The COVID-19 pandemic made it harder for racial and ethnic minority groups to gain access to mental health and substance-use treatment services. In 2021, nearly 23% of U.S. adults experienced a mental illness, with that rate jumping to 34.9% among mixed-race individuals. Mental healthcare is important for overall wellbeing, yet many racial and ethnic minority groups face obstacles to accessing care. These obstacles include insufficient health insurance, lack of racial and ethnic diversity among providers, and financial strain.
During National Minority Mental Health Awareness Month this July, health plans can discover new methods to close mental healthcare gaps for their members. As mental health and substance use disorders often require initial and long-term solutions, follow-up care and medication adherence are essential to HEDIS® and other quality measure scores. This includes the Centers for Medicare & Medicaid Services (CMS) Core Measures for Medicaid and CMS’s proposed “Universal Foundation” of quality measures, which incorporate several measures related to behavioral health. In addition, as the National Committee for Quality Assurance (NCQA) seeks to advance health equity by leveraging race and ethnicity stratification in HEDIS to hold health plans accountable for disparities in care among their patient populations, plans must seek to determine where gaps exist and determine concrete plans that reduce disparities in care and outcomes.
Explore effective strategies for engagement, improve measure scores and prioritize mental health care for your members as part of our Closing the Gap series.
Physical and mental health connections
A 2019 research report from the U.S. Substance Abuse and Mental Health Services Administration shows 27.5% of adults who are Black received prescriptions for medication to manage their mental health conditions, compared with 44.5% of adults who are white. Among those who experienced a major depressive episode, nearly 60% of Black adults received treatment while 70% of white, non-Hispanic adult patients received treatment.
Black Americans have higher rates of chronic conditions such as asthma and heart disease compared to non-Hispanic white adults. Black and Hispanic communities also have higher rates of COVID-19 and COVID-19-related deaths. These factors increase the need for mental healthcare given that poor physical health can create more stress and burden on mental health.
Taking action towards equity
NCQA introduced race and ethnicity stratification (RES) to five HEDIS measures in Measure Year (MY) 2022 and eight more in MY 2023. The addition of behavioral health conditions such as depression and substance use disorders shows that addressing mental and physical health in an integrated way may improve overall health outcomes in adults and children. NCQA also developed a list of candidate measures, including many behavioral health measures, to expand stratification to in MY 2024.
Taking a data-driven approach to improve racial disparities in mental health starts by acquiring clinical data needed to report on HEDIS digital measures. Access to structured clinical data helps to alleviate the problems caused by claims lag, enabling health plans to connect with members sooner and recognize better outcomes. Records containing substance abuse details or psychotherapy notes are not shared electronically without the patient’s express consent. However, other data such as diagnosis codes and medication lists contained within electronic clinical data can be used to identify members with mental health conditions and support outreach activities and interventions. This data can also then be used to support a year-round strategy that is focused on prospective insights, population health, and reducing low-value or wasteful care.
Here are some intentional steps you can take to increase the reach of mental health information to minority groups through culturally competent member engagement:
- Identify high-risk patients and strengthen member outreach. Identify members who are at-risk for developing certain conditions, or who have an unmet need such as being due for preventative screenings
- Consider the statistics on racial disparities in mental health when developing organizational priorities and programs to inspire action
- Utilize structured clinical information to reduce the lag from claims data, receive more timely insights into measure performance, and influence gap closure and provider behavior
- Account for the potential influence of social determinants of health (SDoH) when designing mental health programs
Cotiviti’s Quality and Stars solutions paired with the Eliza® member engagement platform can enable plans to support whole-person, culturally competent and equitable care that can facilitate programs to gather the race and ethnicity data needed to accurately track and report RES stratified measures. Billions of data points craft the right ways to engage each member throughout their journey with the plan and help identify areas for improvement. This approach enables plans to close mental healthcare gaps with structured data and outreach that is tailored to their specific member population.
Be on the lookout for our August blog discussing how to improve immunization rates during National Immunization Awareness Month.
Juggling the many moving parts of HEDIS, Stars, state, and various other reporting initiatives can be complex, time-consuming, and made even more difficult when considered only a seasonal activity. Join experts from Cotiviti during our webinar on Tuesday, July 18 as we wrap up HEDIS MY 2022 and discuss impactful best practices your organization can employ to ensure your quality program remains on track and healthy.
Improve your HEDIS and Star Ratings outcomes by closing care gaps and improving member engagement with a multi-channel, culturally competent approach. Learn more about our solutions to help you reach your members where they are and help ensure they care they need.
HEDIS® is a registered trademark of the National Committee for Quality Assurance.