service offerings in 2021. She is ramping up her activities to get her HEA by the deadline.

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Letitia Barrad, director of program accreditation at Health Net, said the main work will be to expand the data collection infrastructure to include more categories, namely sexual orientation and gender identity. The need will be especially strong in Health Net’s market plans, where such efforts have historically been less sustainable.

The IT team is also determining how best to store data while maintaining privacy, she said.

Once collected, the data populates the insurer’s non-compliance dashboard, which generates targeted medical 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 low coverage Russian-speaking communities.

In addition, Barrad said the company must put in place ways to keep track of internal workforce diversity and hiring trends so that its employees reflect the communities they serve. This also applies to his clinical networks, where he faces some hurdles in collecting data on job diversity.

“We’ve noticed that ISPs aren’t as keen on providing this information, so we’re working on this with our ISP network team to try and get more information,” Barrad said.

It is also in a pilot program with the NCQA for an enhanced version of Health Equity Accreditation that emphasizes community engagement through partnerships with local resources and non-profit organizations.

“I think it’s very effective,” Barrad said of the overall accreditation process. “I think it requires a holistic view of your organization and your activities. You look at the social needs of individuals, the social risks of communities, and then you look at how you fill those gaps. And how then to continue?


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