Comprehensive healthcare is not limited to clinical interventions but is also influenced by various factors beyond the hospital or doctor’s office. The Healthcare Effectiveness Data and Information Set (HEDIS) is used to standardize quality performance measures for health plans and other healthcare and government organizations to address health determinants, reduce disparities, and enhance healthcare quality. More than 90% of America’s health plans, accounting for coverage to 200 million people, use HEDIS, making it the nation’s most widely used set of performance measures. Low HEDIS scores affect these organizations’ health outcomes and negatively impact their bottom line.
Within HEDIS, there are 6 domains of care with over 90 measures. Each measure is vital in taking a proactive approach to healthcare and determining quality scores. The questions in PDHI’s Health Risk Assessment (HRA) align with 4 essential measures: SNS-E, RDM, DSF-E, and LDM. The HRA enables healthcare organizations to collect and report on these measures. The data informs them where to take action toward improving care and, subsequently, their quality scores. Health plans use these reports and data exports as part of their submission to the National Committee for Quality Assurance (NCQA).
Social Needs Screening and Intervention (SNS-E)
Understanding Health Determinants of Health (SDOH)
Social determinants of health encompass a broad range of external factors that impact an individual’s overall well-being. These factors go beyond traditional healthcare settings and include socioeconomic status, access to safe housing, availability of nutritious food, and reliable transportation. According to the World Health Organization, 30%–55% of health outcomes are attributed to SDOH.
The SNS-E measure is vital in recognizing the influence of these determinants on a person’s health and, more importantly, finding ways to address them effectively. The SNS-E measure, introduced by NCQA in 2023, focuses on three distinct categories, each of which plays a critical role in an individual’s health:
- Food Screening and Intervention: Food insecurity can significantly affect physical and mental health. The SNS-E measure looks at whether individuals have reliable access to food and whether interventions are needed to ensure they receive proper nutrition.
- Housing Screening and Intervention: The SNS-E measure examines whether individuals have secure housing and if interventions are necessary to address housing stability and safety issues. Homelessness and inadequate housing can lead to many health problems, making this category crucial.
- Transportation Screening and Intervention: The SNS-E measure evaluates whether individuals can access adequate transportation and whether interventions are needed to overcome barriers. With reliable transportation, individuals may be able to reach medical appointments, get to work, or access necessary services, impacting their health and quality of life.
PDHI’s Role in Addressing SNS-E
PDHI has updated its Health Risk Assessment (HRA) sections to align with the Accountable Health Communities (AHC) Health-Related Social Needs (HRSN) Screening Tool. This tool, developed by the Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (CMMI), is at the forefront of assessing social determinants of health.
By aligning with this tool, PDHI’s HRA is well-equipped to help healthcare providers and plans identify and address the social needs of their members. This alignment allows for more accurate and comprehensive data collection, enabling healthcare organizations to correctly align community resources to overcome social barriers and support to meet the specific needs of their members.
Depression Screening and Follow-Up for Adolescents and Adults (DSF-E)
Mental Health Matters
In healthcare, we often hear the phrase “mental health matters,” and for good reason. Mental health is integral to overall well-being, and its importance cannot be overstated. Mental health issues, particularly depression, are remarkably prevalent and can have severe consequences, such as high suicide rates, if left untreated. Depression is not just a fleeting mood; it’s a complex mental health condition that can affect a person’s thoughts, behaviors, and physical health. It can impair one’s ability to work, interact with others, and engage in daily activities.
The Significance of Mental Health Screening
Acknowledging the profound impact of mental health on one’s quality of life, HEDIS has introduced the Depression Screening and Follow-Up for Adolescents and Adults (DSF-E) measure as a critical component of healthcare quality assessment. The DSF-E measure recognizes the importance of identifying and addressing depression early on. Focusing on depression screening and follow-up on positive screening for adolescents and adults 12 years and older, it aims to ensure that individuals experiencing depression receive the care and support they need to lead fulfilling lives.
PDHI’s Role in Depression Screening
One of the key features of PDHI’s HRA is the inclusion of standardized depression screening questions using the Patient Health Questionnaire-2 (PHQ-2). This questionnaire is a well-established tool for identifying depression. By including it in the HRA, PDHI enables healthcare organizations to screen individuals for depression efficiently and effectively.
Language Diversity of Membership (LDM)
In an increasingly diverse and multicultural society, linguistic diversity is a common and essential aspect of healthcare. Healthcare organizations and payers must acknowledge that their patients and members may speak different languages, have varying proficiency levels in the dominant language, or prefer communication in their native language to achieve effective communication.
Capturing Linguistic Diversity Through PDHI’s HRA
PDHI’s latest version of the Health Risk Assessment (HRA) addresses the Language Diversity of Membership (LDM) measure, which helps identify those needing interpretation services and healthcare information in their preferred language and report on the two-part HEDIS measure. The HEDIS Language Diversity of Membership (LDM) measure assesses the count and percentage of members enrolled during the measurement year by spoken language preferred for health care and written materials.
In practical terms, this inclusive approach fosters the following benefits:
- Enhanced Comprehension: Patients receiving healthcare information in their preferred language are more likely to understand their diagnoses, treatment options, and follow-up instructions accurately.
- Improved Engagement: When patients can communicate comfortably and effectively with their healthcare providers, they are more likely to actively participate in their care, ask questions, and make informed decisions.
- Reduced Medical Errors: Misunderstandings due to language barriers can lead to medical errors. By addressing linguistic diversity, healthcare organizations reduce the risk of such errors.
- Culturally Competent Care: Understanding and respecting linguistic preferences is crucial to providing culturally competent care. It demonstrates a commitment to the patient’s cultural and linguistic background.
Race/Ethnicity Diversity of Membership (RDM)
Demographic disparities in healthcare outcomes and access have been well-documented. These disparities can result in unequal treatment, poorer health outcomes, and reduced access to quality care for minority populations. Such disparities often reflect systemic issues deeply rooted in society and the healthcare system, making them particularly challenging to overcome.
Importance of Addressing Demographic Disparities
The significance of racial and ethnic disparities in healthcare is recognized by HEDIS, which has introduced the Race/Ethnicity Diversity of Membership (RDM) measure. This measure assesses the count and percentage of members enrolled by race and ethnicity at any time during the year.
Collecting comprehensive and accurate data on the racial and ethnic composition of the membership is the first step toward identifying areas where disparities exist. These disparities may take various forms, such as variations in healthcare utilization, treatment outcomes, or access to preventive care. Sharing data on these disparities is important for rectifying them.
PDHI’s Contribution to Addressing Racial and Ethnic Disparities
PDHI has taken an essential role in addressing the racial and ethnic disparities in healthcare by including questions around Race/Ethnicity Diversity of Membership (RDM) in its assessment. This approach is culturally sensitive and allows members to select multiple responses, acknowledging the complexity of racial and ethnic identity. Healthcare organizations that use PDHI’s HRA can gain a nuanced understanding of the racial and ethnic diversity within their member population, allowing them to tailor their services and interventions accordingly. The ultimate goal of addressing racial and ethnic disparities in healthcare is to customize services to meet the unique needs of diverse populations.
Various measures have been introduced to pursue a more holistic and patient-centered approach to healthcare. These include addressing social determinants through SNS-E, recognizing and bridging demographic disparities with RDM, focusing on mental health with DSF-E, and fostering effective communication through LDM. These measures collectively aim to proactively address the broader determinants of health, reduce disparities, and improve the overall quality of healthcare.