HealthcareInsurers wrestle with proposed marketplace rule

Insurers wrestle with proposed marketplace rule


On-the-ground implementation

Insurers on the forefront of the accreditation process speak to its operational requirements, especially where data collection is concerned, and the shifts in programming it can prompt.

CalOptima, an Orange County insurer that provides coverage through Medi-Cal and serves 150,000 dual-eligible members, is working toward earning the health equity accreditation and has hired an outside consultant to help with coming into alignment.

Marie Jeannis, executive director of quality and population health management, said one of the organization’s main focuses will be on its data collection efforts. CalOptima already collects data based on ethnicity, race, age, location and gender, which has helped it identify disparities across Orange County.

To expand on that, she said it will partner with community-based organizations to collect data on education, income, housing, food and the quality of water members are receiving.

“We may not be able to change the social determinants of health, but what we can do is move toward making sure that every single one of our members receives the support they need in a culturally appropriate environment (while) respecting their individual needs,” Jeannis said.

CalOptima is also expanding its internal coding to be more precise when collecting patient data. For example, the changes will allow it to recognize multiracial individuals or people who identify as gender nonconforming.

“It’s really about the individual and how they identify themselves, so we want to make sure we are obtaining that type of information at that detailed level to be able to address it,” Jeannis said.

Health Net, a Centene company that insures approximately 3 million people in California through Medi-Cal, Medicare and exchange plans, renewed its Multicultural Healthcare Distinction across all service offerings in 2021. It is building up its operations to obtain the HEA by the deadline.

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Laetitia Barrad, director of program accreditation at insurer Health Net, said the bulk of the work will lie with expanding its data collection infrastructure to include more categories, namely with regard to sexual orientation and gender identity. The need will be especially great in Health Net’s marketplace plans, where such efforts have historically been less robust.

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

Once collected, the data populates the insurer’s disparities dashboard, which shapes targeted health 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 Russian-speaking communities where uptake is low.

In addition, Barrad said the company must implement ways of tracking internal workforce diversity and hiring trends to ensure its employees reflect the communities it serves. That goes for its clinical networks too, where it faces some hurdles collecting workplace diversity data.

“We’ve noticed that providers aren’t as keen to provide that information, so it’s something that we are working on with our provider network team to try to get more information,” Barrad said.

It is also participating in a pilot program with NCQA for an enhanced version of the Health Equity Accreditation, which emphasizes community engagement through partnerships with local resources and not-for-profits.

“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 operations. You look at the social needs of individuals, social risks of communities and then look at how you are closing those gaps. And then how do you keep it going?”



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