In Florida, where Black residents are three times more likely to be hospitalized or die from asthma-related complications than white residents, one researcher’s efforts to “strip away the jargon” related to asthma treatment strengthened patients’ engagement in a year-long clinical trial. The impact: development of an asthma regimen to help combat disparities in asthma management and outcomes.
The results are one example of the gains that can be made in addressing health inequities—differences in health status or distribution of health resources by race, population, gender, income and more—by exploring the nuances that perpetuate disparities in health outcomes. Through data measurement and community partnership, health plans can make a powerful difference in reducing these inequities to improve their members’ health.
Digging Deeper into Disparities in Care
Disparities in access to care and health outcomes existed long before the COVID-19 pandemic. Disparities in the way medical professionals assess and treat pain in people of color, for example, have been the focus of many studies and reflect an unconscious bias among some medical professionals that prevents members from getting the care they need. Evidence of implicit biases among healthcare professionals fuel distrust of the healthcare system as a whole.
However, COVID-19 illuminated the disproportionate impact of many diseases on specific populations, including Native American, Black and Latino communities. It also magnified the health challenges that exist in pockets of communities, where social determinants of health affect not just access to care, but also how sick a patient may become before seeking care.
As the U.S. devotes more focus to understanding and eliminating health inequalities, health leaders have begun to change the language they use to discuss these challenges. Increasingly, industry professionals are shifting away from terms such as “vulnerable populations” toward “under-resourced populations,” a nuance that underscores the impact of distribution of resources on health status rather than factors such as race or income level alone. There is also greater recognition that race and racism are risk factors for health.
These are solid first steps toward change. However, to truly make a difference in eliminating racial and ethnic disparities in healthcare, understanding the cultural tenets of communities and their impact on when individuals seek care—and at what stage of illness—also is crucial. In Black communities, for example, the ability to push through pain can be seen as a strength. It’s not uncommon for people experiencing physical discomfort to say, “Oh, it’s just a little pressure,” and to power through it. When they do seek care, their condition may be more advanced because the initial markers of disease were not spotted early.
For health plans, access to extensive data around health, health outcomes and social determinants of health puts them in a powerful position to advance health equity. Plans hold a unique vantage point into data patterns that pinpoint where disparities in health and health access exist as well as best practices for intervention. They possess the resources to disseminate this information to providers for broader discussions around population health. Health plans also have a vested interest in strengthening care navigation and coordination for at-risk members, given the opportunities to improve quality of care and life while reducing care costs.
Here are four considerations for health plans on ways to become “data connectors” for health equity.
1. Create a social index score. The National Committee for Quality Assurance (NCQA) has embarked on a major initiative to drive health equity by introducing race and ethnicity stratifications to its quality measures, beginning in the measurement year 2022. Further, the Centers for Medicare & Medicaid Services (CMS) has proposed a health equity index that would create transparency around how health plans address inequities for under-resourced groups. To keep pace with these initiatives, health plans should create a social index score for their own populations, leveraging three types of data: individual-level factors for health such as age, gender, and medical risk diagnosis; social determinants of health (SDoH), such as food and housing insecurity; and the services that members receive—both inside and outside the healthcare system—in areas where social and economic deprivation exists.
From there, data analytic experts can layer in modeling to determine: What is the prevalence of asthma in a particular region? What do the data tell us about the likelihood that a child will be screened for asthma? What factors exist that heighten a child’s risk for asthma, such as higher-than-average levels of air pollution? Is there a higher percentage of children who suffer from asthma by race, income level or other SDoH? This enables health plans to dig deeper, exploring the types of interventions that currently exist and comparing them to best practices in similar communities where interventions have proved successful.
Key to this approach: establishing standards for collecting and exchanging health equity data as well as uniformity in the questions used to collect health equity information. In April, the Blue Cross and Blue Shield Association called for national standards for health equity data collection to better understand and address disparities in care. These include standards for collecting data across dimensions such as race, ethnicity, language, sexual orientation, gender identity, and other SDoH.
2. Track the data over time—and share it widely. The more accessible the data is, the more useful it becomes in improving health for underserved members. As CMS explores changes to reimbursement to reflect health plans’ success in driving health equity, and as standards for measuring the impact of health equity initiatives evolve, health plans should become less territorial about their data. This will begin to lead to an environment where data helps align initiatives to transform care and improve outcomes.
For instance, when Blue Cross Blue Shield of Massachusetts became the first health plan in its state to incorporate health equity measures into its contracts and payment programs, the health plan publicly shared its data around racial inequities in health. Blue Cross also connected with providers to show them how their ability to meet their communities’ health needs compared to those of similar practices.
3. Work in partnership with community organizations and advisors. To build trust with members whose whole health needs typically have not been addressed—whether due to barriers in access to care or misgivings about seeking help from legacy providers—start by connecting with groups they do trust. This might include local barbershops, churches, the YMCA or even the laundromat.
In Virginia, for example, where the mortality rate for Black infants is nearly twice as high as the mortality rate for white infants, partnerships between hospitals and community service organizations ensure mothers receive care coordination, resources and social support. Mothers gain support not just during pregnancy, but also for the first year postpartum.
In New York, HealthFirst, a not-for-profit health insurer sponsored by New York City’s leading hospitals, a partnership with Mount Sinai Health System improved postpartum outcomes among women of color. New moms who are at risk for postpartum complications or poor long-term health outcomes receive support including connections to community resources and transportation reimbursement for postpartum care, driving an 11% increase in postpartum visits. Maternal health improved, and the model is now being explored by other organizations across the state.
4. Provide cultural competency training for health plan staff. The University of South Florida asthma study demonstrates the gains that can be made when health plans and providers ask the right questions in ways that resonate with members. This requires professionals to understand communication differences by race and by culture and to ask culturally competent questions that help uncover obstacles to care and engage individuals in their health. It also necessitates that organizations have strong knowledge of the specific communities they serve. With this information in hand, payers can determine the types of interpreters that might be needed; the extent to which language in written materials, such as surveys, should be tailored to various member groups; and whether to hire care managers with expertise in engaging particular populations for example, including LGBTQ members.
Beyond eliminating obstacles to care, cultural competency training also can position care managers to explore potential health risks more deeply. When members indicate they are consuming more alcohol per week than they were the year before or are experiencing symptoms of depression, sensitivity training helps care managers thoughtfully convey, “Let’s talk about some programs that can give you the right support.”
Data Helps Tell the Story
Data is crucial to understanding where disparities in care and health outcomes exist—and health plans are uniquely empowered to tell this data story. But health plans also need input from the organizations that work most closely with members and insight on interventions that have already been tried to make a substantial difference. By developing a data-informed, highly collaborative approach, health plans can more effectively ignite efforts to eliminate disparities in care and access and improve health for all.
About Rachael Jones
Rachael Jones is Senior Vice President, Performance Analytics and Quality for Cotiviti, a leading solutions and analytics company that leverages clinical and financial datasets to deliver deep insight into health system performance.
