This article was originally published in January 2021 and has been updated.
Patients from linguistically and culturally diverse backgrounds experience health disparities and adverse health outcomes compared to the overall population. By 2044, racial and ethnic minorities will constitute the majority of Americans. And by 2050, nearly one in five people living in the U.S. will be foreign-born. Now more than ever, we must commit to reducing health disparities for patients, no matter what country or culture they come from and no matter what language they speak.
Becoming accredited in health equity is a comprehensive strategy to improve an organization’s response to the health care needs of minority members and those with limited English proficiency (LEP). As such, it demonstrates a credible commitment to improving health equity.
The National Committee for Quality Assurance (NCQA) Health Equity Accreditation is broadly accepted as the seal of approval in healthcare. Because the evaluation process is performed by an external organization, accreditation status delivers an impartial opinion about the healthcare organization’s standard of quality.
Why Pursue Accreditation?NCQA Health Equity Accreditation not only demonstrates credibility, it also helps organizations accomplish the following objectives:
- Aligning staff and leadership to meet equity goals.
- Identifying gaps in care, including data, policy and practice.
- Standardizing processes to improve the quality of care provided to all members.
- Equitably serving all customers and communities.
- Building a plan to address disparities.
- Identifying opportunities for improved and enhanced patient experience.
- Increasing your organization’s appeal for employer and government contract partnerships. (As of August 2021, six state agencies’ contracts require this accreditation.)
Over the last decade, organizations working toward NCQA accreditation have grappled with how to best serve diverse member populations.
The COVID-19 pandemic lent a new sense of urgency to this important issue. From 2020 on, reinvigorated social justice movements, both in the United States and abroad, illuminated the cracks in the system just as the pandemic made the resulting health disparities and inequality impossible to ignore.
Governments, activists, and the general public are now more aware of inequities than ever before, and more focused on quality of care.
This cultural transition means keeping up with Health Equity Accreditation requirements has never been more important.
However, improving health equity isn’t just about doing the right thing or about managing how the public perceives your organization. It’s also good business. As you take steps to correct inequities, you will begin to see:
- Improved outcomes
- Decreased treatment costs (For example, did you know that racial disparities create an estimated $93B in excess medical costs in the US every year?)
- Higher ratings from your members
There’s more to earning accreditation than simply ticking off items on a list. NCQA Health Equity Accreditation gives you a roadmap to evaluate and elevate the health of your members.
NCQA publicly reports quality results, ensuring a fair and consistent comparison among all applicants. In order to become accredited, organizations must demonstrate the following:
- An internal organizational culture, including training, recruiting and hiring, that supports the organization’s health equity goals.
- Collection of race, ethnicity, and language data, plus data on gender identity and sexual orientation.
- Access and availability of language services.
- Building a practitioner network that best serves a diverse membership.
- Identification and action on opportunities for improving culturally and linguistically appropriate services (CLAS).
- Provision of language services.
- Reduction of healthcare disparities.
The NCQA recommends the following timeline of actions for organizations seeking Health Equity Accreditation:
- 12 months in advance: Become familiar with NCQA’s required standards and processes.
- At least 9 months in advance: Conduct an analysis comparing current processes to NCQA requirements and adjust as necessary.
- At least 9 months before desired survey start date: Begin the online application process.
- At least 6 months before the survey start date: Attain compliance with NCQA standards to accommodate the 6-month look-back period.
Health Equity Accreditation Standards
NCQA scores equally on clinical performance, consumer experience, and a set of standards used to measure performance. Requirements include (but are not limited to):
- Organizations must attempt to collect race and ethnicity data directly from members.
- Collected race and ethnicity data must be reported using the Office of Management and Budget (OMB) categories, including options for “Asked but No Answer” and “Unknown.”
- Organizations must use separate stratification for 5 HEDIS measures in 2022, including colorectal cancer screening, controlling higher blood pressure, Hemoglobin A1c control in diabetic patients, prenatal and postpartum care, and child/adolescent well-care visits.
The Role of Language
Studies and data collected for some time show there are indeed disparities in healthcare, and members with limited English proficiency (LEP) suffer the consequences. Research indicates that emergency department (ED) patients with LEP are 24% more likely to have an unplanned ED revisit within 72 hours.
Additionally, hospital stays are 50% longer for individuals with LEP than those of English-speaking patients with similar conditions. Plus, healthcare costs -- including pharmacy costs -- are twice as much for those with limited English proficiency. These culturally and linguistically diverse patients are also at a higher risk for harmful medical errors than English speaking patients.
Health equity simply cannot be addressed without considering the role of language in both assessing gaps and improving services offered. Since the requirements for NCQA Health Equity Accreditation are intended to close these gaps, the standards include processes or organizations to assess and meet their members’ language needs. Accredited organizations must collect and report on language data per NCQA’s standards to ensure that members are able to get the language assistance they need.
To be successful, organizations should follow all NCQA guidelines to track language preferences among their members and to ensure that practitioners are providing appropriate language assistance for culturally and linguistically diverse patients.
Evolution of the Process
As mentioned above, one important lesson learned from the COVID-19 pandemic is the importance of rectifying widespread health disparities. As a result, healthcare organizations are making efforts to strengthen their existing health equity efforts and initiatives. This is, however, a complex and ever-changing process. The NCQA’s offerings in this area have changed over time as well.
For example, in 2021, NCQA replaced its previous Multi-Cultural Health Distinction with the Health Equity Accreditation. The Health Equity Accreditation builds upon the original Multicultural Health Care standards but adds new requirements. For example, organizations seeking accreditation must now:
- Measure organizational diversity, equity, and inclusion.
- Take actions to reduce organizational bias.
- Add gender identity and sexual orientation to data collection.
- Report race /ethnicity stratified HEDIS measures.
They also introduced a new program: Health Equity Accreditation Plus. This accreditation is aimed at companies who already meet the requirements for the Health Equity Accreditation but want to take their commitment to equity to the next level by understanding and addressing the social risk factors of their communities and meeting the social needs of their members.
Guidance for Language Services, accreditation and Beyond
If all the requirements have your team scrambling, ULG can help. From a new accreditation, renewal, or training, our experts are ready to guide your team through the entire accreditation process. For more information about meeting the language needs of diverse populations, schedule a consult today!