Back in December, we published our leadership’s five healthcare predictions for 2023. We predicted, “Along with access, an increasing emphasis on ensuring health equity will lead more plans to offer SDoH solutions and options to their members.” As expected, and following CMS’s proposal to replace the Reward Factor with the Health Equity Index, health plan executives are increasingly seeking to advance health equity.
Based on our unique experience getting members across the spectrum into the care they need, we’re back with three additional predictions for the new year. Well, maybe not so much predictions, but rather a recipe to help your plan focus on improving health equity starting now. Because let’s face it—even though the Health Equity Index is a proposed rule that won’t kick in for a while, you can and should be planning to address health equity now. (Oh, and they’re going to start collecting data on it in 2024!)
Innovators Will Prioritize Health Equity to Achieve Quality Goals
Quality and health equity are inextricably linked. In 2023, we expect to see thought-leading payers start to incorporate health equity into all of their programs, especially those aimed at improving quality ratings. Just look at some of the ways the World Health Organization defines quality of care:
- Timely – reducing waiting times and sometimes harmful delays;
- People-centered – providing care that responds to individual preferences, needs and values;
- Equitable – providing care that does not vary in quality on account of gender, ethnicity, geographic location, and socio-economic status;
- Efficient – maximizing the benefit of available resources and avoiding waste; and
- Effective – providing evidence-based healthcare services to those who need them.
These elements align perfectly with the goals of health equity. Truly, there is no quality care without health equity, and an integral part of quality care is ensuring equitable access.
Member Outreach by Telephone Can Impact Health Equity
While some have hinted at the end of member outreach by telephone in favor of digital-only methods, we believe this is a mistake. This study focused on phone calls as an intervention and found that “of those who were successfully contacted, uptake was significantly greater among those who scheduled appointments versus those who did not (47% versus 9%).” When it comes to personalized member outreach to target specific objectives, there is no substitute for calling beneficiaries.
Early data from our clients shows that engaging care navigators to call members with the specific goal of scheduling preventive care or making referrals to programs designed to help with SDoH improves outcomes across all races, and especially those that are underrepresented and underserved. And focusing on access to care for underserved members is an important way to improve the plan’s record on health equity.
More Member Rewards Will Not Achieve Equitable Access to Care
Dangling carrots—or gift cards—in front of members has been effective to increase member engagement and compliance. But once you reach those members who respond to this, just doing more of the same is not going to help all of the members who truly suffer from inequitable access to care.
The reason? The gift cards do not eliminate the barriers to finding the right provider for your needs and making an appointment. It’s still a tremendous burden to find a provider who:
- accepts their insurance,
- speaks their language
- is accepting new patients.
- Has timely availability
- provides the services they need
- is accessible by their available mode of transportation
And on top of that the member still has to:
- schedule a date and time to get needed care; and
- schedule transportation
Often, even access to the very online tools offering provider directories and schedules and/or incentives is unavailable to them. For these vulnerable members, apps, reminders and rewards alone are not enough to improve health equity, or Stars ratings for that matter. The answer is to eliminate the various burdens of finding care altogether and delivering easy scheduling to members in the moment they’re ready to say, “Yes!”
In 2023, identifying the most effective solutions to address health equity will be key to driving equitable access, improving outcomes and reaching your quality goals.
The first step is to prioritize proven methods to impact equity and quality. When you reach members at the right time and remove the barriers to finding and scheduling care, you leverage the referable moment—the time when members are truly ready to take action to improve their health. Leveraging that moment, along with a proven tech-enabled service, sets you up to close care gaps, navigate access to care and SDoH referrals, improve risk adjustment performance and engage and retain new members.
ReferWell is a New York-area digital health company that leverages the referable moment — the point in time when a person is most ready to take action to improve their health — to improve access to care, increase health plans’ quality performance and reduce the total cost of care while improving the members’ experience and outcomes. ReferWell’s intuitive technology platform and skilled service team helps health plans and providers manage value and help more people get on, and stay on, their healthcare journey by providing an optimized provider search, making it easy to schedule appointments at the point of care to increase patient compliance, and providing a service component to ensure providers close the loop regardless of the EMR they use.
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