Health plans can take several steps to contribute to states’ health equity, including equitable benefit design, leveraging their investments and addressing bias in AI.1 Doing so can bring significant benefits for both the plans and the members they serve.
The United Hospital Fund report outlines six strategies for health plans to improve health equity in their states:2
- Investing in communities’ social determinants of health. For example, health plans in New York have established foundations to invest in specific programs and organizations, such as a bicycle share, or a nonprofit that promotes nutrition among immigrants and people of color.
- Investing upstream. The report recommends policymakers and regulators analyze if such investments would lessen disparities. In Oregon, coordinated care organizations must invest in health equity and SDOH to be able to participate in Medicaid.
- Promoting economic equity. Stakeholders can boost economic equity by buying products and services from members of underserved communities and by offering fair pay and professional development programs.
- Improving network adequacy. The report suggests states rethink their definitions of network adequacy to include diversity measures and that payers ensure their networks reflect the populations they serve. A pending waiver amendment in New York would see health equity organizations presenting data-informed needs for action by health insurers.
- Ensuring equitable benefit design. This could include innovative offerings that address SDOH, as well as adjustments to cost sharing for diseases that disproportionately affect underserved populations.
- Addressing bias in artificial intelligence and clinical guidelines. Health plans must ensure strong oversight of algorithms and should appoint specific employees who will be accountable.
In addition to the recommendations, the report provides several examples of actions already being taken by health plans:3
- A Massachusetts plan provides annual reports on its efforts to improve supplier diversity
- Plans in New York City and Buffalo, N.Y., support local workforce training programs
- The New York subsidiary of a national plan made a $750,000 grant to federally qualified health centers to train and hire community health workers
- An upstate New York nonprofit plan raised wages above the state minimum wage
- A New York City plan partnered with a hospital system to address “health-harming” legal problems, such as evictions.
These types of changes have the potential to improve member health, with benefits for both patients and the plan. Underserved communities tend to have higher rates of illness and death, as well as excess medical costs and productivity losses stemming from health disparities.4
More than 30% of medical costs for Black, Hispanic, and Asian Americans are related to health inequities, according to an estimate from the American Public Health Association.5 These increased costs cause hardships for members and limit plans’ abilities to offer the best possible benefits.
In addressing these inequities, health plans that follow the strategies outlined in the report can see cost savings and health benefits while also fostering trust and positive relationships within the community.
Oxiris Barbot, president and chief executive officer of UHF, notes it “will take an all-hands-on-deck approach” to bring about the structural change necessary to address SDOH, and health plans “have a unique and vital role to play.”
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- Waddill, K. 6 ways that health plans can influence a state’s health equity. HealthPayerIntelligence. May 17, 2023. https://healthpayerintelligence.com/news/6-ways-that-health-plans-can-influence-a-states-health-equity
- Newell, P., Levinson, P. Leveling up: A role for health plans in improving health equity in New York. United Hospital Fund. May 2023. https://uhfnyc.org/media/filer_public/ed/f5/edf5333c-03c5-4344-8335-cc69105fae71/leveling_up_report.pdf
- New UHF report details ways for health insurance plans to improve health equity. United Hospital Fund. May 9, 2023. https://uhfnyc.org/news/article/new-uhf-report-details-ways-health-insurance-plans-improve-health-equity/
- Ndugga, N., Artiga, S. Disparities in health and health care: 5 key questions and answers. KFF. April 21, 2023. https://www.kff.org/racial-equity-and-health-policy/issue-brief/disparities-in-health-and-health-care-5-key-question-and-answers/
- Edwards, J. Health equality, equity, and justice: Know the difference and why they matter. Healthline. Nov. 28, 2022. https://www.healthline.com/health/what-is-health-equality