Darrell Gray II, MD, is the inaugural chief health equity officer at Elevance Health, where he's now spent just over one year leading a company-wide strategy to advance health equity for 45 million members.
A graduate of Morehouse College and Howard University College of Medicine, he's on a mission to elevate whole-person health through new partnerships and out-of-the-box solutions.
Dr. Gray's latest initiative is a partnership with Harvard's T.H. Chan School of Public Health, where he also graduated with a master's in public health. In early November, he will join top Medicaid and equity executives from across Elevance at the university to continue investing in a company culture that embeds health equity at every level.
He sat down with Becker's to talk more about how he believes the partnership provides an opportunity to drive better outcomes for Elevance's 11.3 million Medicaid members across 25 states, along with D.C. and Puerto Rico.
Question: How do you think Elevance has changed strategies since the emergence of COVID-19 to ensure that its care gaps are found and addressed among members?
Dr. Darrell Gray: For decades we had been invested in addressing health disparities in healthcare and health in general. This is reflected through our Medicaid, commercial, exchange and other businesses.
But one of the things that really changed during the pandemic, and certainly during some of this social unrest, is the highlighted opportunity for us to be more intentional with how we drive toward health equity. Part of that was creating a comprehensive strategy that could be executed through all our lines of business. Every associate within our organization can stand behind and own this — it's not just up to one chief health equity officer because health equity is everyone's business. To achieve that, there needs to be leadership to guide this process, and fortunately I was chosen to be part of that leadership. But one of the things that's been very clear even before I was hired, is that to advance health equity it has to be a business priority and a cultural priority. Fortunately for us, both in our board and our CEO, they have driven that to be the case.
Q: Some in public health academia are calling for an end to language around "eliminating health inequities." How should we be discussing health inequities in this country?
DG: We as the health ecosystem are kind of in evolution of the language that is being used. I think the most important thing is that we are all driving towards advancing health equity. Specifically, inequities refers to those differences, whether it be in health outcomes or otherwise, that are unjust and unfair. Health equity is the outcome we want to achieve, when everyone has a fair and just opportunity to be as healthy as possible.
We know that there are some populations that are not on the same level of playing field as other populations. We need to think about how we prioritize resources to ensure that everyone can ultimately achieve their optimal level of health as possible. This cuts across many demographic attributes such as race, ethnicity, language, age, sexual orientation, gender identity, those living with disabilities, those living in a rural versus urban area.
As we talk about advancing toward health equity, it's very important that we appreciate the inclusivity and the intersectionality of that. We talk about those living within rural areas experiencing inequities, but if we dive down deeper, we noticed that those who identify as Black may have the worst inequities in those areas. If we dig deeper than that, we notice those who identify as being a sexual and gender minority, such as a transgender individual who's Black and who's living in a rural area, has the worst outcomes. Appreciating intersectionality is so critically important as we do this work.
Q: Elevance recently gained state Medicaid contracts through the purchases of Integra Managed Care, MMM Holdings and Paramount Advantage. How does Elevance decide on these purchases?
DG: The decision is always made in regards to who we can serve. What is our reach in that population? Our first focus is always the members and how we can center and improve their health and continually push the needle on improving whole health. We're not just thinking about the health system and clinics in that coverage area, but about what happens in the homes, communities and neighborhoods because that impacts social determinants of health. We also think about behavioral health and meeting the pharmacy needs of those we serve.
Q: More than half of Medicaid beneficiaries nationwide are people of color. What's the biggest advantage Medicaid has in addressing health inequities among low-income Americans?
DG: The good news is that Medicaid is no novice to identifying and addressing health disparities and trying to advance health equity. I think what the great opportunity is, is the disproportionate burden of diseases and poor outcomes amongst communities of color, particularly as we think about those who identify as Black or Hispanic. The opportunity that lies ahead of us is narrowing down those root causes and addressing them.
If we identify a population of members who are Black but have poor outcomes with any kind of HEDIS metric that you pick, it's really important to look at the next layer. Where does this patient live? And could that be contributing to it? Are they connected with a doctor or have access to a pharmacy that's close by? We must think about other things that could impede that person from a social landscape standpoint from getting the most optimal care possible. We have to look deeper.
Q: Elevance is sending Medicaid executives to Harvard this week to develop the skills necessary to boost health equity for Medicaid members. Can you tell us more about what they're looking to achieve?
DG: This work of advancing health equity will happen only because of clear intention and because we've embedded it in all the work that we do. We call our approach 'health equity by design,' because we are truly designing our practices, programs and processes for the outcome that we want to achieve. We have to ensure that we are continuing to cultivate leaders within our organization and a culture that will better enable us to provide a culturally humble, consumer-centered experience that allows members to achieve their optimal level of health.
This program and this partnership with Harvard is one opportunity where we get to do that, where we get to help prepare our leaders for this ongoing work in this journey. It's a partnership with Harvard's T.H. Chan School of Public Health, and the course is called Leadership Development to Advance Equity in Healthcare. This year, we're sending all of our Medicaid and health equity directors to this program. We have a cohort of 20 individuals, including myself, and our vision is to make this an annual offering for leaders even outside of Medicaid. We're really excited about this opportunity.
Q: What role should all of academia be playing in reducing health disparities post-pandemic?
DG: I think academia plays a critical role. Elevance Health cannot do this alone and academia can't do this alone. We need to partner with each other and partner with government and community-based organizations to really drive towards our goal of health equity.
As researchers within academia, the temptation is to continue to investigate disparities. Health disparities are well understood and well known at this point. The conversation and academic discourse needs to shift to, what interventions are working to address these disparities? What community-based interventions are actually working and can be scaled to advance health equity?
Q: What are other payers missing about how to improve health outcomes and reduce disparities among their Medicaid members?
DG: All my peers in other payer institutions are trying to establish and to do what works best. My hope is that we will establish this as a best practice and have proof points that they can learn from in doing such partnerships with Harvard. Overall, we have to think outside of our traditional boxes. We partner with the NIH 'All of Us' research program, which is another example of an academic partnership that we have to drive the face of research to be more like the face of America. If we really are serious about providing a personalized care journey for those we get to serve, then a part of that is ensuring the research is inclusive and diverse.
Q: Why does every healthcare organization need a health equity leader in their C-suite today?
DG: Over the past couple of years there has been a shift to where organizations are hiring chief health equity officers. I'm the first at Elevance Health. Humana recently hired theirs as well, Dr. Nwando Olayiwola. The purpose behind the shift is not just for window dressing, it is because companies recognize that there is a business imperative behind doing this work and doing it with intention. Companies such as ours realize that it is incredibly important to hold all of our associates accountable to the outcomes that we hope to achieve and that we have leadership to help to drive toward that. It's critically important that organizations such as Elevance Health be one band, one sound, marching toward advancing health equity. That's what leadership can do.