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Health Equity Reports

Sunflower Health Plan earned Health Equity Accreditation in 2023 through the National Committee for Quality Assurance (NCQA). NCQA Health Equity accreditation gives healthcare organizations an actionable framework for improving health equity. NCQA provides Standards and Guidelines for Health Equity Accreditation. Here the Standards for Health Equity that must be maintained for our accreditation status:

  • HE 1: Organizational Readiness
    • Element A: Building a Diverse Staff
    • Element B: Promoting Diversity, Equity and Inclusion Among
      Staff
  • HE 2: Race/Ethnicity, Language, Gender Identity and Sexual
    Orientation Data
    • Element A: Systems for Individual-Level Data
    • Element B: Collection of Data on Race/Ethnicity
    • Element C: Collection of Data on Language
    • Element D: Collection of Data on Gender Identity
    • Element E: Collection of Data on Sexual Orientation
    • Element F: Privacy Protections for Data
    • Element G: Notification of Privacy Protections
  • HE 3: Access and Availability of Language Services
    • Element A: Written Documents
    • Element B: Spoken Language Services
    • Element C: Support for Language Service
    • Element D: Notification of Language Services
  • HE 4: Practitioner Network Cultural Responsiveness
    • Element A: Assessment and Availability of Information
    • Element B: Enhancing Network Responsiveness
  • HE 5: Culturally and Linguistically Appropriate Services
    Programs
    • Element A: Program Description
    • Element B: Annual Evaluation
  • HE 6: Reducing Health Care Disparities
    • Element A: Reporting Stratified Measures
    • Element B: Use of Data to Assess Disparities
    • Element C: Use of Data to Monitor and Assess Services
    • Element D: Use of Data to Measure CLAS and Disparities
  • HE 7: Delegation of Health Equity Activities
    • Element A: Delegation Agreement
    • Element B: Predelegation Evaluation
    • Element C: Review of Performance
    • Element D: Opportunities for Improvement

Through our NCQA accreditation, Health Equity (HE) Standard 6, Reducing Health Care Disparities, Element A, reporting Stratified Measures, requires Sunflower to monitor and evaluate the following HEDIS measures:

  • Colorectal Cancer Screening (COL)
  • Controlling High Blood Pressure (CBP)
  • Hemoglobin A1C Control for Patients with Diabetes (HBD/GSD)
  • Prenatal and Postpartum Care (PPC)
  • Child and Adolescent Well Care Visits (WCV)

HEDIS measures related to HE 6 Element A, which addresses reducing healthcare disparities, is important as healthcare organizations continue to identify and close gaps in care across various populations, especially in underrepresented or underserved groups. We use member data (race, ethnicity, language, gender identity) to assess the existence of disparities and to focus quality improvement efforts toward improving the provision of culturally and linguistically appropriate services and decreasing health care disparities.

What is HEDIS®?

HEDIS® (Healthcare Effectiveness Data and Information Set) is a set of standardized performance measures developed by the National Committee for Quality Assurance (NCQA) to objectively measure, report, and compare quality across health plans. NCQA develops HEDIS® measures through a committee represented by purchasers, consumers, health plans, healthcare providers, and policy makers.

What are the scores used for?

As state and federal governments move toward a quality-driven healthcare industry, HEDIS® rates are becoming more important for both health plans and individual providers. State purchasers of healthcare use aggregated HEDIS® rates to evaluate health insurance companies’ efforts to improve preventive health outreach for members.

Each quarter, we will publish the most current stratified data here to share our progress.

Health Equity Report Cards

MetricDefinitionExample
HEI IndHealth Equity Index Indicator1=Yes, 0=No
LOBLine of BusinessMedicaid/Medicare/Market Place
Measure YearMeasurement Year for the HEDIS rate calculations 
Plan RatePlan Measure RatePlan Submeasure Numer/Plan submeasure Denom
Plan NameQSI Reporting Population NameAR_MD
Race/Ethnicity SourceSource database, or the analysis procedure used to derive patient race and ethnicityCMS/STATE/GEO-CODING/HEALTH PLAN DIRECT
RateSubmeasure Numer/Submeasure Denom 
ZscoreThe number of standard deviations a value is from the mean.(Submeasure rate - Mean rate/ (STD.P submeasure Rate)
DisparityThe percent variance of a specific member demographic HEDIS Rate when compared to the top performing (Highest rate and denom >30) member demographic.SubMeas/Member Demographic HEDIS Rate- Top Performing SubMeas/Member Demographic HEDIS Rate
New RateThis metric calculates a new plan measure rate by adding the remainder to the plan measure numerator.Remainder + Plan Measure Numer/Plan Measure Denom
RemainderThis metric calculates the actual sub-measure numerator hits under the expected sub-measure numerator hits based on the plan level HEDIS rate.(Submeas Denom * Plan Level Rate)- SubMeas Number = Remainder
Impact LiftThis metric calculates the expected HEDIS Rate increas if the associated member demopgraphic reached the Benchmark Rate.New Rate - Benchmark Rate
Reference GroupTop performing group for the selected plan/submeasure with a denominator >=30. 
DenomUnique members that have met the criteria to be included in the denominator of an associated measure and sub-measure. 
NumerUnique members that are compliant with the requirements for an associated measure and sub-measure