Payers have been upping investments in health equity, adding health equity executives to C-suites and adding equity requirements to contracts with providers.
April is National Minority Health Month. Becker's spoke with four payer equity leaders throughout the month to unpack where payers are making strides in health equity.
Bryan Buckley, DrPH, is the director for health equity initiatives at the National Committee for Quality Assurance.
The NCQA accredits health plans, and the organization introduced a health equity plus designation for health plans in 2022.
One area where health plans are innovating is in data collection, Dr. Buckley told Becker's.
"They're wrestling with some really big questions, which has been really cool to see, around understanding imputed versus self-reported data," Dr. Buckley said. "Because we often see that there's a lot of imputed data, and we know, in many ways, the gold standard is people should be identifying themselves."
Danielle Brooks, director, quality health equity at AmeriHealth Caritas, told Becker's payers have a unique ability to equip providers with more data.
"Oftentimes, when we speak to our providers, it's really helpful when we're able to talk about what their community looks like as a whole," Ms. Brooks said.
"Payers have the opportunity to not only know from a grander scale from the data what real needs look like in the community, but they have the ability to think about that from a trending level, from a systems level," she added. "We are really at the front edge of fighting a lot of equity issues because we have that view."
Dr. Buckley said health plans are also embracing equity at the organizational level, adding health equity to mission statements.
For BlueCross BlueShield of Tennessee, health equity starts within the organization, Chief Medical Officer Andrea Willis, MD, told Becker's.
"What's going really well is that we have embraced it within our walls first, really celebrating our diverse employee base, because that makes us better suited to serve a diverse membership," Dr. Willis said. "What aligns with that is that we truly believe in health equity, and so we have a chance to influence that."
Making investments count
Despite significant investments in health equity by governments, corporations and philanthropic organizations — $179 billion over 20 years — progress has stalled, according to a report from accounting firm Ernst and Young.
In the payer space, a study published in November 2022 found private insurers spent less than 1 percent of their net income on social determinants of health.
Some states are adding more nonmedical benefits through Medicaid programs, designed to support health outcomes for lower-income individuals.
In California, CalAIM, a $9 billion, five-year initiative, provides patients with nonmedical benefits and is designed to keep patients out of emergency departments, jails, nursing homes and mental health crisis centers.
Alex Li, MD, Chief Health Equity Officer at L.A. Care, said Medicaid is taking the lead on addressing social determinants of health, such as housing.
"There's such a large Venn diagram of the social challenges with health and wellness," Dr. Li said. "I think the part that I find challenging, where we have to work with our hospital partners and our social service partners, is how do we put the dollars together to make the investment work? If we just put the shoulder on Medicaid, which is a government-funded program, there's not as many dollars as the private sector."
While health plans are making progress on data collection, collaboration with other organizations can still be a challenge, Dr. Buckley said.
"One of the areas of continued exploration — it's the pebble in the shoe — is how we think about collaboration. How do I partner with healthcare delivery organizations? How do I partner with community-based organizations? How do I actually not just look at the quantitative side, but how am I thinking of the qualitative data as well?"
Coordinating efforts across the 13 states AmeriHealth Caritas operates in can also be a barrier to advancing equity, Ms. Brooks said.
"All the different product lines, whether it's pharmacy, whether its long-term services, whether its Medicaid, they all have different rules and governing pressures. I think one of the biggest difficulties is really making sure that we can advance equity in states that may not be as friendly to it," she said.
One area payers are focused on moving the needle on equity in the next year is Black maternal and infant health.
Dr. Willis said making progress on improving Black maternal health is a focus for BCBS Tennessee over the next year.
"We made so many advances in maternal care over the years, that it blows my mind that there are still women dying with childbirth," she said. "That just should not happen. If we can all focus on that and make sure we have healthy moms and healthy babies, that just keeps paying it forward right there."
L.A. Care is also focused on improving Black maternal health outcomes, Dr. Li said, and it's an issue the payer is well positioned to have an impact on.
"As a Medicaid plan, because we take care of so many moms and kids, we have great data and are able to intervene at the time of pregnancy, as well as after pregnancy," Dr. Li said. "It's one of the times where people are really engaged with the healthcare system."
The path ahead
The biggest challenge for any healthcare organization working to advance equity is understanding how they have benefited from, or been complicit in, a healthcare system built on systems that create inequity.
"The biggest challenge is being able to say goodbye to the old, and many organizations have benefited from the old, and really think about the new," Dr. Buckley said. "The new growth mindset, knowing that these are going to be some really big challenges, but if we do it together, and we do it in a collective fashion and maximize our collective intelligence, we can overcome."