By Tejal Gandhi, MD
As health plans brace for CAHPS survey season, member experience remains a focal point of strategy, central to Star Ratings and gauging satisfaction.
That’s why health plans looking to improve Star Ratings need to reframe their member experiences within the context of diversity, equity and inclusion (DEI).
Over the last two years, DEI has emerged as a clear priority across multiple industries: 72% of employers surveyed in 2021 said they intend to promote DEI-related aspects of their benefits programs over the next few years. Leading health plans are also doing more to demonstrate that they’re serious about health equity. In 2021, Humana and Anthem hired their first chief equity officers, who are tasked with improving member benefits so they’re more inclusive and culturally attuned.
These are positive developments, but only scratching the surface of what’s necessary. To truly raise the bar and see results reflected in quality metrics, health plan leaders need to do two key things: First, they must re-examine processes in data collection, analytics and member engagement to ensure quality improvement efforts align with what their diverse member cohorts actually need. Second, they must also enhance their focus on social determinants of health (SDOH) to ensure members who struggle with issues such as lack of transportation or lack of Internet are being heard and served.
The Case for Revising Processes in Data Collection
Historically some member cohorts have been under-accounted for, mis-identified and offered care and services that aren’t on par with their needs. One problem is that member surveys often lack questions that attempt to gauge a wider range of healthcare experiences and circumstances.
In addition, data-measurement tools and analytics technologies have sometimes fueled bias in healthcare delivery. In a 2019 paper published by the Journal of Global Health, researchers noted that algorithms used for predictive modeling have been known to compound inequities in socioeconomic status, race, ethnic background and other areas—thus amplifying, rather than minimizing, inequities in healthcare delivery.
One example of this was highlighted recently is the Framingham Heart Study cardiovascular risk score, which performed very well for Caucasian but not African American patients. Because Caucasians accounted for 80% of collected data, risk was underestimated for high-risk populations.
All these problems lead to poorer outcomes among minority cohorts.
While progress is being made among health plans, data scientists and providers to better identify flaws in technology and processes that are counterintuitive to inclusivity, more work needs to be done. In recent op-ed written by two Blue Cross Blue Shield of Massachusetts executives, the health plan only realized “race and ethnicity data were lacking for more than 90% of members” after it committed to measuring disparities.
An Updated Approach
Overhauling care delivery to make it more equitable and inclusive of a diverse population will take time and consistent effort from multiple stakeholders. But we can do better by improving the following areas:
1. Data collection. Healthcare organizations need to incorporate better data-measurement tools into survey processes and ensure they’re collecting information and connecting with members in a wide variety of areas. Relying on one type of data-measurement tool (e.g., census data, CAHPS data) doesn’t give us the full, granular picture of member health. Health plans need to cast their nets wider, utilizing broader data-mapping tools to understand behaviors and trends.
2. Survey design. To get the best information, member surveys must be designed to be more inclusive—or, with more than one type of member in mind. Working to develop new survey questions for members and patients that assess a variety of topics—such as the presence of social determinants, or access to technology—ultimately helps health plan leaders do a better job of identifying gaps. Also, paying attention to survey-delivery preferences, such as email or mail, can improve outreach and ensure responses cover a wider array of experiences.
3. Collaboration. To make the most meaningful improvements, it’s important to gain feedback from multiple stakeholders, from members to physicians to plan administrators. One way to do this is to participate in collaborative efforts such as Press Ganey’s Equity Partnership, which aims to bring together stakeholders to address the interconnectivity of employee engagement, patient safety and diversity, equity and inclusion throughout hospitals and health systems. Progress doesn’t have to happen in a silo.
The time is now for healthcare leaders to raise the bar by ensuring their data collection, survey methodology and collaborative processes support DEI efforts. Taking small steps to align processes and technology now will make it easier to implement meaningful changes to members in the future.
Dr. Tejal Gandhi is Press Ganey’s Chief Safety and Transformation Officer