NCQA Supports NASEM’s Report on Ending Unequal Treatment

December 18, 2024 · Becky Kolinski

Health care inequities affect well-being, contribute to millions of premature deaths and cost the US billions each year. Addressing inequities can help people achieve their best possible health outcome and reduce health care costs. NCQA is committed to improving the quality of health care for all by making our health care system more inclusive and equitable.

Ending Unequal Treatment, published by the National Academies of Sciences, Engineering, and Medicine (NASEM), reviews the major drivers of health care disparities, provides insight into successful interventions and recommends five key goals for advancing health equity.

“NCQA strongly supports the goals outlined in the report, and we hope it provides a framework for organizations that want to improve quality by reducing inequities,” says Rachel Harrington, Assistant Vice President of Health Equity Sciences at NCQA. “A lot of the work we do at NCQA aligns with the report’s recommendations, and we continue to look for opportunities to partner with organizations interested in doing similar work.”

Five Goals for Ending Unequal Treatment

The report’s five goals—and how NCQA’s work aligns with each—follow.

Goal 1: Generate accurate and timely data on inequities.

Inconsistent collection, correlation and interpretation of race and ethnicity data means that health care decisions are not data-driven, leaving gaps in our ability to act and limiting uptake of effective interventions.

How NCQA’s Work Supports This Goal

• NCQA created the Race and Ethnicity Stratification Learning Network to investigate the challenges and opportunities of using race and ethnicity data for quality improvement, to gather insights on how plans are overcoming challenges and to get an early look at HEDIS^® measures stratified by race and ethnicity. The project’s summary report includes best practices and recommendations for routine collection of race and ethnicity data for quality measurement.

Goal 2: Equip health care systems and expand effective and sustainable interventions.

Lack of standardized performance measures makes it difficult to hold health systems and clinicians accountable for equitable care. Consistent measures will promote whole-person care, foster strong clinician–patient relationships and reflect the sociocultural needs of the populations served.

How NCQA’s Work Supports This Goal

• NCQA is part of the Institute for Exceptional Care’s National Consensus Workgroup to identify quality measures that are meaningful to individuals with intellectual and/or developmental disabilities. This project recognizes that people with IDD—and their families and caregivers/partners—are uniquely qualified to define the health outcomes important to them. NCQA also contributed to Advancing Health Policy and Outcomes for People With Intellectual or Developmental Disabilities, which defines ambitious national goals to improve outcomes that matter.

Goal 3: Invest in research and evidence generation to better identify and widely implement interventions that eliminate health care inequities.

Health equity research is underfunded, does not reflect the perspectives of diverse groups and lacks sufficient infrastructure and partnerships to conduct wide-ranging, community-based research and translate findings into policies and practice.

How NCQA’s Work Supports This Goal

• With support from Takeda Pharmaceuticals, NCQA identified approaches that support effective cross-sector partnerships between health care and community-based organizations to mitigate health disparities and advance health equity. We created resources organizations can use to better understand processes, structures and approaches for building and sustaining effective partnerships.
• NCQA partnered with The John A. Hartford Foundation and The SCAN Foundation to develop person-centered outcome measures. We released a toolkit to support the measures’ implementation, and created a primer to show how person-centered outcome measures address health equity.

Our work is strengthened by the expertise and insights of our partners, which include Grantmakers in Health, Institute for Exceptional Care, Johns Hopkins University, the National Urban League and The Praxis Project (formerly RH Impact).

Goal 4: Ensure adequate resources to enforce existing laws and build systems of accountability that explicitly focus on eliminating health care inequities and advancing health equity.

Many health equity laws and regulations are underused, and enforcement agencies lack the resources to address complaints. Health care organizations committed to reducing health inequities don’t have adequate structures in place to enable success.

How NCQA’s Work Supports This Goal

• NCQA’s Health Equity Accreditation programs provide an accountability framework for organizations seeking to reduce health care inequities. Health Equity Accreditation focuses on organizations that want to build an internal culture to support health equity and identify opportunities to reduce health inequities and improve care. Health Equity Accreditation Plus focuses on organizations further along in their equity journey that want to collect data on social risk factors to highlight and address inequities.

Goal 5: Eliminate inequities in health care coverage, access and quality.

The US health care system’s structural imbalances result in unequal access to health care services, and disproportionately impact minority populations. Resolving these imbalances will benefit everyone.

How NCQA’s Work Supports This Goal

• To encourage organizations to improve collection of race and ethnicity data to support action on disparities, NCQA evaluates the HEDIS measure Race and Ethnicity Diversity of Membership. For Measurement Year 2024, we will publicly report nine HEDIS measures stratified by race and ethnicity, and provide state, regional and national benchmarks for plans to compare their performance and identify areas that might benefit from targeted quality improvement efforts.
• The behavioral health workforce shortage contributes to inequities in access to care, especially for Medicaid beneficiaries. NCQA evaluated access to behavioral health services and developed a white paper with findings and recommendations for improving behavioral health network adequacy standards and measures.

Moving Forward Together

These examples only scratch the surface of NCQA’s commitment to ending unequal treatment, and the work doesn’t stop here.

“Achieving health equity requires partnership across and beyond the health care system,” says Harrington. “We need to connect with the communities and individuals directly impacted by inequities, expand health care services to address unmet social needs and continue to evolve the measures we use to hold health care organizations accountable for ensuring people achieve the highest possible quality of care.”

NCQA believes that high-quality care is equitable care. Visit our Health Equity Resource Center to learn more about our work. If you’d like to partner with us on health equity research or programs, please contact Erin Oganesian, NCQA’s AVP of Corporate and Foundation Relations at eoganesian@ncqa.org.

Source: National Academies of Sciences, Engineering, and Medicine. 2024. Ending Unequal Treatment: Strategies to Achieve Equitable Health Care and Optimal Health for All. Washington, DC: The National Academies Press. https://doi.org/10.17226/27820.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).