AHIP 2022: How payers could lead the charge in addressing health equity

LAS VEGAS—As the healthcare industry grapples with health inequities and disparities across the country, health insurers are well positioned to lead the charge, experts said Wednesday.

Former Ohio Gov. John Kasich said during a keynote presentation at AHIP's 2022 conference that the payer industry's muscle gives it the ability to bring stakeholders together to drive critical collaboration around health equity. That includes providers, policymakers, physicians and community leaders, he said.

"You ought to be the leader in that you have the data," Kasich said. "This would be such a great thing for people in our country who have been excluded from the power they ought to have."

Health equity was a prevailing theme across multiple days of sessions at the conference and has been a central topic in the healthcare industry writ large in the wake of COVID-19 and the increased attention to social justice concerns nationally following the death of George Floyd in 2020.

At a panel earlier Wednesday, experts said it's critical not to view addressing health equity as a "zero-sum game."

Joneigh Khaldun, M.D., CVS Health's chief health equity officer, said any healthcare organization needs to be intentional in how they're thinking about addressing equity challenges, and they need to understand that there doesn't have to be a choice between addressing equity and disparities.

"I think we have to get out of this mindset that disparities are a just a way of life," Khaldun said.

Earlier in her career, Khaldun served as the health commissioner in Detroit. Figuring out what needs must be met meant investing the time and resources in individual communities, she said.

For example, her team identified infant mortality as a key challenge and was able to both narrow the Black-white mortality gap while also helping the city achieve its lowest infant mortality rate in 100 years.

"We listened; we asked people in the community what their issues were," she said. "You can see those disparities close."

Achieving that intentionality requires buy-in from the top down and a clear culture of equity within an organization, said Marshall Chin, M.D., the Richard Parrillo Family Professor of Healthcare Ethics in the Department of Medicine at the University of Chicago.

Building that culture means embedding equity into every facet of operations, he said, and moving beyond treating equity challenges as individual, patient-level issues. The vast majority of interventions are patient-based approaches, and there is a clear lack of systems-based or policy-based strategies to addressing equity.

For instance, if a healthcare organization wanted to address the fact that Black children are more likely to face complications related to asthma, it would likely stratify the data and identify patients who are not adherent to medications or not coming to doctor's appointments.

Solutions from that individual perspective would not take on the systemic challenges that may be driving the broader issue, he said.

"Oftentimes when you ask the question that way, you have a 'blame the victim' approach," Chin said.

Khaldun added that having the right data to take on health equity issues remains a huge barrier but that the healthcare industry can't sit on its hands while those data come in.

"We can't wait. That is unacceptable, I think, from an equity perspective," she said. "Get what you can get. Data will never be perfect, but you have to act."