CMO Corner: Lawrence Magras, MD, MBA, FHM, FAAPL
Why is Health Equity Important?
Healthy People 2030 defines health equity as “the attainment of the highest level of health for all people.”1 To attain health equity, it is important to address health disparities... read more
The Centers for Disease Control and Prevention (CDC) defines health disparities as “preventable differences in the burden, disease, injury, violence, or in opportunities to achieve optimal health experienced by socially disadvantaged racial, ethnic, and other population groups and communities.”2 This usually refers to differences between groups based on accessibility to care, affordability of care, barriers to care, and quality of care outcomes. The healthcare system can address about 20% of a person’s health outcomes.3 The rest is driven by social and economic inequities, Social Determinants of Health (SDOH), or Health-Related Social Needs (HRSN). Disparities are driven by embedded social norms and socio-economic constructs that are a result of systemic racism or bias. Health disparities have been highlighted by the COVID-19 pandemic. The unwinding of federal programs under the Public Health Emergency is threatening healthcare coverage for millions of the nation’s neediest individuals.
Does your practice know if your patient population experiences health disparities? Are you providing bias-free, culturally competent care? Community Health Network of Connecticut, Inc.® (CHNCT), in partnership with the Department of Social Services (DSS), offers provider offices several reports to understand health outcome disparities and tools to address cultural biases. DSS, with the help of the administrative services organizations (ASOs) and Access Health CT, has been diligently working on notifying HUSKY Health members to reapply for benefits, and has created a toolkit for partner organizations to assist in ensuring that members do not lose coverage. Please contact your CHNCT Provider Engagement Services Representative or Clinical Practice Transformation Specialist for assistance in accessing health equity data and cultural competency tools.
1 https://health.gov/healthypeople/priority-areas/health-equity-healthy-people-2030
The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey
The Consumer Assessment of Healthcare Providers and Systems (CAHPS®)1 survey is a tool used to assess the members’ perception of the care they received by their providers and health plan... read more
The CAHPS® program is overseen by the United States Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ) and administered by The National Committee for Quality Assurance (NCQA). NCQA includes the CAHPS® Health Plan Surveys in its annual Healthcare Effectiveness and Data Information Set (HEDIS®)2; acknowledging that member experience affects care outcomes, which is a critical component of healthcare quality and equity.
The CAHPS® Health Plan Survey, Adult version (Medicaid) and the CAHPS® Health Plan Survey, Child version are offered annually to the HUSKY Health membership. There are two child surveys that are sent to the heads of households of the randomly selected children enrolled in the traditional Medicaid program (HUSKY A/C/D) and for those enrolled in the state’s Children’s Health Insurance Program (CHIP) (HUSKY B). The NCQA certified vendor that CHNCT contracts with to conduct the survey utilizes analytic tools to identify key drivers and identify opportunities for improvement. In addition, the vendor calculates disparity in ratings by health equity among separate demographic elements across specific measures. CHNCT and DSS review the results from the survey to develop initiatives that improve the HUSKY Health members’ experience of care and promote healthcare quality that is equitable across the membership.
The overall results from the 2023 CAHPS® surveys specific to Connecticut Medical Assistance Program (CMAP) providers and specialists are listed in the tables below for each survey. These rating questions and composite measures were identified as scoring statistically significantly higher or lower compared to the national Medicaid benchmarks outlined in the 2022 NCQA Quality Compass (QC®)3 All Plans data, the vendor’s 2023 Medicaid client benchmarks, or both in the 2023 survey that concluded this past May.
| 2023 CAHPS® Medicaid Adult 5.1 Survey (HUSKY A/C/D) |
| Above Benchmark(s) |
| Rating of Specialists (% 8, 9, or 10)* |
| Advised to Quit Smoking |
| Below Benchmark(s) |
| No measures scored below the benchmarks |
|
Sample size HUSKY A/C/D n= 1,958 |
| 2023 CAHPS® Medicaid Adult 5.1 Survey (HUSKY A/C/D) |
| Above Benchmark(s) |
| How Well Doctors Communicate: Doctor showed respect - General population |
| Below Benchmark(s) |
| Getting Needed Care - CCC population |
| Getting Care Quickly - CCC population |
| Getting Care Quickly: Getting routine care - CCC population |
|
Sample size HUSKY A/C/D n= 2,393 |
| 2023 CAHPS® Medicaid Adult 5.1 Survey (HUSKY A/C/D) |
| Above Benchmark(s) |
| Getting Needed Care: Getting care, tests, or treatment - General population |
| How Well Doctors Communicate: Doctor showed respect - General population & CCC population |
| How Well Doctors Communicate: Doctor spent enough time - General population |
| How Well Doctors Communicate: Doctor listened carefully - CCC population |
| Doctor Who Knows Child: Understands effects on family’s life - CCC population |
| Below Benchmark(s) |
| Rating of Specialist (% 9 or 10)*+ - CCC population |
|
Sample size HUSKY B n= 2,393 |
In 2023, the demographic data collected from the Adult survey showed that the response rate among Black/African American HUSKY Health members increased from 14.9% in 2022 to 22.2% in 2023. Black/African American response rates continue to be below the response rate of Whites (65.8%) in 2023, which remained steady from 2022 (65.8%). In terms of ethnicity, the HUSKY Health program saw a decrease in response rates from Hispanic/Latino members from 34.2% in 2022 to 28.1% in 2023.
Race and ethnicity data was not collected on the heads of households in the 2022 CAHPS® Medicaid Child 5.1 surveys, however race and ethnicity data was collected on the children randomly selected for the surveys. In the 2023 CAHPS® Medicaid Child 5.1 survey (HUSKY A/C/D), the response rates for White children increased slightly for the general population 54.4% in 2023 vs. 51.5% in 2022, while the response rates for Black/African American children declined significantly from 26.5% in 2022 to 18.3% in 2023. The response rate by Hispanic/Latino children (53.6%) increased in 2023 compared to 2022 (48.5%). The 2023 CAHPS® Medicaid Child 5.1 survey (HUSKY B) the response rate for Black/African American children was 16.6%, which is down from 18.4% in 2022. The Hispanic/Latino response rate did increase from 33.3% in 2022 to 39.0% in 2023.
The 2022 demographic survey findings prompted CHNCT to implement targeted interventions to increase the Black/African American HUSKY Health membership survey participation rate to better represent the views of the Black/African American members and provide a diversified evaluation of the responses obtained in the 2023 CAHPS® surveys. While out in the field during in-person events and member interactions, Community Health Workers (CHWs) encouraged CAHPS® surveys participation among members. “Your Voice Matters” themed postcards and video clips were created and distributed via email and mail. These materials depicted Black/African American and Hispanic individuals promoting the importance of the survey and encouraging them to respond. CHNCT will continue to build off these interventions and identify opportunities to further improve the response rates of underrepresented populations to promote quality healthcare that is equitable for all HUSKY Health members. Please encourage your HUSKY Health patients to complete the 2024 CAHPS® surveys if they are selected next February!
Quality Compass® Data Extract License Agreement
The source for certain health plan measure rates and benchmark (averages and percentiles) data (“the Data”) is Quality Compass® 2022 and is used with the permission of the National Committee for Quality Assurance (“NCQA”). Any analysis, interpretation or conclusion based on the Data is solely that of the authors, and NCQA specifically disclaims responsibility for any such analysis, interpretation, or conclusion. Quality Compass is a registered trademark of NCQA.
The Data comprises audited performance rates and associated benchmarks for Healthcare Effectiveness Data and Information Set measures (“HEDIS®”) and HEDIS CAHPS® survey measure results. HEDIS measures and specifications were developed by and are owned by NCQA. HEDIS measures and specifications are not clinical guidelines and do not establish standards of medical care. NCQA makes no representations, warranties or endorsement about the quality of any organization or clinician that uses or reports performance measures or any data or rates calculated using HEDIS measures and specifications, and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in Quality Compass and the Data and can rescind or alter the Data at any time.
The Data may not be modified by anyone other than NCQA. Anyone desiring to use or reproduce the Data without modification for an internal, noncommercial purpose may do so without obtaining approval from NCQA. As such, the Data may not be further distributed. All other uses, including a commercial use and/or external reproduction, distribution or publication, must be approved by NCQA and are subject to a license at the discretion of NCQA. ©2022 National Committee for Quality Assurance, all rights reserved. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).
1 CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).
2 The Healthcare Effectiveness Data and Information Set (HEDIS®) is a registered trademark of NCQA.
3 Quality Compass® is a registered trademark of NCQA.
Equity is the Driving Force Behind the HUSKY Maternity Bundle
The Connecticut Department of Social Services (DSS) anticipates transitioning to a bundled payment model for reimbursement of maternity care for HUSKY Health members with a planned launch in January 2024. . . read more
To promote health equity through the maternity bundle, HUSKY Health will:
- Address and remedy disparities of access, utilization, and outcomes for pregnant women
- Place particular emphasis on women of color, women with substance use disorders, and women with a high social vulnerability index as these are the women disproportionately affected by health disparities
- Center the lived experiences of HUSKY Health members in the way we design and implement the maternity bundle
- Include bundle elements that promote equitable access to care and supports (e.g., doulas, breastfeeding supports)
- Examine all services through the lens of race and ethnicity to ensure we are working to close health equity gaps
For more information, including important implementation updates, please click here.
Learn More…The National LGBTQIA+ Health Education Center
HUSKY Health is focused on health equity for all populations. We are always looking to improve and enhance our members’ experiences with their healthcare providers to help them with their basic and complex care needs. . . read more
This includes equity of access, treatments, and outcomes. Members of the LGBTQIA+ community include people who are: lesbian, gay, bisexual, transgender, queer or questioning, plus elsewhere on the gender and sexuality spectrum or allies to the community.
HUSKY Health would like to present the National LGBTQIA+ Health Education Center as a learning resource for your practice. Continuing Medical Education (CME) and Continuing Education Units (CEU) are available for free for many of their programs, including their live and on-demand webinars and learning modules.
More information about the National LGBTQIA+ Health Education Center and learning resources offered is available by visiting www.lgbtqiahealtheducation.org.
