Health plans have a responsibility to their members to find ways of addressing health disparities and ultimately improving the well-being of the communities they serve, the economy they operate in, and the cost of their medical care.
The COVID-19 pandemic has increased the visibility of health disparities and risks among Americans, underscoring the need for key initiatives that support the health of disadvantaged and underserved populations, who see higher rates of death, disease, and poor health conditions. The cost of providing services to combat poor health continues to rise; research has revealed a potential annual gain of nearly $100 billion in excess medical care expenses and $42 billion in untapped productivity if racial health disparities are eliminated.
It’s no longer a question of what role healthcare payers must play in assisting vulnerable populations and promoting health equity, but how payers can achieve these critical objectives and prevent disparities from growing.
Understanding Health Disparities
The CDC defines health disparities as preventable differences in health and care or opportunities to achieve optimal health that are experienced by socially disadvantaged populations. Examples of health disparities can be seen in areas like economic stability, social support, physical environment, education access, food security, and health coverage and quality, among other factors that inhibit people from living at their optimal level of health.
These disparities cause significant burdens on care outcomes and spending and are often exacerbated by social determinants of health (SDOH)—the social and economic conditions surrounding where people live, learn, work and play, and how we are influenced in other ways in our environment. SDOH include housing, food insecurity, poverty, and health illiteracy, all of which increase the risk of adverse health and wellness outcomes.
The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) push for health equity among health plans, who are beginning to make a concentrated effort to encourage meaningful change and close the gaps between groups, transforming how people access and experience their healthcare. But learning how to promote health equity starts with a more comprehensive understanding of the barriers we must overcome.
Addressing Health Disparities
Health plans can actively address the impact of health disparities and detrimental SDOH by adopting a value-based, integrated care model to connect medical, behavioral health, and social services to effectively reduce healthcare costs for the organization and its members. Advanced health analytics and predictive models, specially designed programs, broad case management support, and enhanced education can also enable greater member access to integrated care, particularly for high-risk, high-need populations.
Implementing new approaches to care coordination that consider underlying health disparities and risk factors is extremely valuable. The diverse needs of vulnerable populations in healthcare and complex consumer groups require personalized care plans designed to share information between medical providers, non-medical providers, families, and caregivers.
Several major payers regularly invest in health literacy, financial literacy, and housing programs, funding or collaborating with partners to boost community resources. But even before exploring big-budget deals, payers have a wide range of opportunities to make an impact on the health and well-being of their members.
Effective Payer Initiatives
- Building a robust SDOH network in community resources
- Identifying and addressing policy and process gaps in complex care management
- Adopting an integrated care model for physical and behavioral health services
- Utilizing health analytics to identify marginalized groups and target interventions
- Enhancing risk identification and care coordination methods
- Providing implicit bias training and education on disparities and SDOH
- Investing in consistent member engagement strategies
- Promoting cost transparency for medical services and medications
- Improving communication and health literacy efforts
- Embracing telehealth, technologies, and digital strategies
Bringing Clarity through Clinical & Operational Management Programs
To establish a better link between the quality and cost of care and work toward the elimination of modern health disparities, it’s crucial that health plans develop optimized, end-to-end clinical and operational management programs. To do so means adopting transformational, holistic clinical solutions to serve existing member populations, expand to new, complex markets, and remain agile through program management, system advancement, data-driven innovation, and cross-departmental alignment.
Working with an experienced consulting organization like Clearlink is a reliable way to accomplish this aim and find targeted areas for improvement to navigate a dynamic healthcare ecosystem. By partnering with our experts, you’ll equip your organization with the tools to make great strides in your contribution to equity in today’s healthcare system.
Learn more about Clearlink and our suite of services for payers and contact us to discuss your current challenges and goals for growth.