Five Keys To Realizing Health Equity In US Health Plans
As the COVID-19 pandemic continues to widen existing health and health care disparities in the United States, the attainment of health equity looms large and is arguably our most pressing national priority to curb the pandemic. Social and economic vulnerabilities that have long preceded COVID-19 have perpetuated staggering challenges. Many in our nation now understand what public health experts have known for decades—underlying socioeconomic conditions in communities across the country predict health and health care outcomes more reliably than health care delivery itself. We are now increasingly compelled to declare racism as a public health crisis and have demonstrated that systemic racism, oppression, and discrimination can, in fact, be dismantled in weeks (not years). We are headed in the right direction.
The combination of a formidable virus and the unleashing of anger and action around social injustices in the US has created fertile ground to create synergy around health care and social justice. Subsequently, companies previously ambivalent on these issues have entered the roster of organizations and corporations taking action to achieve health equity as a moral and business imperative. Eliminating health disparities has moved from a goal post for public health agencies, nonprofits, philanthropists, community-based organizations, and researchers, to a necessity for the private sector—including the nation’s health plans.
America’s health plans assume the risk for millions of Americans and are responsible for the health of most Americans. In a health care delivery system that is highly fragmented, health plans are uniquely positioned to coordinate whole-person care across the lifespan. These organizations are also poised to lead efforts in health equity that will address the systemic and structural factors that have perpetuated health inequities for too long. To succeed in achieving health equity in these companies, it is crucial that investments in health equity leadership be made, at the highest level, and that health equity is weaved into the organizational fabric, strategic plan, and business goals of every health plan. What, then, should we expect to see if health equity leadership is prioritized and realized in our nation’s health plans? How can leadership in this space apply a health equity lens that is sustainable and scalable? As the inaugural chief health equity officer at Humana, I believe that successful health equity leadership in health plans will result in five major priorities and achievements.
Five Keys To Integrating Health Equity Into Health Plans
The role of chief health equity officer in national health plans is an emerging one, but one that is most certainly overdue. As I have assumed this role at Humana, I am inspired by our bold vision of making health equity a key part of a health plan business model. To thrive in this role, I will need to effectively lead work that defines enterprisewide measures of equity, define and create health equity improvement goals, and coordinate efforts to achieve those goals across all of Humana’s lines of business. This will require creating deep partnerships across all segments of the business, including care delivery, home health, retail, and commercial segments.
The five major priorities (and the achievements that will result from these priorities) for health equity leadership in health plans I’ve identified are:
- Prioritizing Prevention and Wellness: Benefits and care delivery redesign
- Prioritizing Communities: Engagement and investments
- Prioritizing Innovation: Population and digital health
- Prioritizing Education, Research, and Workforce Development: Academic-community collaborations
- Prioritizing Action and Accountability: Data-driven improvement
1. Prioritizing Prevention And Wellness: Benefits And Care Delivery Redesign
Having spent my early career as a community health center physician and leader, I am astutely aware of the importance of health plans in supporting a commitment to prevention and wellness. Health plans play a critical role in defining what is valued by determining what is reimbursed. Inequities are well-documented in countless, preventable health conditions and social problems. Black populations, for example, are disproportionately impacted by chronic diseases, including cardiovascular disease, diabetes, kidney disease, asthma, and human immunodeficiency virus (HIV), as well as by infant mortality, maternal mortality, incarceration, and poverty. However, many of these conditions can be ameliorated or prevented through intentional focus on wellness, prevention, culturally competent, whole-person care, and value-based care. Expanding access to and removing barriers for necessary preventative services and wellness programs should therefore be a priority for every health plan. In addition, plans should support a home-based care strategy, which provides deeper insight into potential social and structural factors that lead to poor health. This can be central in understanding unique patient needs as health plans set goals and propose solutions. Additionally, health equity should be the focus of benefits design experiments to better understand the impact of benefit changes on existing health disparities—an area where data are still limited but promising. Deconstructing the fee-for-service model with a health equity lens can accelerate the transition to value-based care, particularly when coupling new payment models with care delivery redesign; reengineering of technical, infrastructure, and human resources for service delivery; and alignment across various plans. Health plans focused on health equity should also devise or adapt tools to measure clinician performance, member engagement, and organizational performance on a host of health equity-related domains, such as population-level vaccination rates or reduction of avoidable hospitalizations in patient populations that have been made vulnerable. The role of senior health equity leaders with expertise in prevention and wellness is paramount. A fully matured health equity ecosystem in our health plans will see the collective elevation of preventative care and wellness as fundamental to its core, with requisite performance improvement and assessment.
2. Prioritizing Communities: Engagement And Investments
By fostering or coordinating partnerships with philanthropists and community leaders, I have witnessed accelerated opportunity and improved health of our most underserved communities. A senior health equity leader in a health plan should spend time understanding community-level challenges and channeling human, technical, financial, and other expert resources to improve them. Deep engagement with communities, such as the Bold Goal efforts at Humana, have been useful in building trust and understanding what communities need and how best to respond as a health plan. Advancing this work will require more explicit goal setting and measurement.
More health insurance companies are also entering the philanthropic space, with charitable giving by health plan foundations increasing steadily over the past decade. This is further driving public health advocacy and community engagement. As health plan foundations direct a larger part of their focus to social determinants of health, they can serve as powerful partners in co-creating health equity-focused programs with community partners. Through strategic investments in local organizations, community leaders, and research, foundation-based health equity can empower communities that have been made vulnerable. These investments ultimately impact social and structural factors that have created and exacerbated health inequities, such as housing discrimination and instability, intergenerational poverty, education deprivation, environmental toxicity, joblessness, food insecurity, digital disparities, and other social vulnerabilities. Health plan foundations can also be instrumental in restoring community infrastructures devastated by the COVID-19 pandemic and natural disasters. These investments allow for further upstream intervention within the capacity of a health plan. A senior health equity leader will ensure that health plan foundations achieve healing and trust in underserved or ravaged communities and that community investments (human, technical, capital, technology, expertise, and other) are applied to empower those we serve.
3. Prioritizing Innovation: Population And Digital Health
The COVID-19 pandemic has hastened innovation in the delivery of care and advancements in digital technology for public health, population health, health care, social engagement, employment, education, and almost every other facet of American life. While “frugal innovation” has often been essential to creativity under the most resource-limited conditions, “pandemic innovation” has given health plans a remarkable platform to accelerate solutions that empower and engage underserved populations in creative ways. For example, in a post-pandemic world, health plans can play a role in scaling telehealth innovation in ways that meaningfully achieve patient-centered, culturally competent, and cost-effective care, reach more patients where they are comfortable, and avoid worsening the digital divide. Health plans focused on health equity through dedicated leadership are uniquely positioned to advance population health efforts and deliver a culturally sensitive experience for members and employees. They can also expand and redefine services, such as home-based care; behavioral health; mail-order pharmacy benefits; wellness and prevention; use of remote monitoring tools; and primary, specialty, and hospital-based care delivered through technology. Health plans are increasingly becoming both payer and provider, which creates additional room for creative and innovative action with cultural sensitivity. For example, an eye toward health equity is paramount as Humana continues expanding primary care delivery, digital connectivity, and care in the home. Because health plans command outsized influence in defining what is considered “high performance,” leadership in population health efforts must be synergistic with the other pillars and across sectors. A senior health equity leader will be a critical voice for culturally competent and sensitive, holistic, and person-centered population health innovation. As this part of the health equity leadership role gains ground, we will certainly experience more agility and creativity across the health plans.
4. Prioritizing Education, Research, And Workforce Development: Academic-Community Collaborations
Health plans incentivize and catalyze health equity through collaborative efforts with the academic health systems and community organizations that are responsive and reactive to gaps identified in social, education, clinical, or other indices in a community. Partnerships between insurance companies and academia have historically led to investments in individual and social capital, training, and capacity-building in the workforce. This can accelerate research, provide support and resources for learners from underserved communities and diverse backgrounds to gain education and training that prepares them for the workforce, and ultimately invest back into historically underprivileged communities. Health plans, academic institutions, and community organizations can collaborate through formal educational agreements, research partnerships, internships, and community impact programs that galvanize health equity efforts. For instance, the Humana Integrated Health System Sciences Institute at the University of Houston is “committed to producing high-impact research that changes policy, innovative educational programs that prepare a new generation of health care providers and novel programs that support community transformation.” A successful senior health equity leader will drive the organization to create and expand mutually beneficial relationships that achieve tangible results and promote ongoing professional growth and scholarship, and broadly disseminate findings to ensure that all health plans and their members can benefit.
5. Prioritizing Action And Accountability: Data-Driven Improvement
The largest health plans have a tremendous advantage because, in aggregate, they can leverage massive data sources to understand and measure gaps, drive action, and create a framework for accountability. They have access to not only clinical performance and outcomes data but also utilization data, sociodemographic data, and community level data, which allows for surveillance that captures health disparities as they arise. A health equity leader in a health plan must use such data to define and improve health equity measures, set priorities for the health plan, and foster ongoing ingenuity and innovation. For example, health plans are well positioned to define target areas for directing health equity interventions based on place-based geographic information system and community (census tract, neighborhood, and so on) mapping tools such as the Centers for Disease Control and Prevention (CDC) Social Vulnerability Index, the COVID-19 Community Vulnerability Index, the Health Opportunity Index, and the Kirwan Institute Opportunity Index. Analyzing such data with health plan membership data can be invaluable as plans work to identify areas to focus and prioritize health equity initiatives, investments, engagement, partnerships, and benefits.
Banding Together
As I embark on this journey as the chief health equity officer for Humana, I am thrilled at the opportunity to craft an equitable health strategy for a health plan and wellness company that provides care and coverage for millions of Americans. The nation is ready, not just for this work to be done at one health plan but for national health plans to band together around a shared vision for health equity. Together, we can show what a commitment to senior health equity leadership can do; how the journey will end if health equity is core to the business and leadership mission of health plans; and how we will know when we’ve achieved our goals. I believe that we will truly reach the health equity bullseye when health plans: 1) reengineer what we deliver and value in health care through prevention, wellness, and the elimination of health disparities, giving everyone a fair chance to experience full health; 2) sufficiently resource communities made vulnerable through socioeconomic deprivation to overcome social and structural factors that impede health and wellness; 3) ensure that patients and populations across demographics and across the lifespan benefit from creative and innovative solutions that optimize their quality of life in a culturally meaningful way; 4) create career growth and workforce empowering opportunities rooted in community engagement, scholarship, and inquiry with dissemination of what we learn; and 5) leverage existing and emerging data to understand inequity, drive impactful changes, and create structures for accountability and continuous improvement until health inequities are non-existent.
I look forward to studying the effectiveness of my chief health equity officer leadership role at Humana and the interventions and activities it inspires, disseminating the findings and sharing the lessons we learn along the way. Together, we can be a powerful force with a focus on the return on mission, achieving health equity cohesively. We can do it. We have started already.