NY DFS Issues Industry Letter on Health Outcomes and Disparities

New York health insurers are required to respond to a New York State Department of Financial Services (DFS) industry letter on health disparities and health outcomes. The questionnaire included within the letter indicates a heightened departmental focus on steps that these insurers are taking to measure disparate health outcomes among affected demographic groups.

On Nov. 30, DFS issued the industry letter to all

• accident and health insurers admitted in New York;
• Article 43 corporations (not-for-profit health insurers);
• health maintenance organizations;
• student health plans certified pursuant to Insurance Law § 1124; and
• prepaid health services plans

offering fully insured commercial comprehensive health insurance. The letter introduces the term “health disparities,” meaning “inequitable health outcomes (which may occur by race, ethnicity, language, gender, sex, sexual orientation, geography, socioeconomic status, etc.) caused by social barriers to individual or community health, as well as to any opportunities leading to better health.” The letter notes that “many health insurers in New York State already have programs or initiatives which aim to reduce the impact of health disparities, develop solutions that directly address such disparities, and/or promote more equitable health outcomes for New Yorkers (hereinafter described as ‘health equity 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 addressing health disparities or designed to advance health equity? The recipient is to include the reason for the program and its intended goals. The recipient is also to indicate how the company defines the “health disparities” it has identified (e.g., based on race, ethnicity, language, access, geography, serious mental illness, substance use disorder, etc.).
   
   
2. The company should describe all 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, colon cancer, adult and child vaccinations, utilization of dental care, utilization of mental health care for those with mental illness, and utilization of substance use services. In addition, the company may include any internal workforce activities or investments; programs for provider cultural competency; or diversity, equity and inclusion training of providers.
   
   
3. Has the company entered into any arrangement with a health care provider entity (hospital, health system, accountable care organization, independent physicians association, federally qualified health center, community health center, community-based organization or other provider) through which the company incentivizes such health care-providing entity to address health disparities or cultural competency in health care?
   
   
4. Has the company achieved any kind of health equity accreditation for any of its lines of business (including any National Committee for Quality Assurance (NCQA) accreditation such as the health plan accreditation, health equity accreditation or health equity accreditation plus)? If so, the company is to identify which lines of business have achieved such accreditation and their corresponding accrediting entity (e.g., NCQA).
   
   
5. Does the company use health equity and/or cultural competency metrics and/or data in its determination of network adequacy? Does the company require or collect health equity and/or cultural competency data in connection with any arrangement or contract with health care providers? 

Race, Ethnicity and Language Data

1. Does the company collect race, ethnicity, gender identity, cultural and/or language data? If so, the company should describe the source of the data (e.g., direct from plan member, from provider or from elsewhere) and the method for collection of such data. Does the company collect data that can be disaggregated by race, ethnicity, gender identity, culture and language on any of the following dimensions: infant mortality, maternal mortality, pediatric asthma, diabetes, hypertension, breast cancer, colon cancer, adult and child vaccinations, utilization of dental care, and utilization of mental health care for those with mental illness and utilization of substance use services? On any other dimensions?
   
   
2. Does the company’s method for assessing plan-member race and/or ethnicity data include best practices for collection and use?
   
   
3. The company must describe any quality standards the company applies for 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 programs or other programs unrelated to health equity.
   
   
5. The company should provide a description of how the company uses race and/or ethnicity data, gender identity data, cultural data, and language data to monitor and assess health care services covered under its health plans, if at all.
   
   
6. The company should describe how the company 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 should describe any barriers or challenges, including legal or regulatory, to the collection and use of race, ethnicity, gender identity, cultural and language data. Intended actions or information that such barriers and/or challenges prevent, and any efforts to overcome them, should be included in this response.

Responses are due within 30 days of the addressee company’s receipt of the letter.