The Affordable Care Act: 12 Years Later

The Affordable Care Act: 12 Years Later

Since its launch in 2010, the Affordable Care Act (ACA) has increased access to quality, affordable coverage and care. A record 14.5 million people signed up for coverage in 2022 through state and federal marketplaces. Looking at 2023, CMS is strengthening focus on reducing disparities in the U.S. healthcare system with new, dedicated policies proposed in the HHS Notice of Benefit and Payment Parameters.

The Future of ACA

Addressing social determinants of health (SDoH) is essential to eliminating health disparities in our country. Identifying health and social care needs enables the delivery of preventive, whole-person care for members, and reduces the burden for healthcare systems. With our long-term experience in SDoH strategies and community partnerships, we’re sharing our recommendations based on the changes CMS is considering to help ACA health plans in the Marketplace to advance health equity.

Effective Data Collection and Reporting

Despite industry-wide recognition of the importance of collecting comprehensive data at the community level, incomplete datasets continue to negatively impact the ability to track disparities and underlying social determinants, and the ability to design culturally specific, quality-improvement activities. In our experience, behavioral nudges—such as changing default options or providing clear explanations of how data will be used—may help increase participation and reduce skepticism. Creating more specific categories can reduce confusion in health surveys, better capture critical information from hard-to-reach populations, such as sexuality and gender minorities, and generate a greater buy-in and willingness to participate.

Provider Networks

Data is essential for health plans to effectively tailor provider networks and service offerings to meet the evolving needs of members in specific geographic areas. Health equity goes beyond clinical care and starts in the community. When health plans are considering how to build an effective network, they must move beyond clinical providers and include network capacity for behavioral health and social care providers to best address SDoH in their members.

Accreditation Requirements

CMS is considering requiring health plans/insurers to obtain NCQA’s Health Equity Accreditation. Beyond standard accreditation, NCQA is also releasing a new program, Health Equity Accreditation Plus module, which encourages organizations to build community partnerships and invest in health equity. We can support health plans in meeting accreditation requirements and improving other quality metrics by assisting with collecting data, identifying needs, and connecting individuals to relevant community resources.

Coordinated Whole-Person Care

As we work with health plans to address disparities in their communities, we have discovered how an integrated, end-to-end approach is essential to ensuring impact. Key components of an effective health strategy include:

• Shared, community-wide infrastructure: A shared platform enables coordinated care outside the clinical walls, and seamlessly connects those seeking support to the care they need in the communities where they live using a no-wrong-door approach.
• Intuitive technology platform: Health and community providers can access a single platform integrated with existing systems and workflows to screen for unmet social needs, refer for services, and track each person’s longitudinal care journey through closed-loop referrals and structured outcomes.
• Meaningful collaboration and secure data sharing: Real-time, actionable metrics on outcomes and provider performance help our clients proactively address the complex needs of our most vulnerable populations, and measure and drive impact.

The Future of Healthcare

We encourage CMS to continue evaluating opportunities to incorporate health equity in the healthcare marketplace.

Engaging the community is essential to ensuring all individuals have equitable access to care. This approach further helps strengthen members’ trust in the health system, especially for those who have experienced discrimination in the past.

We are uniquely positioned to support health plans with dedicated technology and data capabilities to coordinate care across clinical and community settings, monitor impact, and target community investments to improve health outcomes.

Advance Health Equity with Unite Us

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