Health equity is top of mind for Milliman, its clients, and other stakeholders. Milliman’s interactive tool, created by Milliman under CMS’ Qualified Entity Program, allows users to explore how healthcare system performance is associated with regional social determinants of health (SDoH) characteristics such as race and ethnicity, socioeconomic status, and provider supply, after accounting for the differences in underlying disease burden that are expected to impact performance.1
As a certified qualified entity (QE) for all 50 states and the District of Columbia, Milliman has a combined claims dataset of over 50 million Medicare fee-for-service (FFS) beneficiaries and over 100 million commercially-insured members.2 Milliman’s first QE Report includes results on the combined data for 10 quality measures related to hospital-based acute care for 2018 through 2020.
Acute care services and services following hospital discharge are major contributors to overall healthcare costs, and performance below benchmarks on these measures may reflect shortcomings in the provision of high-quality care during the acute care encounter itself, the follow-up period post-discharge, or more generally in ongoing health management over time in the community. Understanding variation in provider quality performance in different geographic areas highlights potential gaps in care that may represent opportunities to improve quality and reduce healthcare costs.
Layering healthcare claims data with SDoH characteristics
It is important to acknowledge the impact of SDoH— safe housing, racism, education level, income level, and other individual and community risk factors—and the role they play in shaping individuals' health outcomes.3 Healthy People 2030 defines health equity as “the attainment of the highest level of health for all people” and goes on to state, “Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.”4
Milliman is committed to helping advance health equity. Therefore, to supplement the claim-based quality measure results, the interactive tool displays key SDoH characteristics for geographic areas that present a more comprehensive, contextual view that may highlight opportunities to reduce health disparities observed in healthcare system performance.
The interactive tool provides users with information to help understand healthcare system performance for people who live in a geographic area. The interactive tool presents two primary map-based views:
- Metrics by Geography: This view allows users to view results on a map of the United States for a single metric—either an SDoH characteristic or a quality measure result.
- Geographic Comparison: This view allows users to compare SDoH characteristics and quality measure results between a collection of small geographic areas in one U.S. census division and a collection of small areas in another census division. Users may choose a range of values for select SDoH characteristics, and the map and summaries update to reflect the collection of small areas that meet those criteria.
For additional detail on the methodology and external data sources used to populate the interactive tool, download the Detailed Methodology.5 For additional detail on how to use the interactive tool, download the Report User Guide. For the best user experience, please access the interactive tool via Chrome.
