Payers uniquely positioned to enhance health equity, United Hospital Fund report says

Payers can and should be doing more to address health inequities, a new report by the United Hospital Fund says.

The New York-based nonprofit aims for the report to serve as a road map for payers looking to do the work of elevating equity.  Payers are uniquely positioned to address disparities as they are major employers, control vast resources through premiums and spend billions of dollars on goods and services, the report said. Besides reeling in massive profits, payers also pay an estimated $93 billion annually in excess direct medical costs attributed to disparities.

The report (PDF) offers examples of interventions payers are already taking or can take. The areas where companies can incorporate equity lenses include DEI efforts, investments, provider networks, benefit design and data collection.

“The COVID pandemic made it painfully clear that scant progress has been made,” UHF President and CEO Oxiris Barbot, M.D., said in a press release. “It will take an all-hands-on-deck approach by all parties to bring about the structural change necessary to address social drivers of health.”

Regulators, too, have a role to play—when Blue Cross Blue Shield plans in New York and Pennsylvania planned to combine in 2019, state regulators approved the agreement on the contingency that they commit $10 million toward efforts to improve racial and health inequities. 

“It is important to view these contributions in the context of the resources health plans command,” the report noted. Some local leaders in western New York argued the $10 million commitment was not enough.

Other equity-focused interventions include improving supplier diversity, supporting programs to upskill local residents, socially responsible investments and helping federally qualified health centers train and hire community health workers.

Blue Cross Blue Shield of Massachusetts has taken an “aggressive and transparent” approach to its supplier diversity, the report said, using purchasing power to support diverse businesses and build capacity in the business community. Healthfirst, a nonprofit plan sponsored by hospitals, partnered with a tech company to create a professional development program to prepare residents of the Bronx for a career in IT. It hopes to hire up to 40 contractors trained in the program. 

A federal Medicaid waiver program in New York aimed to reduce hospital readmissions by encouraging collaborations between providers and community-based organizations. Such an approach helps connect enrollees with trusted, local sources of information, thereby improving the diversity of local provider networks and building trust in the medical system. 

Loan forgiveness programs can help improve the diversity of the healthcare workforce, which is lacking. Payers can also partner with academic medical schools, teaching hospitals and nonprofits to increase the supply of physicians from underrepresented groups. 

Regulators can and do demand some cultural competency. Contracts for New York’s Medicaid Managed Care program include requirements like training of staff, provider certification and community needs assessments. California requires such training for all healthcare providers and recently added a requirement for implicit bias training.

Benefit design is a creative way to support the social determinants of health with much room for improvement, the report said. Some public plans have introduced SDOH interventions through authorities for community care coordination services and value-added services. Others include supplemental benefits like food, pest control and general financial support. These benefits are not as common in the commercial market, but federal rules have provided states with a pathway to update their essential health benefits packages. 

With so many data at their fingertips, payers should consider becoming stewards of AI to help oversee and prevent algorithmic bias. Colorado is establishing guidelines for payers when large amounts of external data are used to prevent discrimination. Pennsylvania is working with Medicaid managed care plans to mitigate bias in the algorithms that health plans use.

Just last month, the National Committee for Quality Assurance (NCQA) launched a race and ethnicity stratification learning network—a free, interactive tool that offers data and best practices to help payers improve how they collect race and ethnicity data on their enrollees. It is based on a survey of 14 commercial and government plans. So far, a few thousand people have interacted with the tool, Keirsha Thompson, manager of performance measurement at NCQA, told Fierce Healthcare. 

“We hope that interest will kind of be consistent going forth,” she said. “Even the smallest of plans are figuring out how to do this.”

Prioritizing alignment and close collaboration will be key to avoiding wasting resources and implementing interventions short- and long-term. “Perhaps most importantly, state leaders and plans could provide a desperately needed sense of urgency,” the report concluded.