Optimizing Member Race, Ethnicity Data to Reduce Disparities, Improve Resource Allocation

Without accurate race and ethnicity data, health plans may be missing the opportunity to address population health and close gaps in care for their members, says Paige Killian, MD, chief medical officer of Inovalon.

In this interview with First Report Managed Care, Dr Kilian offers advice for health plans looking to improve their data and better allocate resources for underserved populations.

What obstacles prevent payers from having the full picture of members’ race and ethnicity data?

Data is a challenge. When we talk about race and ethnicity data, self-identification is the gold standard. We need to understand how the member perceives themselves. We do not want an observer judging by appearance, last name, or whatever other context they are using to formulate an opinion.

Unfortunately, self-identification data are rarely gathered, and a great deal of the race and ethnicity data we do have are inaccurate. Plans are working to close this gap, primarily through surveys, but that brings about another problem. Often the data collected in those surveys—good, member-reported self-identification data—is housed in some disparate system that is not connected to outcomes in other health care data. This limits the data's usability in the current space.

Other barriers include the fact that people can be reluctant to answer when they perceive the questions to be sensitive or do not know where the data will be stored and used. What conclusions are going to be drawn? What is the effect, benefit, or consequence of answering these questions?

Then, when patients are asked sensitive questions and do provide self-identified data, there is the challenge of getting the information codified into the medical record. Uptake of Z-coding, which is how we get that information into the claim system, is vanishingly small.

The upshot is that race and ethnicity data are largely incomplete, inaccurate, or absent altogether.

How can incomplete data impact health plans and individual patients?

What we really are talking about is addressing health care disparities. Even where health plans and providers are aware of the disparities that exist for various populations, they do not know precisely where those populations are to direct necessary resources to them. We need more data.

We need to look at important outcomes like hospitalizations, emergency room visits, medication adherence, and other quality measures; determine how they break down across populations; and develop programs and interventions to improve them and close the gaps. These could be things like allocating meals or transportation, providing fans for patients with asthma who are living in tough conditions, implementing SilverSneakers programs, etc.

Now that Medicare Advantage programs can cover non-medical benefits to help overcome these socioeconomic disparities, health plans need to know where to direct those programs and finite resources so they can be used meaningfully. The health plan does not want to spend money in the wrong place, and the patients who are in need must be identified to receive the services for which they qualify. Accurate, complete data allows health plans to do this.

Thank you, Dr Kilian. Is there anything else you wanted to add about how data improvements can benefit payers and the health care system?

The benefit we seek is for the patients. We all hope to improve outcomes across the board and close gaps driven by socioeconomic risk while we are at it.

There is a lot of opportunity in this space because little research exists on the effectiveness of ancillary benefits for closing these gaps. We do not have a full picture of what does or does not work. We need to start tracking and measuring outcomes, but we are limited by the fact that ancillary services are not identifiable in claims data.

The industry needs to invest in prospective studies evaluating program effectiveness to understand where investment is driving improvement. For example, our team partnered with a client looking at a SilverSneakers program. Our research showed some exciting results, including a 16% overall cost reduction, with a reduction in admissions and an improvement in screening programs. This is promising data, but we need more of it so we can maximize results and eliminate disparate outcomes.

What advice would you offer to payers who are hoping to get more data?

Invest. Payers need to invest in conducting surveys to gather this self-identification data—at enrollment is ideal, but later, if necessary. They need to invest in technology to connect disparate data systems and make them usable.

Educating providers and pushing practices to gather race and ethnicity data can be done. But doctors are already under administrative burden and have a degree of skepticism about whether these data will be used to drive improvement in disparities. So I do not view this as a leading, viable option for closing gaps.

Medicare will be requiring these data next year, and the National Committee for Quality Assurance is adding race and ethnicity stratification for several HEDIS measures. Invest in direct data acquisition now.

Where there are gaps, Inovalon can help enrich the data indirectly. Our data scientists have developed an algorithm to evaluate geographic data down to the household level and reconcile it with US census data. We can help health plans approximate outcomes disparities at the population level and prioritize where supportive resources should be targeted.

Is there anything else you would like to add?

I would love to reemphasize the goal, which is to correct health care disparities, of course. To do it, we need to do a better job collecting accurate data. There will be discomfort as we look at ourselves closely and see where we are starting.

We must measure and report to move forward and prioritize those finite resources. I think we all recognize there is a moral imperative to do that, but there is also an economic imperative. Data show that addressing disparities and reducing social risk also reduces cost and improves outcomes for everyone.

About Dr Kilian

Paige Kilian, MD, is the chief medical officer for Inovalon, where she has worked for 15 years. She is an internist by training and practice, and she remains a primary care physician at heart.