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WHY HEALTH PLANS ARE VITAL TO HEALTH EQUITY

by Rachael Jones, SVP of Performance Analytics and Quality at Cotiviti
06/28/2022 Leave a Comment

Rachael Jones, SVP of Performance Analytics and Quality at Cotiviti

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.

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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. 

Tagged With: Advance Health, Asthma, Care Coordination, Clinical Trial, CMS,
Color, Cotiviti, Depression, Health Equity, medicaid, medicare, model, Mount
Sinai, NCQA, Nuance, Payers, Population Health, risk, Social Determinants of
Health, Vital


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