Can a Health Insurer Make Health More Equitable? | Deloitte US has been saved
By Jay Bhatt, D.O., executive director of the Deloitte Health Equity Institute and the Deloitte Center for Health Solutions, Deloitte Services, LP
Health equity is everyone's business. Deloitte’s actuaries recently concluded that health inequities account for about $320 billion a year in annual health care spending (see our report on the Economic cost of health disparities). Health inequities can be seen across a wide range of health conditions including hypertension, asthma, diabetes, cancer, mental health, and heart disease. If left unaddressed, the cost of health inequities could swell to $1 trillion by 2040. Health equity extends beyond racial and ethnic disparities. It also includes rural equity, gender equity, equity for veterans, and equity for people with disabilities.
A separate survey, conducted by Deloitte’s Health Equity Institute, found that most people are comfortable sharing their race and ethnicity data with their health insurance carrier, but nearly 60% of respondents were concerned that the data would be sold or shared with third parties without their consent. (More information on the survey can be found here.) Inconsistent and incomplete data about health plan enrollees’ races and ethnicities can make it difficult to track and evaluate efforts to reduce health inequities, according to new research funded by Elevance Health (formerly Anthem, Inc.) and conducted by the Urban Institute, the American Benefits Council, and Deloitte’s Health Equity Institute. (Download the full report here.)
I recently spoke with Dr. Darrell Gray, II, MD, MPH, FACG, the inaugural chief health equity officer at Elevance Health, about some of the challenges in making health equitable for everyone. He is leading an effort to make whole health more equitable for its 47 million+ members. Darrell was previously deputy director of the Center for Cancer Health Equity at The Ohio State University. He and I are alumni of the Commonwealth Fund fellowship for minority health policy. Here is an excerpt from our conversation (click on the embedded links below to hear directly from Darrell).
Jay: Why is understanding the cost of health inequities important?
Darrell: This report magnifies the fact that we literally cannot afford to maintain the status quo. We can't afford it financially or morally. And we can’t afford it because lives are at stake. Eliminating health inequities doesn't just improve the health of those who have been economically or socially marginalized, it improves the health of us all—our neighbors, our coworkers, our friends, our families, and frankly, our nation. Advancing health equity is a social and moral imperative as well as a business imperative. While we expect to see better health outcomes, we need to consider both the return on investment and return on mission. We shouldn’t expect to see a reversal of health inequities in quarterly results reporting. We are in it for the long haul. It is vital to understand the cost of health inequities because it allows us to understand what is at stake and the investment required have meaningful impact.
Jay: What is your organization doing specifically to make health more equitable?
Darrell: Every system is perfectly designed for the results that it gets. Our health system is not equitable because it was not designed to be equitable. Health equity won't be achieved by happenstance or chance. It will only be achieved if we embed equitable principles in the design of everything we do. Our whole-health approach is anchored in the need to advance equity. This is a strategic priority for us. It goes beyond developing products that cater only to certain populations. Health equity crosses all lines of business and is a priority for all of us—from the executive leadership on down. For example, we have a metric within our annual incentive plan that is tailored to improving maternal health equity. This metric is embedded in incentive plans and is tied to employee compensation. We are holding our employees accountable to help us achieve our goal of improving maternal health equity.
Eliminating health inequities is a journey that we approach with intentionality. We want to be a trusted partner in health. But to do that, we must know our members and their communities better. Health goes beyond what happens in clinics and hospitals. Health takes place in homes, in neighborhoods, and in communities.
Something as simple as understanding a person’s preferred language so that we are prepared to engage with them in the language they prefer can make health a little more equitable. We should know each member’s preferred pronouns, their race, ethnicity, and their geography. The more we know about our members, the better prepared we are to exceed their expectations. Equity cuts across everything that we do.
Jay: What sorts of internal headwinds are you experiencing as you work to remove inequities? What do you see as the first step?
Darrell: Alignment is the first step. Not so much our internal alignment, albeit we are on a journey to bolster our internal culture of health equity, but our alignment as an industry with other stakeholders including CMS [the Centers for Medicare and Medicaid Services], hospitals and health systems, and provider groups, to name a few. I look at alignment from the perspective of data. Figuring out how to share data is a headwind. How do we help our health systems and provider groups identify and address health-related social needs? That's a headwind.
Your report demonstrates why health equity needs to be at the forefront. I truly believe that we are positioned to help lead in this industry. But it can't just be us. We cannot do this alone. I cannot emphasize that enough. It's going to take companies like Deloitte. It's going to take CMS. It's going to take our public health infrastructure, and it's going to take us solving data interoperability with our community partners.
Jay: One of the issues around health inequities is that we are not going upstream far enough to address preventable hospitalizations. What actions can be taken to educate and support your network providers?
Darrell: We are committed to offering great support to our providers. They often have many competing priorities as they work with patients throughout a day. Our providers need more support if we expect them to deliver on what we're asking them to do, whether that is social-risk screening or closing care gaps. We also need to offer greater support to get them into value-based contracts. We also need to incentivize the outcomes that we want to see. We need to help them collect self-reported data on race, ethnicity, sexual orientation, and gender identity, and then share that information with us. We need to demonstrate the value of sharing that information. We also need to demonstrate to the provider how they are [or how they are not] making progress when closing those gaps. That's part of our value proposition, as we talk about value-based care and creating incentives for providers to deliver on advancing health equity.
Jay: What is your company doing to change a historically inequitable system of health? How do you get your network providers to focus more attention on health disparities?
Darrell: We strongly value our providers and know that they aim to deliver high-quality care. That’s why we are leading with data—the evidence of inequities—in our partnership with providers to advance health equity. The data tells the story and allows them to see where improvements can be made in their practice and the impact those changes can have.
We also offer opportunities through continuing medical education courses to both enhance their knowledge and ability to deliver care with cultural humility and to identify and ultimately mitigate implicit biases that can adversely impact the care they are providing. Look, we all have biases. We want to help our providers understand their biases so that they can mitigate them. Such biases can also show up in the algorithms that support care management. We have an Office of Responsible Artificial Intelligence that is working to prevent, identify, and address biases in AI algorithms.
Jay: What kind of an impact do climate and sustainability have on health inequities?
Darrell: Sadly, the problem of climate change and associated inequities is not a new one. There's not much standardization in this area regarding how organizations are held accountable either. When I think about climate change, I think about socially and economically marginalized populations. For example, Black and Brown people are more likely to live in higher polluted areas than other populations. It is not just a health system’s chief of sustainability or chief of health equity who should be accountable for efforts to combat climate change. It's the entire organization, and we have to create accountability measures so that we can see whether we are having an impact in making health and health care more equitable for everyone.
The executives’ participation in this article are solely for educational purposes based on their knowledge of the subject and the views expressed by them are solely their own. This article should not be deemed or construed to be for the purpose of soliciting business for any of the companies mentioned, nor does Deloitte advocate or endorse the services or products provided by these companies.
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Jay Bhatt, D.O., MPH, MPA is a physician executive, internist, geriatrician, and public health innovator. As Executive Director of the Deloitte Center for Health Solutions (DCHS) and the Deloitte Health Equity Institute (DHEI), Dr. Bhatt directs the research, insights, and eminence agenda across the life sciences and health care industry while driving high-impact collaborations to advance health equity. He is a prominent thought leader around the issues of health equity, health care transformation, public health, and innovation. Passionate about patient care, Dr. Bhatt will continue practicing medicine at local community health centers in Chicago and Cook County while serving in his leadership role at Deloitte. Prior to joining Deloitte, Dr. Bhatt was senior vice president and chief medical officer at the American Hospital Association. While there, in addition to his enterprise role, he served as president of the Health Research and Educational Trust and helped lead the Institute for Diversity and Health Equity. His early work in health care involved practicing primary care at Erie Family Health Center, sitting on faculty at Northwestern Medicine, acting as chief health officer of the Illinois Health and Hospital Association, and serving as managing deputy commissioner and chief innovation officer for the Chicago Department of Public Health. Dr. Bhatt earned a B.A. from the University of Chicago; Doctor of Osteopathic Medicine (D.O.) from Philadelphia College of Osteopathic Medicine; Master of Public Health from the University of Illinois at Chicago; and Master of Public Administration from the Harvard Kennedy School of Government as a Zuckerman and Commonwealth Fund Minority Health Policy Fellow. He is board certified in Internal Medicine and Geriatrics. Dr. Bhatt's work has earned the attention of top media outlets seeking his expertise. He is a recipient of the Harvard Kennedy School Alumni Award, a Presidential Leadership Scholar, and an Aspen Institute Health Innovator Fellow.