In a recent panel discussion hosted by Freed Associates at the California Association of Health Plans (CAHP) Seminar on Data, experts discussed the latest challenges for health plans when it comes to complying with new healthcare equity and quality data collection and reporting requirements. The panel also discussed how data analysis can be improved to support health equity efforts.
The panel was moderated by Shanti Wilson, Vice President of Client Solutions at Freed Associates. The panelists included Timshel Tarbet, Vice President of Business Excellence and Diversity Strategy at SCAN Health Plan, and Genia Fick, Vice President of Quality at Inland Empire Health Plan (IEHP).
Key takeaways and insights from the panel discussion, “Health Equity and Quality Data: Going Beyond Regulatory Compliance.”
The pressure is on. Health plans are working rapidly to adapt and meet compliance standards.
Health plans are facing new regulatory requirements aimed at increasing data reporting requirements to decrease health inequities. Federal and State regulating entities, including Centers for Medicare and Medicaid Services (CMS), the California Department of Health Care Services (DHCS), and the California Department of Managed Health Care (DMHC), are requiring changes that are having a major impact on health plan operations.
Some of the largest health equity data challenges that health plans are dealing with are tied to determining a single source of truth, obtaining meaningful data, and conducting insightful data analysis that eliminates bias and surfaces the highest needs.
Countering healthcare inequity hinges upon the right types of data collection.
Health plans should start by assessing their existing data, identifying gaps, leveraging available data sources, and then augmenting the data through surveys and provider-reported sources. Plans know they need to increase communication with members and providers to gather the necessary data and comply with regulatory requirements. In particular, collecting sensitive personal information such as sexual orientation and gender identity (SOGI) data is a struggle. Despite knowing what to do, how to do it is more challenging; building trust and breaking down silos isn’t easy to accomplish and doesn’t happen overnight.
KEY INSIGHT: Sensitive information such as SOGI data cannot effectively be collected the same way an organization would verify a member’s address. The best way to gather this data with minimal complaints from members is to gradually introduce related questions over time through trusted providers and care management services.
Education is essential.
One major challenge health plans face is the fact that providers have not been trained to gather data. In particular, social determinants of health (SDOH) data, which is critical to improving health equity.
KEY INSIGHT: In addition to collecting SDOH data through medical providers, health plans can partner with community-based organizations (CBOs) to understand and address the SDOH needs of members. CBOs are particularly effective in understanding and navigating cultural differences within specific communities that have higher SDOH needs.
The right approach to data governance and analysis is critical.
Making assumptions based on preconceived notions can hinder the identification of effective interventions. In order to facilitate data-driven decision-making, it can be useful to develop a data governance council that includes cross-functional team members who set parameters and analyze data. It’s important for any governance council to challenge assumptions and remain open to alternative perspectives by continuously scrutinizing and segmenting data to uncover additional interventions beyond initial findings.
KEY INSIGHT: Data slicing and comparison are effective ways to identify differences and inequities in health outcomes based on age, race, ethnicity, zip code, and provider group. Once inequities are identified, organizations can set targets and pilot initiatives to reduce differences in outcomes. When discussing benchmarks and goals, it’s important to acknowledge that setting a single standard across all subpopulations may not be effective. It is important to recognize the unique challenges within each subpopulation and focus on progress and improvement rather than a one-size-fits-all approach.
It’s going to take a different strategy.
Making significant progress in improving health equity requires cross-functional collaboration within organizations. It requires the creation of spaces for dialogue, sharing data, and partnering across the healthcare ecosystem. It requires building trust, overcoming fear, breaking down silos, and understanding that all stakeholders share the common goal of improving people’s health. And ultimately, it requires organizations to guarantee that information flows effectively across different touchpoints, such as enrollment, care management, and customer service.
KEY INSIGHT: Partnering within and across organizations and integrating workflows can help facilitate screenings, data sharing, and targeted interventions.
About Our Expert Panel.
Timshel Tarbet is the Vice President of Business Excellence and Diversity Strategy at SCAN Health Plan (change since seminar – Chief Equity Officer at Providence Health plan). She is focused on meeting initiatives to expand DEI efforts, which include diversifying SCAN’s employee population and member population to be more aligned racially and ethnically with the community SCAN serves. She has been a leader in HR and DEI efforts within the healthcare industry for more than 20 years.
Prior to SCAN, Timshel spent 16 years at Cambia Health Solutions, where she led the ethics department and succeeded in transforming the program into a nationally recognized, award-winning initiative with enhanced engagement across a 5,000 FTE organization. She also spent time as an enterprise risk management and corporate accountability team expert, worked in HR for the state of Oregon Department of Fish and Wildlife, and was a staff sergeant in the United States Air Force.
Genia Fick is the Vice President of Quality at Inland Empire Health Plan (IEHP). She leads a diverse team that supports IEHP quality programs, including health equity accreditations, program evaluations, value-based programs, and quality audits. In addition to her work at IEHP, Genia has also served as a certified Healthcare Effectiveness Data and Information Set (HEDIS) compliance auditor for the National Committee for Quality Assurance (NCQA), where she conducted health plan and independent association audits for HEDIS.
Shanti Wilson is Vice President of Client Solutions at Freed Associates. Throughout her 25 years of healthcare experience, Shanti has worked with organizations at the federal, state, and local levels, including Medi-Cal, Public Health, CMS, health plans, health systems, hospitals, and rural providers. With her deep expertise in designing and implementing changes to support CMS, ONC, Medi-Cal, and other federal and state requirements, Shanti advises clients on the development of strategy, governance, and infrastructure to reduce risk and achieve regulatory compliance. Her past projects have included designing a nationwide strategy to meet compliance requirements for a multistate health plan, driving policy and operational improvements to manage regulatory audits, and providing advisory services to a public entity preparing for upcoming healthcare legislative mandates.
To learn more about meeting and exceeding CMS, DHCS, and DMHC data reporting requirements, contact us today.