Plans must use data to ensure socioeconomic factors do not impact member access to care or health outcomes.

• Identify disparities: Analyze health outcomes, utilization and costs by demographic factors such as race, ethnicity, gender and socioeconomic status to provide insight into populations at risk for poor health outcomes.
• Tailor interventions: Address the specific needs of different populations rather than creating a one size does not fit all approach.
• Monitor progress: Track health equity programming over time to understand which interventions are working and which need to be revised.
• Engage members: Target members identified as having a higher risk for poor outcomes to provide support for better management of conditions and diseases.

Plans can use a variety of strategies to address provider network issues, including direct outreach to providers, financial incentives, automatic assignment of members to PCPs, and prompt payment policies. Many states require minimum provider rates in their contracts with MCOs that may be tied to fee-for-service rates.

• Analyze network data: Use provider contracting and claims data to understand where shortages of certain providers or facility types might exist in their current network.
• Monitor utilization: Study member utilization patterns to determine if provider networks are meeting the needs of the members.
• Engage providers: Deploy utilization data to engage with prospective providers and encourage them to participate in their network. Demonstrate the potential volume of patients available and which services members are seeking.
• Monitor member satisfaction: Leverage member satisfaction data and engagement rates to evaluate the quality of care provided by their network providers and identify areas of improvement or opportunities for provider incentives.

Value is measured by comparing actual health outcomes to the cost to achieve those outcomes. The better the outcomes, the greater the value.

• Analyze cost and utilization data: Examine cost and utilization patterns to identify inefficiencies or opportunities for cost savings, and design value-based care models that incentivize providers to deliver high-quality care at a lower cost.
• Evaluate provider performance: Use performance data to identify providers who are delivering high-quality, cost-effective care and those who may need additional support or training.
• Incorporate patient outcomes: Consult patient outcome analytics—hospital readmission rates, patient satisfaction, and health status improvement—to design models that prioritize the delivery of care that leads to improved outcomes.
• Collaborate with providers: Offer providers access to performance data, use network performance data to inform and engage them in the design of care models, and deliver the analytical resources they need to improve the quality and efficiency of care.