Race & Ethnicity Stratification of HEDIS Measures

Achieving top Star ratings requires organizations to implement initiatives to engage their respective hard-to-reach populations. Recently, the National Committee for Quality Assurance (NCQA) announced the addition of a three-year implementation plan to include race and ethnicity stratification for key Health Effectiveness Data and Information Set (HEDIS) measures. Developed and maintained by the NCQA, HEDIS was created to measure the clinical quality performance in health plans. With the new 2022 race and ethnicity stratification requirements, plans will need to identify disparities and develop strategies to effectively reach and serve their culturally and linguistically diverse populations. This blog post will explain how organizations can identify gaps and reduce disparities in healthcare.

Why Stratify?

ULG is driven to help organizations provide equitable care. We know closing gaps in care for culturally and linguistically diverse populations begins with understanding the health profiles of the populations your organization serves. ULG endorses the new 2022 HEDIS race and ethnicity stratification requirements and can help your organization prepare.

Measurement is a critical first step in supporting population health initiatives among culturally and linguistically diverse populations. To adequately address and eliminate health disparities, the nature and extent of health care disparities must be measured and publicly reported. Stratified reporting provides useful information for:

• Targeting quality improvement activities and resources.
• Monitoring health plan performance.
• Advancing the development of culturally and linguistically appropriate quality improvement interventions and strategies.

Presenting a perspective on health plan performance by race and ethnicity will help organizations understand where disparities exist and don’t exist. With this information, health plans can address care gaps and learn from top performers.

HEDIS Measures Selected for Stratification

HEDIS is requiring health plans to stratify five select measures by race and ethnicity. Data collection in these five areas will enable health plans to evaluate health outcomes for culturally and linguistically diverse populations.

The HEDIS measures selected for stratification are:

1. Colorectal Cancer Screening
2. Controlling High Blood Pressure
3. Hemoglobin A1c Control for Patients with Diabetes
4. Prenatal and Postpartum Care
5. Child and Adolescent Well Care Visits

These measurements were selected with considerations around the:

• Use of the measure across multiple plan product lines (Medicaid, Medicare, Commercial).
• The degree to which the health topic has been prioritized in state equity measures.
• The likelihood of denominators being large enough to report outcomes when stratified.
• The extent of known disparities by race and ethnicity for each topic.

Our Recommendations

Due to the established data completion goal of 80% for the health care plan population, NCQA prefers that race and ethnicity data are collected directly from members through surveys, disease management registries, databases, or other sources.

With this information, health plan customers can identify health equity initiatives. We suggest you consider the following during this data collection phase:

• Include protocols to ensure race and ethnicity questions are asked and recorded.
• In addition to meeting the race/ethnicity stratification standards, collect more detailed race/ethnicity/language information needed to support focused population health interventions.
• Be a part of a broader quality improvement structure from a marketing and sales perspective.
• Review and ensure health plan alignment with the recommendations developed by NCQA and other national organizations to drive quality and safety standards for digital health care delivery.

Given our many years of cultural competence expertise in healthcare, we are ready to help groups successfully meet these new requirements. For example, ULG can help your organization prepare for NCQA Health Equity Accreditation, as well as support ad hoc initiatives and pilot programs aimed at multicultural populations.

Closing gaps in care for culturally and linguistically diverse populations begins with understanding the health profiles of the populations your organization serves. With the new stratification requirements in place, organizations will be more equipped to provide equitable care for all their members. Need help implementing of the 2022 HEDIS race and ethnicity stratification requirements?

Contact us to learn more about our services.