Health Equity in HEDIS 2023: How to Prepare for Success

What’s New

Confirming its long-term focus on advancing health equity, NCQA announces changes for Healthcare Effectiveness Data and Information Set (HEDIS) in measurement year 2023, including:

• Race/ethnicity stratification in eight additional HEDIS measures with integration to additional measures planned over the next several years
• Gender-affirming approaches to ensure HEDIS measures appropriately by acknowledging and affirming members’ gender identity
• New social needs screenings and interventions measure to encourage plans to assess and address members’ unmet food, housing, and transportation needs using prespecified instruments

Understanding Diverse Social Needs Through Risk Stratification

Measuring stratification by race, ethnicity, gender, as well as other social risk factors, is critical to understanding diverse social needs in the population and addressing disparities.

Looking beyond clinical encounters and claims data, health plans can uncover hidden risk and devise proactive, whole-person approaches.

It’s important to note that social and economic indicators such as Z-codes, surveys, and geographic-aggregated data can help but have limitations. On average, 11,000 people live in a single ZIP code. Incomplete information or broad categories can lead to assumptions on larger populations and do not facilitate understanding or action. More detailed and standardized data fields help:

• Generate greater trust in data collection efforts.
• Better capture critical information on hard-to-reach populations.
• Increase efficiency and leverage meaningful and actionable data.

Unite Us’ Social Needs System (SNS) analytics framework helps zero in on the impact of social drivers of health. For example, we have observed that highly socially underserved members represent 30 percent higher regression on mental and physical health (Health Outcomes Survey).

Measure stratification can help not only better assess how social marginalization impacts plan performance and quality outcomes, but also better drive targeted interventions, and measure and prove impact.

Closing the Loop on Care with Social Screenings and Interventions 

Social needs screenings and referral tools should be integrated into systems of record to create a seamless and intuitive experience for care teams and ultimately members.

Feedback from our users highlights the importance of integrating social care in their care management platform and workflows to achieve true community care coordination.

Data standards, pre-built forms, and collaborative workflows reduce errors and improve efficiency in working with the community while also improving the ability to measure impact and close the loop on care.

Health plans can now build on social needs measures, assessments, and referrals to make sure their investments are driving impact on quality outcomes in their population—turning this from an additional effort to the key to unlocking value.

By connecting members with a consistent, accountable community network and real-time, actionable metrics, health plans can monitor and optimize impact on outcomes such as:

• Decreased waiting time
• Percentage of needs resolved
• Co-occurring needs and service gaps that need attention

Dedicated reporting can offer a health equity lens to help ensure and monitor that all individuals are receiving equitable access to care.

HEDIS 2023 updates are part of a larger industry and policy trend to shift focus and funding to effective and preventive whole-person interventions. The business case of health equity interventions rests on the ability to connect these interventions to impact on outcomes, lowering costs while promoting access to care and long-term sustainability.

Explore our solutions to learn how Unite Us enables health plans to succeed in meeting these new requirements, advancing health equity, and increasing value.