Simply Healthcare earns national health equity accreditations

Holly Prince Tammy MacDonald,
Simply Healthcare is the only health plan in Florida to earn the NCQA accreditations.

Health equity doesn’t happen naturally. At least not now.

Tammy MacDonald, Staff Vice President for Accreditation and Quality Programs for Elevance Health, says health equity efforts are intentionally designed. They use clinical and social data to better understand the social determinants of health care to make sure all communities are served.

Elevance, owner of Simply Healthcare Plans Florida, was one of nine companies nationwide and the only one operating in Florida to earn the National Committee on Quality Assurance (NCQA) Health Equity and Health Equity Plus accreditations last month.

MacDonald and Holly Prince, President of Simply Healthcare Medicaid for Florida, said the accreditations provide the health insurance company with the building blocks it needs to rethink how health care is being delivered to different populations and how to eliminate equity gaps.

“Health equity really forces us to take a different approach. So instead of a one-size-fits-all for all Florida members, the standards require — and it’s the work we are doing — to really be looking local. Our members in Broward County and our members in Hillsborough County, they are different,” MacDonald told the NCQA in an Oct. 12 podcast.

“They have different needs. They have different barriers to care, and the populations look a little different. And we have to think differently about how we meet those members, with what services they need and what their preference is. And that’s really how we are going to make a difference here.”

MacDonald says it also requires a commitment from management to be open minded.

“I know it sounds a little corporate, but this accreditation does take commitment of resources. Not only on the people’s side, but financial resources to develop tools to implement programs. To dedicate people to these programs,” she said.

“So, if you don’t have that buy-in and a commitment to thinking outside of the box from those senior leaders, it’s going to be very, very, difficult when it comes time to say, ‘Hey, we found a program that we think is going to work and we need to implement that.’”

Prince agreed that cultural awareness is a prerequisite for success, and noted Simply Healthcare’s Plans staff is as diverse as Florida’s population.

“We are one the largest Medicaid providers and Medicare providers in the state of Florida, and our employee base is representative of that diverse fabric of what makes up our Florida community,” she said.

“Culturally, linguistically and even just geographically, (Florida is) incredibly very diverse. And peoples’ needs are different. And when we think about health equity, (it’s about) getting personalized care that promotes the whole health for the individual,” she said.

Eliminating health equity gaps requires a commitment on many levels. Companies must be committed to collecting from their members more than just clinical data. It requires the collection of social data and the ability to, moreover, analyze the data they are collecting on a statewide, regional, and even ZIP code levels to craft programs that assist their members.

Prince stressed organizations also have to believe what the data shows them.

“You have to open your heart and your mind to go where the data takes you. It might not be what you had thought it might be at the outset. So you really have to be willing, able to analyze that and think, ‘This is the need here,’” she said.

By 2044, racial and ethnic minorities in the United States will constitute the majority of Americans, according to the U.S. Census. Data show inequitable access to health care in the United States leads to an estimated $93 billion in excess medical costs and $42 billion in lost productivity. It causes higher death rates in some communities and leads to an uneven distribution of resources.

Eliminating disparities in underserved populations will result in better health care outcomes for traditionally underserved populations and will reduce overall treatment costs.

According to the NCQA website, the accreditations can take between nine and 12 months to earn.

Additionally, according to NCQA, the Health Equity Accreditation focuses on the foundations of health equity work, including building an internal culture that supports the organization’s external health equity work; collecting data that helps the organization create and offer language services and provider networks mindful of individuals’ cultural and linguistic needs; and identifying opportunities to reduce health inequities and improve care.

The Health Equity Accreditation Plus program focuses on collecting data on community social risk factors and patients’ social needs to help the organization offer social resources that can have the most impact; establishing mutually beneficial partnerships that support community-based organizations (CBOs); building meaningful opportunities for patient and consumer engagement; and identifying opportunities to improve social need referral processes and the partnerships that make them possible.

Prince said earning the Health Equity Accreditation Plus signifier taught her how to be more strategic. For instance, the organization had a history of working with CBOs. But in going through the steps to earn the accreditation, Prince said, she better learned how to ensure the community programs the plan develops are strategic.

“How do we really use our data and what we know about these individuals who make up our health plan? What do we know in that area? How do we know we are being effective with the programs that we put in place in the community organizations we are working with and the pilots and the different programs that we do?” Prince asked.

“Connecting the dots and being very strategic about it so that it is a very structured, targeted approach that at the end touches those individuals who most need it so we are being impactful in the best way possible … that was, for me, the greatest takeaway, that partnership with NCQA to help us think strategically.”

Christine Jordan Sexton

Tallahassee-based health care reporter who focuses on health care policy and the politics behind it. Medicaid, health insurance, workers’ compensation, and business and professional regulation are just a few of the things that keep me busy.


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