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.
Caveats and limitations
Milliman’s interactive tool was developed to advance health equity by allowing users to explore variation in healthcare system performance measured using claims data in the context of the SDoH characteristics of a geographic area. As explained further in the Detailed Methodology and Report User Guide, the SDoH characteristics of a geographic area that are displayed in the interactive tool do not directly represent the specific individuals included in the combined data.
All information displayed in the interactive tool, including the Milliman Health Disparity Risk Index (MHDRI), was developed for geographic areas and should not be used to draw conclusions regarding individual member risk.
Any interpretation, conclusion, and/or opinion reached based on the information displayed in the interactive tool does not constitute the findings, policies, or recommendations of Milliman.
The American Academy of Actuaries requires its members to identify their credentials in their work product. One of the authors is a member of the American Academy of Actuaries and meets its relevant qualification requirements.
For a comprehensive list of limitations, refer to the ‘Caveats and Limitations’ section in both the Detailed Methodology and Report User Guide.
1 Milliman uses race and ethnicity to identify racial and ethnic minority groups that may experience racism, where racism is the SDoH.
2 CMS. Qualified Entity Program. Retrieved June 8, 2023, from https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/QEMedicareData.
3 Healthy People 2030. Social Determinants of Health. HHS. Retrieved June 8, 2023, from https://health.gov/healthypeople/priority-areas/social-determinants-health.
4 Healthy People 2030. Health Equity in Healthy People 2030. HHS. Retrieved June 8, 2023, from https://health.gov/healthypeople/priority-areas/health-equity-healthy-people-2030.
5 Social Deprivation Index (SDI) data was used with permission from the American Academy of Family Physicians.