NY DFS issues industry letter on health outcomes and disparities | Kramer Levin Naftalis & Frankel LLP

New York health insurers are required to respond to a State Department of Financial Services (DFS) industry letter on health disparities and health outcomes. The questionnaire included in the letter shows the department’s increased focus on the steps these insurers are taking to measure various health outcomes among affected demographics.

On November 30, DFS issued the industry letter to all

  • accident and health insurers admitted in New York;
  • Article 43 corporations (non-profit health insurers);
  • health maintenance organizations;
  • student health plans certified under Insurance Law ยง 1124; and
  • prepaid health care plans

offering fully insured commercial comprehensive health insurance. The letter coined the term “health disparities” to mean “inequitable health outcomes (which may occur because of race, ethnicity, language, sex, gender, sexual orientation, geography, socioeconomic status, etc.) caused by social barriers to individual or community health, and any opportunities leading to better health.” The letter notes that “many health insurers in New York State already have programs or initiatives that aim to reduce the impact of disparities in health care, develop solutions that directly address these disparities and/or promote more equitable health outcomes for New Yorkers (referred to below as “health programs”) and explains that the purpose of the information request is to understand and support these programs.

The letter asks the following general questions:

Health Equity Programs

  1. Does the recipient company have any program specifically targeting health care disparities or designed to promote health equity? The recipient should include the reason for the program and the intended goals. The recipient must also state how the company defines the “health disparities” it identifies (eg, based on race, ethnicity, language, access, geography, serious mental illness, substance use disorder, etc. ).
  2. The company must describe any programs the company has developed to address health disparities, including those programs developed to address disparities in the following areas: infant mortality, maternal mortality, pediatric asthma, diabetes, hypertension, breast cancer, lung cancer colon, vaccinations for adults and children, use of dental care, use of mental health care for people with mental illness, and use of substance use services. In addition, the company may include any internal workforce activities or investments; provider cultural competency programs; or diversity, equity and inclusion training for providers.
  3. Has the company entered into an arrangement with a health care entity (hospital, health system, accountable care organization, independent physician association, federally qualified health center, community health center, community-based organization, or other provider) through which the company incentivizes such a health care delivery organization to address health disparities or cultural competence in health care?
  4. Has the company achieved any type of healthcare equity accreditation for any of its lines of business (including any National Committee for Quality Assurance (NCQA) accreditation such as Health Plan Accreditation, Health Equity Accreditation, or Health Equity Accreditation Plus)? If so, the company should identify which lines of business have received such accreditation and their respective accrediting entity (eg NCQA).
  5. Does the company use health equity and/or cultural competency metrics and/or data in determining network adequacy? Does the Company require or collect health equity and/or cultural competency data in connection with any agreement or contract with health care providers?

Race, Ethnicity, and Language Data

  1. Does the company collect data about race, ethnicity, gender identity, culture and/or language? If so, the company must describe the source of the data (eg, directly from a plan member, from a provider, or elsewhere) and the method of collecting that data. Does the company collect data that can be disaggregated by race, ethnicity, gender identity, culture and language along any of the following dimensions: infant mortality, maternal mortality, pediatric asthma, diabetes, hypertension, breast cancer, colon cancer, vaccinations of adults and children, use of dental care and use of mental health care for people with mental illness, and use of substance use services? In some other dimensions?
  2. Does the company’s method of evaluating data on the race and/or ethnicity of plan members incorporate best practices for collection and use?
  3. The company must describe any quality standards the company applies to the race, ethnicity, gender identity, cultural and language data it collects.
  4. The recipient company is asked to describe the extent to which race, ethnicity, gender identity, cultural, and language data is used in connection with health equity or other non-health equity programs.
  5. The company must provide a description of how it uses race and/or ethnicity data, gender identity data, cultural data, and language data to monitor and evaluate the health services covered by its health plans, if any.
  6. The company must describe how it uses race, ethnicity, gender identity, cultural and language data to monitor, assess and reduce biased behavior among its network providers, if at all.
  7. The company must describe any obstacles or challenges, including legal or regulatory, to the collection and use of race, ethnicity, gender identity, cultural and language data. Anticipated actions or information that such barriers and/or challenges impede, as well as any efforts to overcome them, should be included in this response.

The response is due within 30 days of receiving the letter from the addressee company.

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