NCQA Health Equity Accreditation and Its Impact on Medicaid Managed Care Organizations

For many years and as amplified by the impact of the Covid-19 pandemic, health plans have recognized that caring for a person’s Social Determinants of Health (SDOH) is just as important as caring for a person’s physical or behavioral health needs to result in the best outcomes for their members and improved health equity. To drive these outcomes and encourage activities focused on SDOH and health equity, state agencies are implementing regulations and contractual requirements for their Medicaid Managed Care Organizations (MCOs). In Michigan, ProspHire is seeing these regulatory requirements take hold, as the state is requiring all recently awarded Medicaid plans to obtain the National Committee for Quality Assurance’s (NCQA) Health Equity Accreditation to better care for their members. This is a trend ProspHire is seeing across multiple states, highlighting the importance of health plans awarded in a state with NCQA Health Equity requirements to remain cognizant of the amount of time and effort that goes into applying for this accreditation and act swiftly to ensure their health equity program meets the necessary criteria to avoid being penalized by the state. 

As defined by NCQA, Health Equity Accreditation focuses on the foundation of health equity work: 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; identifying opportunities to reduce health inequities and improve care^[1]. This accreditation requires that plans submit hundreds of documents to prove to NCQA that they are compliant with the Health Equity standards and are capable of adequately caring for their members with a health equity lens. It’s also important for plans to realize that applying for Health Equity Accreditation requires immense coordination from a variety of departments such as Credentialing, Population Health and Quality. 

As previously noted, one state that has recently moved to require NCQA Health Equity Accreditation among their Medicaid MCOs is Michigan. In October of 2023, the Michigan Medicaid Managed Care Comprehensive Health Care Program (CHCP) RFP was released and requires that all health plans obtain NCQA Health Equity Accreditation, among other requirements^[2]. For plans that don’t currently have NCQA Health Equity Accreditation, this requirement will be a major undertaking that they need to efficiently prepare for to remain complaint. As states continue to call health plans to action and seek accreditation, resources will be needed to address this significant requirement in the set timeframe.

As plans begin to work towards achieving or maintaining Health Equity Accreditation, it is important that they continue investigating the current health inequalities in their population. Continuing with Michigan as an example, one major disparity across the population is a correlation between race and the level of care received post-discharge. A 2021 study focused on 60-day outcomes for post-COVID-19 hospitalizations found that black patients had the lowest rate of follow-up post-discharge^[3]. Poor follow-up post-discharge can lead to worse health outcomes and possible re-admission. Another disparity in Michigan is related to geographic location. For example, a Michigan State University study determined that there is a gap in maternity and prenatal care services in rural Michigan counties^[4]. Decreased access often leads members to face a difficult decision of whether it’s worth traveling significant distances to get the care they need. 

These kinds of insights can help drive health plans to create new programs to better care for their members. Using Michigan State’s findings as an example, a health plan may seek to address poor or inequitable health outcomes by offering incentives towards maternity members receiving prenatal care or credentialing additional providers in rural areas. NCQA will specifically look at how plans are tracking their member’s demographics and what programs they have created to mitigate the identified healthcare inequalities. Thus, it’s clear that continuing to collect data on the population is essential for plans to remain aware of current health inequality trends so they can adjust their programming and policies to earn or remain complaint with NCQA standards. Without proper data collection methods and adequate care programs put into place, not only will health plans not be able to receive or maintain NCQA Health Equity Accreditation, but healthcare disparities will only continue to grow.  

Submitting for NCQA Health Equity Accreditation requires dedicated resources who are solely focused on what it takes to pass NCQA’s evaluation. Significant planning and coordination across departments is vital for the plan’s NCQA application to be successful. Plans simply can’t check a box by submitting minimal evidence to secure this accreditation. Attention to detail and going above and beyond the minimum NCQA standards is crucial to produce evidence packets that will satisfy NCQA’s criteria. Plans often do not have the time or the resources to dedicate towards NCQA accreditation, leading to costly submission delays, contract penalties and even the need to re-survey at a later date if scores aren’t high enough after the initial submission. 

ProspHire is well versed in NCQA Health Equity Accreditation requirements and has been successful in achieving both the Initial and Renewal survey accreditations for their clients. 

ProspHire also has experience in achieving NCQA’s Health Equity Accreditation Plus, which is an extension of the work done for the Health Equity Accreditation with a greater emphasis on understanding a membership’s social risks and social needs. ProspHire is committed to understanding your plan’s readiness for Health Equity Accreditation and identifying potential gaps in your survey materials. NCQA Health Equity Accreditation is a long, time-consuming process, let ProspHire help lighten the load with in-depth knowledge of the NCQA Accreditation process and extensive Health Equity experience. 

^[1] NCQA | Health Equity Accreditation

^[2]Health Management Associates | Michigan Medicaid RFP

^[3] The Michigan Daily | Surveying Research on Racial and Ethnic Health Disparities in Michigan

^[4]The Michigan Daily | Exploring Geography-Based Health Disparities in Michigan