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Medicare and Medicaid plans have the most complete race and ethnicity data, while employer-based or individual plans are the furthest behind, according to Caroline Pearson, a senior vice president of NORC at the University of Chicago, a nonpartisan research organization.
Marketplace plans tend to be somewhere in the middle: During the 2022 open enrollment period for federal marketplace plans, race or ethnicity data was collected for about 70% of enrollees, according to researchers at the Center on Health Insurance Reforms at Georgetown University. In state-based marketplaces, race or ethnicity was captured for approximately 77% of enrollees.
The percentages may soon increase, as the federal government rolls out programs to include equity data in quality measures.
The Centers for Medicare and Medicaid Services will begin requiring the issuers of marketplace and Medicare Advantage plans to submit race and ethnicity data for members in January 2023. By 2024, marketplace plans will have to submit any available quality data, stratified by race, for measures such as colorectal cancer screening, high blood pressure management and prenatal care.
Some accrediting bodies are also adding enhanced data collection standards to their requirements for insurers, such as carriers of Medicaid, exchange and employer plans in some states.
In anticipation, insurers have launched surveys via mail, websites and mobile apps to collect race, ethnicity and other information on their members. They’re tapping data brokers and employers for help and directing case workers and call centers to ask about identity during customer interactions.
But there are kinks in each strategy, requiring insurers to take a multipronged approach, Reynolds said.
Surveys could have selection bias. The member may not fall into any of the provided categories or want to give the information at all, making the data incomplete.
The definition of race and ethnicity can differ among brokers, health plans and other entities, posing difficulties with verification and combined datasets. Adding optional race and ethnicity questions on enrollment forms for employer-based health insurance requires an extra layer of communication between insurers and employers.
And in cases where an insurance representative is involved, the worker may assume the race of the member by their appearance or the sound of their voice, which can cause inaccuracies.
“What is missing right now is there is no systematic or standardized collection,” Reynolds said.
Federal agencies provide some direction for insurers when it comes to sorting data. The Office of Management and Budget established broad demographic categories in 1997 for federal reporting; in June, agency officials announced a review of the standards, expected to be completed by 2024. The standards comprise five broad categories for race—American Indian/Alaska Native, Asian, Black/African American, Native Hawaiian/other Pacific Islander, and white—and one category, Hispanic/Latino, for ethnicity.
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