Pandemic planning is incomplete without health equity at its core - MedCity News

The health care system will enter a new reality with the lifting of the public health emergency

After several renewals, most expect the Public Health Emergency (PHE) Covid-19 to be lifted in 2023, with huge implications for health plans and members. Medicaid/CHIP enrollment increased with 18.2 million since the start of the pandemic in February 2020. As part of PHE, states ended the need to reconfirm member eligibility for Medicaid. This can be a complex process where the member must show that they are in poor health, have a low income, or in some cases both. The process varies greatly from state to state and there is no doubt that many current members will lose coverage—the Kaiser Family Foundation estimates that between 5 million and 14 million people will lose Medicaid coverage after PHE is finished.

Players in managed healthcare are preparing for what lies ahead. UnitedHealth Group CEO Andrew Whitty said recently that the redistricting would be a “huge obstacle” to the progress made in covering people and that it could lead to members being “displaced” from the system. The longer plans wait to help members through this redetermination process, the more frustrating it can become, increasing the risk that members will lose coverage. There’s no denying that this will be a significant challenge, but plans that get ahead of helping members through redetermination immediately give themselves the best chance to avoid significant member losses.

Plans will work to improve clinical measures, but member satisfaction will be key

When the 2022 star ratings were released last year, CMS allowed plans to choose the better of their ratings from the two years prior to minimize the effect of Covid-19 on accurate reporting and plan performance. The result? Record high ratings for 2022, with 68% of plans earning four stars or more. But that number dropped to 51% for 2023.

In 2023, health plans will refocus on making sure members are doing the things that are good for their health, and driving quality will measure plan performance. A good place to start is to entice members to receive Annual Wellness Visits (AWV) because they have been shown to help drive other health actions if and when needed—one plan found that AWV made members 9 times more likely to fill other gaps in health care, such as cancer screening. In addition, Icario’s research found that members who receive AWV are 40% more likely to complete health actions than those who do not. These activities include blood tests for diabetes, cancer screenings, eye tests, and more. There will also be significant emphasis on improving the health experience to reduce member abrasion.

Although health plans would like to see an increased focus on clinical measures, CMS has increased the weight of the Consumer Assessment of Providers and Healthcare Systems (CAHPS) surveys to 4x for the 2023 star ratings. This means that member satisfaction will be one of the most important factors for Medicare Advantage plans to increase or maintain their star ratings. Gaining data-driven insights from members—through mock surveys and other tools—will be critical to prioritizing operational and member improvements that directly impact CAHPS performance.

Plans will have to become more serious about the social needs of members

The healthcare industry as a whole understands how social determinants of health (SDoH) impact healthcare equity and access to care, but the new regulations and guidelines will help ensure that plans and providers proactively address the specific needs of their members and patients. From 2023, the National Committee for Quality Assurance (NCQA) has corrected itself HEDIS measures a new Social Needs Screening and Intervention (SNS-E) requirement. The measure will determine the percentage of members who received a screening related to social need and those who received an appropriate intervention based on an identified need within 30 days of a positive screening. The intent of this initiative is twofold: to make health plans more responsive to the social needs of their members and to improve the documentation of SDoH data. It’s also just the right thing for plans to do for their members. Many in the industry believe that SNS-E will become a star rating measure by 2025 or 2026.

While there are various social needs that affect members’ ability to receive care, one area where I hope to see significant improvement is access to reliable broadband internet service. Alternative channels to access care have increased during the pandemic and we will see this continue in 2023, but members need a solid internet connection to take advantage of these services. The fact is that ISPs have made minimal investments in improving Internet access in some underserved locations in the US. What’s promising, however, is that health plans are increasingly offering free or low-cost broadband as a benefit to members, helping to ease the “digital divide” and getting more members the care they need.

However, there are many other measures that health plans can take to ensure that members’ welfare needs are met. For example, they may offer housing stabilization services to help members find and keep housing; they can create non-emergency transportation programs to help members get to and from meetings; they can address food insecurity by creating partnerships with community-based organizations that can help provide resources to members, and they can overcome cultural barriers and sensitivities by using a wide variety of languages ​​in their communications with members . As a concept, SDoH has been talked about for years, but 2023 could be the year plans start to make significant strides towards addressing it for their members.

Photo: Nuthawut Somsuk, Getty Images

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