By Dr. Tejal K. Gandhi
Large health plans are making deliberate moves to show members they’re serious about health equity. In August 2021, Dr. Darrell Gray, a gastroenterologist, became the first chief health equity officer at Anthem, not too long after Humana hired its first chief health equity officer in January 2021: Dr. Nwando Olayiwola.
Both health leaders, and others, have cited the urgent need for health plans to make care and benefits more inclusive and equitable. As Dr. Olayiwola noted in a recent article published in the journal Health Affairs, “America’s health plans assume the risk for millions of Americans and are responsible for the health of most Americans” and, as such, “are uniquely positioned to coordinate whole-person care across the lifespan.”
Currently, many health plan members are not achieving their optimal health outcomes, and this can be manifested by missed preventive care opportunities, less activation in their care, or rating health plans poorly on quality measurement surveys.
For health plans and their provider partners, now is the time to shift this dynamic by devoting greater resources toward improving health equity, in combination with other calls for change, including equity initiatives espoused by the Centers for Medicare and Medicaid Services (CMS) and new accreditations offered by the NCQA.
An elusive problem
Before they can demonstrate a commitment to improving equity, health plans need to first understand where equity is lacking—a difficult endeavor without the right data.
A recent STAT op-ed authored by two Blue Cross Blue Shield of Massachusetts executives illustrates this point: It wasn’t until the health plan committed to measuring disparities that leaders realized “race and ethnicity data were lacking for more than 90% of members.”
In response, the organization made deliberate efforts to gather data by inviting members to self-report their race and ethnicity and supplementing that with data shared by employer customers and health systems. This effort produced valuable discoveries that could direct plan improvements (e.g., Black and Hispanic members were 15%–20% less likely than white non-Hispanic members to receive recommended management of antidepressant medications).
Data is a central challenge, but there are other obstacles to addressing health equity that aren’t always obvious—for example, lack of access to the internet or mobile devices that can facilitate virtual care encounters. Given the increased importance of communication technology in the first two years of the COVID-19 pandemic, this problem is particularly concerning, though often underreported.
Preparing for the future
Although implementing any change comes with challenges, health plans should look at the following areas when considering improvements:
- Data collection
Most health plans could benefit from a more comprehensive approach to the collection of demographic data, such as race, ethnicity, language, and sexual orientation/gender identity, to ensure all member populations are accounted for. Cross-referencing multiple data sets, such as census data and tools like the Centers for Disease Control and Prevention Social Vulnerability Index, can give health plans a more granular picture of individual and community needs. Once data is collected, quality, safety, and experience measures must be routinely segmented to understand where inequities exist.
- Member communications
The way health plans communicate and listen makes a huge difference in member perception and utilization of resources. One way to account for a diverse pool of member concerns is to design surveys that encourage specific feedback and identify opportunities for improvement. Engaging members for suggestions and feedback via focus groups and other mechanisms is also critical to ensure that communication is meeting member needs.
The coronavirus pandemic accelerated the adoption of telehealth; a November 2021 survey of Medicaid managed care plans found that 95% of health plans are committed to the telehealth transition. Health plans need to step up their virtual care benefits and ensure access to technology like telehealth is seamless and equitable (e.g., by making special accommodations for members without reliable internet access).
- Clinical performance measurement
Clinicians need to be incentivized to undertake quality improvement efforts for members who are experiencing inequities. Dr. Olayiwola suggests in Health Affairs that health plans should devise or adapt tools to “measure clinician performance, member engagement, and organizational performance on a host of health equity–related domains, such as population-level vaccination rates or reduction of avoidable hospitalizations.”
- Member services
According to Deloitte’s 2021 Drivers of Health Survey, which polled 49 health plan leaders and 251 health system leaders, most healthcare organizations are screening their patients and members to determine whether they might need access to services such as food banks, but most plans aren’t yet actively connecting members to needed services. Health plan leaders need to think outside of the box—for example, by establishing formal in-house programs, focusing on social determinants of health, and forging partnerships with community-based organizations to expand access to these services for all members.
Time is of the essence, and these are just a few ideas to help health plans to get started. As CMS and other agencies continue to roll out changes, healthcare organizations that are doing their part to address and resolve inequities will be better positioned to serve an increasingly diverse beneficiary population for years to come.
Dr. Tejal K. Gandhi is Press Ganey’s chief safety and transformation officer.