Four Ways Regulators Prioritize Health Equity into Network Adequacy

Four Ways Regulators Prioritize Health Equity into Network Adequacy

In the pursuit of high-quality healthcare, it is essential to go beyond network adequacy metrics and prioritize health equity. In a conversation between Scott Westover, SVP of Network and Regulatory Strategy at Quest Analytics, Michael Conway, Colorado Insurance Commissioner, and Grace Arnold, Minnesota Department of Commerce Commissioner, we learned how these leaders are working together to drive a collaborative movement towards better health equity not just in their own states, but across the nation. Here are some valuable insights they shared

The Role of Regulations in Advancing Health Equity 

Health equity aims to provide fair and just healthcare opportunities to everyone, regardless of factors like race, ethnicity, disability, or socioeconomic status. While we all agree on the importance of health equity, laws and regulations are necessary to overcome barriers and make meaningful progress. According to Arnold and Conway, regulations serve as a catalyst to address the challenges we face in achieving health equity.

Grace Arnold: Setting Expectations to Ensure the Market Serves All

Arnold emphasizes the importance of setting clear expectations. By doing so, we ensure that the healthcare market serves everyone by considering their diverse healthcare needs. This “floor-setting” exercise creates standards that hold healthcare providers accountable for serving every individual in their respective states.

“We need to ensure that the market is going to serve our citizens and serve all of them as well as it can. And so that does take a floor-setting kind of conversation—one that I’m really excited to be having.” – Grace Arnold

Michael Conway: Ensuring an Equal Playing Field and Achieving The Shared Goal

Conway echoed Arnold’s perspective and discussed the role of regulations in creating an equal playing field for healthcare providers that prioritizes the delivery of the best healthcare for everyone. He emphasized his role as the Colorado Insurance Commissioner in promoting decisions that prioritize healthcare quality over corporate competition. 

“That’s where we step in, and we help folks make better decisions. That’s our job.” – Michael Conway

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Why Are Laws and Regulations Necessary to Achieve Health Equity?

During our conversation, Westover asked Conway and Arnold about the role of laws in achieving health equity. Their insights shed light on how regulations facilitate conversations and remove barriers created by competition. Watch the video to get a deeper understanding of how laws and regulations promote health equity, straight from the experts themselves.

Four Areas of Emphasis for Health Equity and Network Adequacy

To advance health equity in network adequacy, Arnold, Conway, and other policymakers focus on four key areas.

1. Focus on the Human Connection

Constituent input is vital to the process. By engaging with health plans in discussions and having their understanding of how people use healthcare services, regulators can identify and address areas in the system that need improvement. Prioritizing the human element helps regulators gain a nuanced understanding of consumers’ challenges and enables them to shape effective regulations.

Arnold and Conway stress the importance of hearing from health plans, as they have unique insights from direct interactions with claimants. Regulatory bodies should incorporate this feedback to gain a holistic view of the system gaps. Arnold emphasizes that this feedback is crucial, as it provides a more complete picture than consumer complaints alone. Regulators need to use all available information to ensure that health equity remains at the forefront of their decision-making.

2. Acknowledge Community Differences

Just as every patient is different, every community is unique. And when it comes to achieving health equity, it’s crucial to understand that each community has its own set of needs. Regulators must zoom in and pay attention to each community’s specific goals and requirements. This means considering the overall population and focusing on the specific health goals and requirements of each person within that population.

Arnold highlights the contrast in places like Washington, D.C., where they face their unique challenges of health disparities within a ten-mile radius. It illustrates from a macro perspective, every community in every state has its own story to tell and distinct needs. This recognition becomes even more critical when we consider state and federal requirements.

Watch the video below to hear more from Arnold

Play Video about Grace Arnold on Designing Health Equity Standards: Listen, Learn and Customize for Community Needs

Insights on Designing Health Equity Standards

Listen to Grace Arnold, the Minnesota Department of Commerce Commissioner, share her insights on designing health equity standards that truly matter,  drawing on personal stories from communities. Arnold discusses the conversations that are essential for creating a healthcare system that works for everyone. She emphasizes the power of listening, empathizing, and understanding diverse experiences.

3. Build Culturally Competent Networks

More than simply providing access to healthcare is required, says Conway. We need to build networks that have culturally competent providers who can effectively communicate with patients and understand their unique needs. While it may not always be possible to have a network that perfectly reflects the diversity of the community, there are steps we can take.

Conway recommends one way to achieve this is by providers receiving cultural training. He also suggests incorporating cultural competency requirements into network contracts as a means of expanding diversity and building the desired network. In the end, a more inclusive network might require some effort, but it is important for patients to feel comfortable and respected.

4. Use Data to Identify Gaps and Disparities

As the public health emergency measures end, collaboration between regulators and health plans becomes crucial for identifying areas of need and preventing individuals from losing health insurance coverage. By using data analysis and information sharing, regulators and health plans work together to fill gaps and provide comprehensive care to all members.

“We have a very different view. We’re in the business of getting them enrolled or making sure the coverage they have meets the needs as a regulator, but health plans see it from a different perspective,” Arnold says. “You can be nimble at identifying where there are gaps or if everyone in an area has lost coverage. Flag it and let us know. That’s really helpful.”

Key Components For Promoting Health Equity in Network Adequacy Measures

Promoting health equity in network adequacy measures requires collaboration and understanding among policymakers, regulators, and healthcare providers. Clear expectations, equal playing fields, community engagement, and acknowledging differences between communities are all critical components to ensure healthcare for everyone. Achieving health equity requires universal recognition and the transformation of present expectations to meet the unique requirements of each community.

Dive Deeper into Health Equity and Network Adequacy

Want to explore the topic of health equity and network adequacy in more detail? Watch the on-demand webinar from Michael Conway, Colorado Insurance Commissioner, Grace Arnold, Minnesota Department of Commerce Commissioner, and Scott Westover, SVP of Network and Regulatory Strategy at Quest Analytics. Watch Now

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