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. By 2050, nearly one in five people living in the United States will be foreign-born. Now more than ever, we must commit to reducing health disparities for patients, regardless of the country or culture they come from or the language they speak.
Becoming accredited in health equity is a comprehensive strategy for improving an organization’s response to the healthcare 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 a seal of approval in healthcare. Because the evaluation process is performed by an external organization, accreditation status provides an impartial assessment of a healthcare organization’s standard of quality.
Why Pursue Accreditation?
NCQA Health Equity Accreditation not only demonstrates credibility, but also helps organizations accomplish the following objectives:
- Align staff and leadership around equity goals.
- Identify gaps in care, including gaps in data, policies, and practices.
- Standardize processes to improve the quality of care provided to all members.
- Equitably serve all customers and communities.
- Build a plan to address disparities.
- Identify opportunities to improve and enhance the patient experience.
- Increase the organization’s appeal to potential employer and government contract partners. As of August 2021, contracts with six state agencies required this accreditation.
Over the last decade, organizations working toward NCQA accreditation have grappled with how best to serve diverse member populations.
The COVID-19 pandemic brought a new sense of urgency to this important issue. Beginning in 2020, reinvigorated social justice movements in the United States and abroad illuminated cracks in the system, just as the pandemic made the resulting health disparities and inequalities impossible to ignore.
Governments, activists, and the general public are now more aware of inequities than ever before and more focused on the quality of care.
This cultural transition means that keeping up with Health Equity Accreditation requirements has never been more important.
However, improving health equity is not just about doing the right thing or managing how the public perceives your organization. It is also good business. As you take steps to correct inequities, you may begin to see:
- Improved outcomes
- Decreased treatment costs—for example, racial disparities create an estimated $93 billion in excess medical costs in the United States each year
- Higher ratings from your members
Earning Accreditation
There is more to earning accreditation than simply checking items off a list. NCQA Health Equity Accreditation gives you a roadmap for evaluating and improving the health of your members.
NCQA publicly reports quality results, ensuring fair and consistent comparisons among all applicants. To become accredited, organizations must demonstrate the following:
- An internal organizational culture, including training, recruiting, and hiring practices, that supports the organization’s health equity goals.
- Collection of race, ethnicity, and language data, as well as data on gender identity and sexual orientation.
- Access to and availability of language services.
- Development of a practitioner network that best serves a diverse membership.
- Identification of and action on opportunities to improve culturally and linguistically appropriate services (CLAS).
- Provision of language services.
- Reduction of healthcare disparities.
NCQA recommends the following timeline for organizations seeking Health Equity Accreditation:
- 12 months in advance: Become familiar with NCQA’s required standards and processes.
- At least nine months in advance: Conduct an analysis comparing current processes with NCQA requirements and make adjustments as necessary.
- At least nine months before the desired survey start date: Begin the online application process.
- At least six months before the survey start date: Attain compliance with NCQA standards to accommodate the six-month look-back period.
Health Equity Accreditation Standards
NCQA scores organizations on clinical performance, consumer experience, and a set of standards used to measure performance. Requirements include, but are not limited to, the following:
- Organizations must attempt to collect race and ethnicity data directly from members.
- Collected race and ethnicity data must be reported using Office of Management and Budget (OMB) categories, including options for “Asked but No Answer” and “Unknown.”
- Organizations must use separate stratification for five HEDIS measures in 2022, including colorectal cancer screening, controlling high blood pressure, hemoglobin A1c control for patients with diabetes, prenatal and postpartum care, and child and adolescent well-care visits.
The Role of Language
Studies and data collected over time show that disparities exist in healthcare and that members with limited English proficiency experience the consequences. Research indicates that emergency department patients with LEP are 24% more likely to have an unplanned emergency department revisit within 72 hours.
Additionally, hospital stays are 50% longer for individuals with LEP than for English-speaking patients with similar conditions. Healthcare costs, including pharmacy costs, are also twice as high for those with limited English proficiency. These culturally and linguistically diverse patients are also at a higher risk of harmful medical errors than English-speaking patients.
Health equity cannot be addressed without considering the role of language in both assessing gaps and improving the services offered. Because the requirements for NCQA Health Equity Accreditation are intended to close these gaps, the standards include processes for organizations to assess and meet their members’ language needs. Accredited organizations must collect and report language data according to NCQA standards to ensure that members can access the language assistance they need.
To be successful, organizations should follow all NCQA guidelines for tracking language preferences among their members and ensuring that practitioners provide appropriate language assistance to 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 addressing widespread health disparities. As a result, healthcare organizations are making efforts to strengthen their existing health equity programs and initiatives. However, this is a complex and continually evolving process. NCQA’s offerings in this area have changed over time as well.
For example, in 2021, NCQA replaced its previous Multicultural Health Care Distinction with Health Equity Accreditation. Health Equity Accreditation builds upon the original Multicultural Health Care standards while adding new requirements. Organizations seeking accreditation must now:
- Measure organizational diversity, equity, and inclusion.
- Take action to reduce organizational bias.
- Add gender identity and sexual orientation to their data collection.
- Report HEDIS measures stratified by race and ethnicity.
NCQA also introduced a new program: Health Equity Accreditation Plus. This accreditation is intended for organizations that already meet the requirements for Health Equity Accreditation but want to take their commitment to equity to the next level by understanding and addressing the social risk factors affecting their communities and meeting the social needs of their members.
Guidance for Language Services, Accreditation, and Beyond
If these requirements have your team scrambling, Propio can help. Whether you are pursuing a new accreditation, preparing for renewal, or providing training, our experts are ready to guide your team through the accreditation process. For more information about meeting the language needs of diverse populations, schedule a consultation today.
