How the Updated CMS Health Equity Framework Will Improve Member Experience in Light of SDoH

With the release of the CMS Framework for Health Equity 2022–2032, the CMS Office of Minority Health (CMS OMH) is taking bold steps to assess the impact of social determinants of health (SDoH) and map a plan of action for those struggling with barriers. The framework encourages all entities of the health care ecosystem to look at programs and incentive structures in light of the factors that can actually be changed to address unmet social needs. It also considers how to connect members to the services they require once risk data is captured.  

Member experience and satisfaction go hand-in-hand with the five priorities detailed in the CMS framework, and health plans can now use the updated direction to take a fresh look at their current approach to outreach. This will begin the process of enhancing the focus on underserved communities and those facing discrimination and barriers to obtaining care. It brings challenges related to race, age, disability, sexual orientation, low socioeconomic status, and more to center stage. 

This blog explores the 5 CMS priorities and how Icario can help plans take specific actions to address each. 

Expand the Collection, Reporting, and Analysis of Standardized Data

To understand health care disparities, CMS emphasizes that data collection needs to expand beyond capturing simple contact details. For example, knowing a member’s race, age, ethnicity, and income status can highlight whether that person may have greater difficulty accessing healthcare than someone else in similar circumstances. However, CMS says data collection should be voluntary.  

This is problematic because many members distrust the health care system following years of poor experiences. Additionally, accurate contact data is notoriously difficult to obtain particularly for Medicaid members. 

Although the intent of this priority is good, the reality is there are opposing forces at play here. Members will likely limit their willingness to share key information, putting the onus on plans to find other ways to capture risk data.  

How Icario Can Help:
Consumer-focused companies have become well-known for their ability to collect and capitalize on individual-level demographic data and preferences. However, most health plans and the government don’t have the resources to purchase and leverage third-party commercial data collection practices the way big retailers can. Icario has relationships with these entities and the highly accurate, restricted databases they maintain to help with data enrichment. 

Additionally, Icario works with plans to promote health action, such as completing Health Risk Assessments (HRAs) and Annual Wellness Visits (AWVs), two critical sources of gathering member data. Using rewards and incentives, as well as personalized messaging, Icario helps health plans navigate the fine line between positive engagement and member abrasion to help get the data needed. 

This priority is about moving from observation (priority 1) to action by improving access to care and offering better support for members in their communities. This goal evokes NCQA’s recent HEDIS measures for social needs screening and interventions (SNS-E).  

Although CMS has not formally adopted these changes, they address social disparities by requiring plans to offer support for challenges within 30 days of identification.  

Of particular note, Medicaid redetermination is a blend of priorities 1 and 2. Many expect the recent extension to be the final one. This means Medicaid beneficiaries must take action to requalify their eligibility, a process that hasn’t been required for 3 years. Many newer Medicaid members are wholly unfamiliar with this process, and all members will need to be educated on how to re-certify to maintain coverage.    

How Icario Can Help:
Icario excels at targeting members and getting them to take an identified health action that enhances their overall experience. This involves identifying needs through data collection and understanding disparities. The next step is crafting education programs that leverage different communication channels to inform members about available resources and how to use them.    

Specific to Medicaid redetermination, Icario supports the re-identification of need, education of importance, and activation into the process necessary for members to continue benefits. This engagement will be crucial not only to help plans keep their members but also to support those with chronic conditions.  

Build Capacity of Health Care Organizations to Reduce Health Disparities 

With priority 3, CMS is looking for plans to align its process, people, and technology strategies. This includes improving communication with patients, families, and caregivers.  

Also, as mentioned previously, connecting members to supportive services requires an assessment of their social needs (HEDIS SNS-E measures), important work many are already doing.    

Building capacity is critical to expanding the activity happening today through organic relationships between local nonprofits. So the question is: How do we expand these programs to reach members, capture social needs data, and then reduce disparities?  

The goal is to get individuals care when and where they seek it, including using home and community-based services. Factoring in transportation needs is also a key consideration. 

How Icario Can Help:
Icario works with clients to offer the new Icario Benefits Care Card, which now helps plans give members—including those in hard-to-reach rural areas—a flexible way to use their reward incentives for grocery, transportation, and other types of funds to improve their health. This new program ensures plans comply with CMS’ rewards and incentives guidelines while promoting improved member satisfaction through various benefits on a single, easy-to-use card. 

Advance Language Access, Health Literacy, and the Provision of Culturally Tailored Services 

This priority is about getting back to basics. Members can’t become educated about their health or benefits if they don’t understand the materials they receive. In addition, cultural competency and language are essential to breaking down health equity barriers.

This means each member’s native language, cultural norms, and expectations need to be captured and built into outreach.

If all of a plan’s materials are in English, they’re missing a large swath of their population. It’s also important to simplify complex medical concepts and use everyday words. The goal is to communicate at a 5th-grade reading level. 

How Icario Can Help:
Icario research shows that when members in specific populations find a doctor who speaks their language and knows the particulars of their culture, word of mouth spreads, and the clinic is overwhelmed. This underscores the need to build cultural competency into all of your outreach.  

Accomplishing this requires capturing native language early in the engagement process as a fundamental step toward building a trusting relationship with the member. Over time, regular communication shapes health literacy, helping members understand how to interact with their plan, what benefits are offered, and how to manage chronic conditions.   

Advance Language Access, Health Literacy, and the Provision of Culturally Tailored Services 

The CDC estimates 1 in 4 people in the United States has a disability, and this number increases to 2 in 5 for those over 65. Considering these statistics, this priority focuses on infrastructure, emphasizing the need to evaluate access to buildings, services, and even communications for accessibility.  

One aspect of this is the continued advancement in telemedicine. During the pandemic, the country advanced significantly with this technology as CMS knocked down financial barriers for practitioners by making payments the same for virtual and physical visits. This even included AWVs. Continual investment in telemedicine is an essential component of this priority, but success relies on member access to technology and far better broadband, especially in rural areas. 

How Icario Can Help:
Icario’s Digital Bridge Program helps plans improve broadband access and digital literacy for members. A fundamental flaw with digital health and telehealth is the assumption that everybody has access. A member can’t complete an online AWV if they don’t have access to the internet or education on how to use telehealth programs on smart devices. The Digital Bridge Program provides resources on free or low-cost devices like tablets, access to internet service providers or programs that offer low-cost or free broadband options, and support related to enrolling in subsidy programs and technical troubleshooting.  

This CMS framework is an important step toward improving healthcare access and the member experience for those facing uphill health equity battles. But there’s a lot of work to be done. When it comes to member outreach and engagement, health plans have the opportunity to evaluate their existing practices and identify new ways to reach, educate, and support their members. Icario is here to help every step of the way.