Navigating Year-End Updates: Adapting to Evolving Healthcare Machine-Readable File Regulations
The recent proposal introduced by the Centers for Medicare & Medicaid Services (CMS) on July 31, 2023, outlined significant changes to the Price...
As a health plan, you are likely familiar with the National Committee for Quality Assurance (NCQA). A government agency whose mission is to “work for better health care, better choices, and better health,” the NCQA offers a wide variety of programs for health care providers and practices, health plans, and around data and information technology, all designed to improve the quality of health care.
One of the NCQA’s main roles in regards to health plans is its Health Plan Accreditation program. The Health Plan Accreditation program provides a framework for quality improvement and measurement based on results of clinical performance and consumer experience. It describes itself as a “roadmap for improvement,” with benefits that enable health plans to:
- Improve operational efficiencies
- Satisfy state requirements and employer needs
- Keep patients happy and healthy
- Demonstrate commitment to quality
Over 1,100 health plans are currently accredited through the Health Plan Accreditation program, but that may be about to change. In August, the NCQA announced new and revised quality measures for 2023. These include “the introduction of race/ethnicity stratifications and revisions to acknowledge and affirm member gender identity.” The changes “build on NCQA’s dedication to advancing health equity” – but also introduce new demands for health plans.
Specifically, one of the new measures will require health plans to actively understand their members’ barriers to health and social needs. The NCQA describes this measure as the Social Need Screening and Intervention (SNS-E)”, which has a stated goal:
To encourage health plans to assess and address the food, housing and transportation needs of their patient populations, this measure helps health plans identify specific needs and connect members with resources necessary to address unmet social needs. This measure assesses members who were screened, using prespecified instruments, at least once during the measurement period for unmet food, housing, and transportation needs, and who received a corresponding intervention if they screened positive.
Health plans should carefully evaluate this measure both for compliance in the ongoing NCQA accreditation, as well as meeting core operational objectives: improving care and offsetting costs. By understanding and addressing social determinants of health, health plans gain a 360-degree view of their members. This enables payers to identify members’ societal needs, beyond their basic demographics.
When health plans address members’ health holistically, members trust their health plans and engage more with them. Health plans can help members access services that they may not have been aware of, get members more embedded into their community of health, and teach them to use their available resources appropriately. These shifts translate to fewer ER visits, better ambulatory visits, better preventative care, improved medication adherence, more telehealth visits, and a plethora of other benefits – in short, they connect members to services that are more effective and lower cost instead of those that are more complex and expensive.
How can health plans begin to introduce social determinants of health into their member profiles? The first step: accepting that you can’t do it manually. It’s simply too complex to rely on one-off systems and manual efforts. To meet the new NCQA standards, and to realize the opportunity of addressing social determinants of health, health plans need proven technology.
Look for a data-driven solution that empowers you to identify and address social determinants of health. A solution should consolidate information from 10,000 data sources to deliver advanced analytics that quantify social risk and impact. With batch processing that can handle high amounts of data, API integrations that enable instant access to a complete individual or community profile, and risk intelligence that accurately evaluates member risk, the data solutions provider should allow health plans to mitigate the underlying causes of health inequities in member populations.
80% of health outcomes can be attributed to social determinants of health. From meeting the new NCQA standards to improving patient care to reducing costs, health plans have ample reason to add these data insights to their knowledge base.
For more information on how to improve your social determinant of health strategies, check out our guide to advancing health equity through data. You’ll read key takeaways including:
- How housing, food, transportation, adverse life events and social isolation impact health
- Why implementing data-proven interventions drives ROI and enhances wellness
- How using accurate socioeconomic data improves operational sustainability
