3 Things Health Plans Must Do to Understand Their Impact on Health Equity

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By Teresa Younkin, Senior consultant and Ed Daniels, Senior consultant


Health Plans across the United States are asking questions about Health Equity in their communities, among their employers, with their providers, and in their own organizations. Where are the biggest health disparities, and where can we make the most impactful investments? How do we measure up against our own goals? Where do we stand in comparison to other Health Plans? We have identified three key areas that all Health Plans should prioritize to measure where they stand in terms of Health Equity and to obtain the necessary information to establish a plan of action. 

First, let’s define Health Equity. According to the Robert Wood Johnson Foundation, “Health equity means that everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.”1 Racism, coupled with a history of mistreatment, has created mistrust of health care providers and the health care establishment. Embedded in this definition is the goal for everyone to have a fair and just opportunity to be as healthy as possible.  

Critical success factors for Health Plans involve three key activities, including: 

Key Activity #1 – Assess and measure health equity in our communities 

Health Plans have extensive clinical and economic knowledge available from their clinical and business teams. Plans can use these data resources to provide insight into the health and social environment of their members, customers, providers, and communities. Additional data are available from provider networks, including hospitals and physician practices and from local, regional, state, and federal government agencies. Compiling and analyzing these data provide the ingredients Plans need to measure and monitor health equity in their communities and among critical subpopulations. Each Plan should ask the question, “Controlling for age, sex, and certain other factors, what are the impacts of social determinants of health such as poverty, unequal access to health care, lack of education, stigma, and racism?” Each of those determinants, along with others that may be unique to each region, make up the contributing factors that lead to health inequities.3  

Collaborating with their community partners, each Plan should make a concerted effort to understand and fill data gaps to quantitatively measure the impact of inequities in their communities. Establish an ongoing collection and monitoring process using the same data analytic tools you use in other aspects of your business to create a Health Equity Dashboard. The first attempt will not be perfect, but it is important to share ownership in the development of the dashboard, communicating and understanding that this is an iterative process. Be willing to share it openly, despite its flaws, to obtain honest feedback. Collaborate in your review of the Dashboard, and discuss working together over time to improve and validate the measures.  

Key Activity #2 – Identify systemic obstacles to Health Equity within the Plan itself, within Provider organizations, and with customers leveraging multi-stakeholder initiatives 

Only recently have we, as a society, realized that mechanisms generating health disparities are built into the very fabric of our organizations, our government programs, our educational system, our drug development processes, and our health care delivery system. Because we have grown up with our respective organizations, and because we deal with them every day, we don’t have the benefit of perspective. And, we haven’t built the analytics to understand how we perpetuate health disparities through our routine processes.  

Could we augment our current plans to be more inclusive of new populations? Could we recruit more providers who differ from our standard provider profile? For example, providers might be currently serving a patient base including communities of color, immigrant communities, impoverished communities, and communities suffering from violence and drug addiction.  

Key Activity #2 includes systematically evaluating our own organizations, as well as our provider networks and customer organizations, to identify activities that negatively impact health equity, as well as those that enhance health equity with innovative activities that could be amplified to make a positive difference.  

This assessment should use the Plan’s internal team members who have relationships within the community to invite participation from representatives of provider organizations, customer organizations, and representatives of disenfranchised communities to create a wholistic view of their communities to identify disparities. 

By quantitatively and qualitatively understanding the positive and negative impacts of each Plan’s own day to day business processes, we can identify and monitor our progress as we plan and work to resolve these limitations. 

Key Activity #3 – Inventory community resources and determine their strengths, weaknesses, opportunities and threats 

Within each Plan’s service areas there are a wide variety of programs and organizations that are working to address health disparities. These include faith communities, government agencies, non-profit organizations, and for-profit companies. Even though Plans may know these resources exist, we need a deeper dive to understand where gaps may exist in the market. We need an exhaustive inventory of these resources, including their capacity and an assessment of their potential to extend services and to interconnect and coordinate with new Health Equity programs that your Plan may implement.  

Every day Plans build new and improved processes that serve their own organizations. Plans assess their own procedural strengths and weaknesses and do what is necessary to improve. Plans evaluate, hire, discipline, and train their own personnel. Plans cultivate leaders and place them in positions of authority. Plans build software and connect networks to monitor their operations and communicate with their providers, customers, and members. Plans can use these skill sets and tools to identify prospective new partners and additional community resources. Plans should invite members the community identified in Key Activity #1 to participate in this inventory and evaluation process. By having a Plan’s skilled and educated team members collaborate with community members who personally experience and observe the day-to-day impact of organizations, we can work together to identify new community partners that can help us achieve greater equity in both our operations and in our services.  

Maximizing Health Equity going forward 

These three key activities are critical to understanding where each Health Plan stands with respect to the communities it serves, and to the goal of achieving health equity not just for our Plan members, but for all community members.  

Beyond the measurement and assessment activities described in Key Activities 1, 2 and 3, Plans need to put this information to work. Using the information gathered, and the community relationships established through this inclusive process, Plans can establish a strategy to make an ongoing positive impact on health equity in all the communities they serve, while creating greater trust and inclusion in the process. 

Does your organization need support with the health IT aspects of your health equity initiatives? Reach out to us at teresa.younkin@pocp.com and ed.daniels@pocp.com. We are happy to help!