Healthcare Disparities
Poverty, a major Social Determinant of Health (SDOH), drives healthcare disparities in the US. Most disparities reports are extensive, complicated, unwieldy, and rely on difficult-to-collect demographic information on each person. We have developed an alternative method that does not require detailed information on each enrollee/person and focuses on income differences rather than differences across racial/ethnic groups.
Assessing with a Quality Index
Health Insurance Disparities Index (HeIDI) was developed by a team from Cornell University’s Brooks School of Public Policy Sloan Program in Health Administration using publicly available data to measure progress in addressing healthcare disparities between high- and low-income people. Since type of health insurance is driven by socioeconomic status, comparing quality of care performance and identifying disparities between Commercial/Private HMOs and Medicaid HMOs is an appropriate complement to DEI-based approaches.
Measures
A portfolio of HEDIS® metrics were selected meeting set criteria that include endorsement and/or utilization by:
NCQA (Accreditation and/or Health Plan Rankings)
CMS (Medicaid Core Measures for Adults and Children/Adolescents)
National Quality Forum (NQF)/Partnership for Quality Measurement (PQM)
Core Quality Measure Collaborative (CQMC)
Preponderance of States either publicly reporting or using a measure for Value Based Payments (VBP) programs
Criteria
HeIDI Measures and Weights for HEDIS Reporting Year 2025 (Measurement Year 2024)
HeIDI Measures and Weights for HEDIS Reporting Year 2024 (Measurement Year 2023)
HeIDI Measures and Weights for HEDIS Reporting Year 2023 (Measurement Year 2022)
Formula
HeIDI index in year t = ∑ ([(Cᵢ–Mᵢ) × wᵢ] × I[Cᵢ > Mᵢ]) / (∑ wᵢ × Cᵢ)
where Cᵢ and Mᵢ represent the average performance of commercial and Medicaid plans nationally, respectively, for measure i in year t; wᵢ is a weight equal to 1 when i is a process measure and 3 when i is an outcome measure; and I(Cᵢ > Mᵢ) is an indicator function that equals 1 when Cᵢ is greater than Mᵢ and 0 otherwise. Each performance measure is measured as the percentage of patients in a type of plan who receive the recommended medical care or achieve the recommended outcome, where a higher value indicates superior medical care, on average, for the enrollees.
For comparisons between commercial and Medicaid plans that have behavioral health services included in the benefit package for enrollees, portfolio of measures include both physical and behavioral health measures in the HeIDI calculations. When comparisons are being made where behavioral health services are carved-out of the benefit package, consider utilizing the Non-Behavioral Health (NBH) HeIDI methodology which excludes the behavioral health measures in the portfolio.
Reported and Most Current Results
A positive score: commercial enrollees are receiving higher quality care.
HeIDI demonstrated (using the Standard and the Non-Behavioral Health Tools) a gradual worsening of disparities (the higher the value, the poorer the performance) nationally with a substantial deterioration during and after the COVID-19 pandemic years between individuals with Commercial/Private and Medicaid managed care from 2017 to 2022. The HeIDI improved slightly in 2023.
Summary of Potential Benefits in Using HeIDI
HeIDI is a practical tool for assessing progress in addressing and eliminating healthcare disparities between different insurance product lines.
Since HeIDI is based on socioeconomic differences between population groups, it is an appropriate alternative method to DEI-based approaches.
Since health insurance is driven by socioeconomic status, comparing quality of care performance and identifying disparities between Commercial/Private HMOs and Medicaid HMOs is an appropriate alternative to DEI-based approaches.
HeIDI can allow health systems researchers to explore various underlying variables contributing to the performance of an entity (such as states, health plans, delivery systems), including the impact of carved-out services, health plan size, tax status of organizations, state eligibility rules, benefits provided, waiver programs, financial incentives, implementation of alternative payment mechanisms, existence of “sister” Commercial/Private plans alongside Medicaid, and regional characteristics.
LATEST NEWS
On November 11, 2025, the American Journal of Managed Care posted our study, “Assessing New York’s Health Care Disparities Using Health Plan Quality Data”.
Using the newly developed Health Insurance Disparities Index, we found that New York’s Medicaid health maintenance organizations (HMOs) outperformed Medicaid HMOs nationally in closing the gap for health care disparities by enrollee income. Additionally, New York’s Medicaid Health and Recovery Plans for severely mentally ill Medicaid beneficiaries also outperformed mainstream Medicaid HMOs in other states. The following characteristics of New York’s approach for managing Medicaid managed care could explain its strong performance:
Value-based payment and quality incentive programs
Waiver programs
Eligibility and benefit design
Integration of physical health services with behavioral health
Health plan characteristics
Links to Published Articles:
Am J Manag Care. 2025;31(9):468-475. https://doi.org/10.37765/ajmc.2025.89701