29 ways payers can improve equity

Health plans are working to improve health equity, appointing chief health equity officers, improving data collection and implementing initiatives to reduce disparities in health outcomes. 

Becker's asked 29 executives where payers can have the biggest effect on health equity. 

The executives featured in this article are all speaking at the Becker's Payer Issues Roundtable, which will take place Nov. 9-10 at the Swissotel in Chicago.

To learn more about this event, click here.

If you would like to join as a speaker, contact Randi Haseman at rhaseman@beckershealthcare.com.

As part of an ongoing series, Becker's is talking to healthcare leaders who will speak at our roundtable. The following are answers from our speakers at the event.

Question: Where can payers have the most impact on health equity?

Don Antonucci. President and CEO of Providence Health Plan (Portland, Ore.): Gathering member data, including race, ethnicity, language preferences, sexual orientation and gender identification, is a vital foundational step in advancing health equity. Then, utilizing this data to drive actionable ways to innovate, monitor progress and ultimately improve health outcomes is essential. Equally crucial is instilling a deep understanding of health equity throughout your workforce, ensuring it remains at the forefront of meetings, practices and daily operations. This kind of comprehensive approach will provide the most positive impact within your organization and beyond.

John Bulger, DO. Chief Medical Officer of Geisinger Health Plan (Danville, Pa.): Payers have the opportunity and responsibility to work collaboratively with the provider community and community-based organizations to compile and analyze the data that is needed to understand the what, where, and who related to health equity opportunities. Health plans have a wealth of data and have the ability to fill holes in the current understanding of health equity. The database must be expanded and democratized.

Neel Butala, MD. Assistant Professor of Medicine-Cardiology at the University of Colorado School of Medicine (Aurora); Chief Medical Officer of HiLabs: Payers can have the largest impact on health equity by ensuring adequate access to care. This starts with managing network affiliations and contracting to ensure that all members have in-network access to both primary and specialty care. The next step is to ensure that this access to care is adequately conveyed to members through clean provider directories, which have historically been plagued with data errors. Finally, foresighted payers can take the initiative to meet the psychosocial and logistical needs for patients to actually make it to their appointments. Taken together, these steps can help eliminate health inequities and reduce costs associated with delayed treatment, care at high-cost facilities, and surprising billing, which ultimately affect the payer bottom line.

Ceci Connolly. President and CEO at Alliance of Community Health Plans (Washington, D.C.): It is imperative that payers commit to improving health equity and removing barriers to care that too many communities face. At ACHP, our members are deeply ingrained in their communities, working closely with local partners to reach underserved and marginalized communities — in barber shops, mobile clinics, grocery stores and more — to provide greater access to high-quality, affordable care. This close relationship offers a unique advantage: trust. When patients are familiar with and can trust their providers, we can drive real change.

Tenbit Emiru, MD, PhD. Executive Vice President and Chief Medical Officer of UCare (Minneapolis): Addressing health inequity requires a systematic approach and long-term commitment to change policies, procedures and structures that have resulted in health disparities. While payers may not have all the data, they are better positioned to capture accurate, timely and actionable data that is foundational to tackle challenges in health equity. Data and analytics tools using population assessments, clinical and laboratory data (when available), claims data and other information on social drivers of health, combined with members' ability to manage their medical conditions, can lead to a well-rounded population health program, which in turn can be used to design clinical programs and services that address health disparities. In addition, payers can have the most impact by creating strong partnerships with community organizations and provider systems across different markets to co-create solutions and apply the learnings in multiple communities. Payers can also make an impact by partnering with local, state and federal governmental organizations to advance policy changes, legislation and healthcare reforms that reduce disparities and enhance access/affordability at the federal and state level.

Michael Grier. Director of Federal Affairs at the National Committee for Quality Assurance (Washington, D.C.): To truly make healthcare more equitable, payers must embed the principles of equity throughout their organizations. Externally, this includes everything from benefit design to customer service to community outreach in service areas that are often disconnected and disenfranchised. Internally, payers must invest in a culture of equity that all staff commit to and view as the gold standard and a key measure of success in their roles.

It's not enough to simply invest in these organizational changes, however. While core principles of health equity can be addressed through administrative changes, payers must foster an underlying organizational urgency to create a culture that can effectively improve health equity now and into the future. The NCQA Health Equity Accreditation guides payers through this work and provides them with a roadmap for sustainable change. By doing this work, payers will begin to change how they address the needs of their members, employees and communities, and create a foundation to drive systemic change that improves the lives of people across America.

Robert Groves, MD. Executive Vice President and Chief Medical Officer of Banner|Aetna (Phoenix): Health equity is imperative for the health of a population and a society. There is much that can be done and much that we are doing at Banner|Aetna to address these challenges. For example, we are implementing an overhaul of care management to bring it up to speed in the current environment and to create communities of care.

Services like the Banner|Aetna Kitchen that offers a "cooking-show-like" experience for members. We offer this to those at high risk with metabolic disease such as diabetes mellitus. For multiple sessions they attend weekly dinner clubs that include both a chef and a dietician, where they learn about cooking delicious and nutritious meals easily and then leave with the ingredients to make those meals that they just learned about at home. Rather than have information spewed at them in a lecture, they learn first-hand through dialogue and hands-on interaction with peers and experts. The program has been both popular and effective.

Building on this momentum we have created a new leadership position and comprehensive plan to take this concept to the next level. By partnering, not just referring, with existing community services, we can maximize our effectiveness and our reach all while creating a sense of belonging and community. 

Mike Hill. CEO of Total Control Health Plans (Holland, Mich.): Payers can have the most impact on health equity by working to reinvent the current reimbursement model in order to create a new system that incentivizes lower costs. The incredibly flawed provision of the ACA that introduced the medical loss ratio has created a system where everyone but the premium-payers benefits when healthcare costs go up. The average annual family premium has increased by over $7,000 in 10 years, and the average deductible has doubled. These changes have the biggest impact on the lowest-income portion of the population who now routinely can't afford to use the health insurance they can barely afford to have. Until payers work to reform the incentives that reward them when costs increase, health equity will be harder and harder to obtain.  

Dennis Hillen. Senior Vice President and Market Leader of Oscar Health (New York City): One of the biggest opportunities for payers to improve on health equity is to put it at the core of the technology and products they bring to market. The end goal should be designing a community and culturally adaptive end-to-end member experience with equity at its foundation, supported by purpose-built networks, plan designs and mission-aligned partners.

Allison Hofmann. VP Health Systems at Cigna Healthcare. (Bloomfield, Conn.): Cigna Healthcare is dedicated to advancing health equity among the populations we serve, and we have made positive changes for those we serve in a number of areas, including policy reform, increased awareness and research and data collection. Yet with our continued focus on integrating health equity into all that we do, we recognize that collaboration and partnership is central to the success of this work. Truly achieving health equity requires long term dedication from all stakeholders. Healthcare leaders, policymakers, and insurers must continue to prioritize and invest in initiatives that eliminate disparities and promote equitable healthcare delivery. 

Krista Hoglund. CEO of Security Health Plan (Marshfield, Wis.): Payers can help improve health equity in their communities by creating access to care and at a price people can afford.  Health plans play a significant role in offering robust networks and bringing virtual or alternative care options to patients, especially in rural communities where access is stretched. Health plans must also continue to partner with providers to find ways to reduce the cost of care, including addressing root cause social determinant issues as well as managing chronic conditions. 

Angela Jenkins. Vice President of Accountable Communities at Prisma Health (Greenville, S.C): Payers have an opportunity to influence collaboration between healthcare systems and community-based organizations, including community clinics, to pilot programs that address social health needs (e.g., transportation, access to healthy food, housing, etc.) by providing financial incentives through formal partnerships that are shared with all participating agencies. Payers need to incentivize prevention and early interventions through pediatricians and primary care for populations burdened by health disparities. It's critically important for payers to incentivize a broad range of interventions that meet the needs of diverse populations and not rely solely on technology and telephonic outreach to address patient care needs, particularly for people living in rural areas with limited access to broadband and technology.

Gregg Kimmer. President and CEO of ATRIO Health Plans (Salem, Ore.): In my view, the most impactful way (for a Medicare Advantage plan) is by optimizing all parts of the company such that plan benefits can result in benefits that focus on health equity. For example, Dental coverage is included in most plans. But, if the operational parts of the business aren't enhanced, the result can be lackluster plan designs that unintentionally create health disparities for beneficiaries.     

Tekisha King, PhD. Health Practitioner at Cook County Health (Chicago): Patient engagement. 

Alex Li, MD. Chief Health Equity Officer at L.A. Care (Los Angeles): Health plans can play a significant role in advancing health equity and improve the health and wellness of their members. Here are five efforts that one can consider adopting: 1) Utilize the NCQA methodology to stratify the Healthcare Effectiveness Data and Information Set and other key measures by race and ethnicity and set and report goals; 2) Consider hiring a chief health equity officer at a C-suite level to help set the vision and take on the community building efforts; 3) Employ people from communities where your members are; 4) Use health plan and community data to determine what and where to invest in, e.g., community-based organizations and partners that address key health and/or social service gaps that your members experience; and 5) focus on the disparities that you and your organization want to address. 

Brian Li. System Director of Community Health Strategic Initiatives at CommonSpirit Health (Chicago): 

  1. Health Inequity Data: Health plans can collect and analyze data on health disparities within their member populations. This data can help identify groups at higher risk for health inequities and guide targeted interventions to address these disparities.
  2. Community Partnerships: Collaborating with health systems, community-based organizations and local health departments can help health plans address social determinants of health. These partnerships can support initiatives such as community health workers and outreach programs focused on vulnerable populations.
  3. Health Literacy: Health plans can invest in health literacy initiatives to educate members about their healthcare options, rights and responsibilities. This empowers individuals to make informed decisions about their health, reducing disparities in healthcare utilization and increasing self sufficiency.
  4. Advocacy and Policy Change: Health plans can advocate for policies that promote health equity at the local, state and national levels. This includes supporting legislation that provides social service reimbursements, protects members against discrimination  and funds public health initiatives like community health worker programs. 

Ed McFadden. Assistant Professor of Health Care Administration at Trevecca Nazarene University (Nashville, Tenn.): There are no silver bullets to create health equity, but there are basics that translate into improved health outcomes and reduced costs that payers can impact.  Recognizing that nutrition is a critical factor for all humans, when payers find ways and are willing to pay to eliminate food deserts for underserved populations, that is a starting point. A second way payers can impact health equity is to create reimbursement structures that provide incentives for health systems, providers, and community agencies to manage chronic diseases. With the rise of the "payviders" and payer-provider or even employer-provider collaborations, payers can simplify the approval and payment processes to help individuals get items (nutritious food, air conditioners, etc.) that reduce chronic diseases or acute episodes.

Nwando Olayiwola, MD. Chief Health Equity Officer & Senior Vice President of Health Equity & Social Impact at Humana (Louisville, Ky.):  Payers have a tremendous opportunity to influence health equity because they have a unique and oftentimes holistic view of their members and patients. They are able to understand member preferences, behaviors and social needs; manage and disaggregate diverse datasets, and identify opportunities for program, benefit and resource design. At Humana, our work is rooted in a foundational principle that members' voices matter — what our members say, do, choose, need and value is important to us, and we take time to glean those insights from them, then solve for the things they have shared. We lean in to understanding those needs and barriers in various subpopulations, disaggregate our data in meaningful ways so that we can find trends and opportunities, innovate around new ideas and strategies, and empower our employees and community partners to be agents of change. This builds trust, capacity and ultimately breaks down the barriers to equitable health.

James Polo, MD. Vice President, Chief Medical Officer, Carelon Behavioral Health (Indianapolis): For our communities to thrive there must be equity in all community and social systems that impact healthcare. Payers have an enormous amount of claims data. Payers need to implement concerted efforts to identify and understand where health inequities exist, and then incentivize strategies that will address them. Successful strategies must consider all social determinants that impact health and facilitate improved collaboration and coordination with social support systems to improve health outcomes for all marginalized members within the community. Providers would benefit most if all payers can work together to standardize which metrics are used and which ones are incentivized.

Kimberly Reich. Privacy and Compliance Officer at Lake County Physicians' Association (Gurnee, Ill.): Health equity must stay central to all that payers and their leaders do. Health equity is a value that must live and breathe from the top down in the organization and be felt and lived by all in the organization — it should not just be thought of as the buzzword or program of the day. To be successful, it must be incorporated into the organization's mission and values statements and drive the organization's success. 

Bruce Rogen, MD. Chief Medical Officer of Cleveland Clinic Employee Health Plan: I think the impact payers can have on health equity comes from collecting and using data on social determinants of health in combination with clinical and claims data to reduce barriers to healthcare access, preventive care, pharmaceuticals and healthy food. Payers can design benefits using variances in social determinants of health data to support transportation needs for segments of the population to get to healthcare visits, promote preventive screenings, ensure access to necessary medications, and even help obese and diabetic patients make better food choices if they have limited access to fresh fruits and vegetables and protein. That may include discounts on specific items, or discounts on health premiums and copays when members achieve specific access targets, preventive screenings, medications compliance rates, or weight and diabetic outcomes.

Praveen Thadani. President of Priority Health (Grand Rapids, Mich.): In our quest to achieve health equity we are keenly aware of the role and importance of addressing the social drivers that lead to differences in health outcomes. Unfortunately, systemic and funding challenges, coupled with non-continuous coverage, hinder the acceleration of our goal — healthcare that is accessible and exceptional for all. The greatest role a payer can have is unwavering commitment and focused wins: We must stay the course until we reach our destination — celebrating wins, large and small, and utilizing change agents with a vested interest in the cause at hand. 

Ashish Shah. CEO of Dina (Chicago): Payers have a massive opportunity to shift care into the home through plan design, and then their own care navigation, to ensure timely access to those home-based benefits. By being in the home, payers can delight members with better delivery, but also unlock volumes of new data that highlights the ongoing needs of a member (and their family). Often those needs are non-medical in nature and can address challenges with health equity and other SDOH factors. Payers have an opportunity to be invited into the homes of those they serve, and they should not take that lightly. It's a win-win for all involved.

Jack Shoemaker. Business Operations Delivery Lead at Medical Home Network (Chicago): Actions to reduce health equity disparities work best when they are local. Payers should find community-based organizations, like federally qualified health clinics, that have an existing presence in the communities they serve. Those embedded platforms allow payers to implement care management and similar programs aimed at improving health equity.

Johanna Vidal-Phelan, MD. Chief Medical Officer, Quality and Pediatrics, UPMC Insurance Services Division and Clinical Assistant Professor of Pediatrics at UPMC Children's Hospital (Pittsburgh): According to the CDC, healthy equity is "the state in which everyone has a fair and just opportunity to attain their highest level of health." Non-medical social needs, also known as social determinants of health, comprise up to 80% of factors influencing one's health outcomes. Addressing both medical needs and non-medical social needs is the most impactful way payers can support individuals to optimize their health and promote health equity. At UPMC Health Plan, fostering trust and building relationships with community-based organizations (CBOs) are at the heart of our programming, with the goal of providing support for our members who experience housing, financial, and food insecurities and lack of access to care. Through our UPMC Center for Social Impact and UPMC Neighborhood Center and CBO partners like Neighborhood Resilience Project, Fabric Health, Hosanna House and Erie Center for Arts and Technology, we collaboratively work toward the shared goal of promoting health and advancing health equity by meeting people where they are

Howard Weiss. Vice President of Public Policy and Government Engagement of EmblemHealth (New York City): Organizations with a commitment to equity can have a significant impact. Health plans have data allowing them to identify where inequities cause gaps in care. For example, EmblemHealth constantly evaluates whether individuals within historically underserved communities can benefit from tailored outreach to ensure they receive vaccinations, diabetes screening, and other necessary health services. We also go beyond traditional health plan roles. Our family of companies includes AdvantageCare Physicians (ACPNY), a major primary and specialty care physician practice operating in underserved areas, and several healthcare navigation centers called Neighborhood Care. ACPNY doctors often refer patients to neighborhood care navigators, who can enroll them in diabetes self-management classes or provide free healthy food, including fruit and vegetables, during the food markets we regularly offer at these locations. These activities reflect EmblemHealth's commitment to reducing inequities, which was recently recognized when we were awarded Health Equity Accreditation from the National Committee on Quality Assurance (NCQA), commending health systems that continuously improve — and prioritize — health equity for the patients and the communities they serve.

Darren Wethers, MD. Chief Medical Officer of Atrio Health Plans (Salem, Ore.): Most health plans lack a sufficient database of elements such as ethnicity, sexual orientation and gender identity; we simply haven't asked our members for this information and are therefore unable to see which segments of our membership are experiencing disparate health outcomes. I believe that obtaining this information is a critical first step. Armed with this data, plans must make a meaningful effort to determine which members are suffering health inequalities and find ways to learn more about the members and hear their perspectives. Too often, we plan interventions for members without involving them in the planning process — we don't know if our efforts will be acceptable, effective or will fall flat due to lack of cultural sensitivity. Contracting with providers who represent the communities where we want to focus is one key approach; use of community educators is another. Dieticians who are familiar with the cultural norms of the focus group are important to impacting conditions such as diabetes and hypertension. Maternal outcomes in communities of color have received a lot of attention recently; why is it that even with access to prenatal care these women still experience excessive morbidity and mortality? What role does provider bias play? Does the gender of the provider impact outcomes? Payers can pose questions such as these, which will lead to better understanding of the issues and hopefully the development of better solutions.

Cameual Wright, MD. Vice President and Market Chief Medical Officer of CareSource Indiana (Dayton, Ohio): To excel at population health, payers must prioritize health equity and ensure that the care received by members is affordable, accessible, respectful and equitable.  The managed care industry can have the largest impact on health equity by engaging meaningfully with members and the community-based organizations who represent them.  Embracing the adage "nothing about us without us," intentional efforts must be made to hear stories, understand concerns and elicit feedback from those with lived experience. Payers must then allow that input to inform payer policies, procedures and initiatives, which are culturally appropriate and responsive to the needs of an increasingly diverse membership. 

Adam Wolk, MD. Regional Chief Medical Officer at Alignment Health (Orange, Calif.): Payers, like Alignment Health, can have direct and long-lasting impacts on health equity by offering innovative plan benefits that lower barriers to health and wellness as well as by employing clinicians who can meet historically underserved patients in non-traditional settings like home or work and provide supplemental care and care coordination directly to them for free. 

 According to Alignment's "2023 Social Threats to Aging Well in America" report, economic instability, food insecurity, lack of support and access to transportation were cited as the top barriers to senior health. Studies like this one can help payers and other healthcare organizations better understand the obstacles to living longer, healthier lives. With the rising cost of food, gas, utilities and healthcare, payers can offer greater support and ease the financial burden by providing supplemental benefits such as grocery and over-the-counter allowances, free rides to medical appointments, fitness memberships, pet services, companion care and more. This holistic approach to health helps improve health outcomes and lower costs — a win-win for everyone.

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