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Approximately 50% of Americans access healthcare through their employers, and that puts benefits managers in a unique position. Benefits professionals, including employer teams, brokers, and consultants, influence who gets access to quality healthcare. They decide plan details, out-of-pocket costs, and available health resources for millions of Americans.
This fact also puts self-insured employers on the frontlines of the fight for health equity. You’ve probably heard this term in benefits industry news, along with several others: social determinants of health, healthcare justice, health disparity, etc. But what does this mean, and what can benefits managers, brokers, and consultants do about it? Let’s find out.
Health equity is equal access to healthcare resources, regardless of socioeconomic status, race, ethnicity, gender, sexual orientation, geography, and other factors. Essentially, health equity is achieved when everyone receives the care they need when they need it. The World Health Organization offers this definition for health equity:
“Health equity” or “equity in health” implies that ideally everyone should have a fair opportunity to attain their full health potential and that no one should be disadvantaged from achieving this potential.”
When a family living in poverty in rural Wyoming has the same ability to achieve their full health as a wealthy family living in the Bay Area, we will have achieved health equity or healthcare justice. The concept is related to discussions around gender equity, social justice, racial justice, and other movements like this. Proponents want a level playing field for those seeking healthcare instead of a stratified system where the powerful and wealthy receive far better healthcare, further widening the divide.
Recent events surrounding the White House’s COVID-19 outbreak have brought health equity into the mainstream news. President Trump received a level of care, including an experimental antibody cocktail, unavailable to most Americans suffering from COVID-19. The president had access to special treatment, the best doctors, and even drugs that aren’t on the market yet, sparking further conversations about health equity. President Trump himself acknowledged the disparity between his own treatment and those being administered to ordinary Americans, pushing for emergency authorization and promising to make the Regeneron antibody cocktail free to all who need it.
What causes health inequities? Let’s look at another term that’s buzzing in the benefits industry: social determinants of health.
We’ve written about the social determinants of health in the past, and it’s a concept that’s resonating with benefits industry experts. Social determinants of health are a set of conditions that affect your health based on where you live, work, learn, play, and experience life. It boils down to all the outside factors that may cause an individual to suffer from poor health:
We know that individuals who live in impoverished areas of the country are more likely to be diagnosed with chronic conditions such as Type II diabetes, heart disease, and obesity. On the other hand, those who grow up in wealthier neighborhoods are less likely to contract childhood diseases, more likely to eat nutritious foods, and more likely to have reliable health insurance.
Recognizing, measuring, and addressing social determinants of health not only helps improve population health as a whole, but also helps address health equity. The term “social determinants” can be controversial in some circles. Many anti-poverty activists feel that health is not determined by social status and conditions; they assert that poor health is not an inevitable outcome of poverty (not “pre-determined”). Instead, many feel that equal access to the healthcare system would lead to equal outcomes for those born into or living in poverty.
In plain terms, these social determinants of health can be reversed or mitigated. Children who grew up in poverty can attain higher salaries, education levels, and healthcare access as adults. Adults with chronic conditions could access care management to help them better manage and even reverse the course of their disease. But these strides don’t happen on their own. Social determinants of health can be reversed if those with the power to make change reverse them. It takes public health officials, government policies, and yes, employers who are providing health benefits, to address health equity issues.
Social justice issues are on the minds of many HR and Benefits leaders this year. With ongoing demonstrations for racial justice around the country, many large employers are examining their own policies and culture to search for ways to support employees of color. Benefits industry news sites all published guides to inclusion, racism, and diversity at work. These conversations are essential, and equality begins with representation in leadership, bias training, and allyship within a company culture. Employee health benefits are another key way to supporting social justice. Health equity is a huge factor in supporting employees and helping them achieve equality, inside and outside the workplace.
What can benefit managers really do about health equity? While you can’t build better hospitals in impoverished zip codes or new grocery stores in food deserts, you can certainly contribute to health equity in the programs you already offer to employees and their families. The following programs, strategies, and questions can help you get started:
Financial wellness: Are you helping employees save for the future? Do your programs contribute to financial stability? Have you addressed cost of living increases in the geographies where you operate? Do you have a compensation philosophy that addresses income inequality? Do your financial benefits (401k, HSA/FSA, etc.) meet the needs of your population?
Member education: Have you helped members understand their benefits? Do they know where to go for routine care vs. emergency care? Are your benefits materials written so they can be understood by everyone (all languages and education levels)? Are you reaching everyone with your communication channels, both those with email access and those without?
Onsite Clinics: Are all employees and their families able to access care near them? Are you working with onsite clinics to share data and population health measures? Can employees take the time to visit your onsite clinic without being penalized for missing work?
Flu Shot Clinics (and other health events): Are you making it convenient for members to get flu shots, vaccinations, dental cleanings, and other annual preventive care services? Can employees’ families come to these health events too? Do members understand the benefits of these services? Are they covered under your plan?
Healthcare analytics: Do you have a holistic view of your population’s health? Do you know where in the country your members are healthier/unhealthier? How is your population health trending? Can you find gaps in care quickly and address them? Do you see regional or income-based health concerns in your population? Is your data warehouse or data partner providing you with insights into health equity or social determinants of health?
Network evaluation: Can you members get care that’s convenient for them? Do they have access to a primary care provider or specialists as needed? Does your network reach all your members? Are you working with Centers of Excellence or direct contracting with health systems near your office locations?
Mental healthcare: Is your Employee Assistance Program working for you? Do members know about the EAP? Are they visiting the emergency room when seeking mental healthcare? Do you have a data-driven mental healthcare strategy? Are you tracking absenteeism or disability days as a result of mental health diagnoses? Does your current coverage offer affordable therapy options for everyone?
Employee feedback/satisfaction: Are you conducting regular surveys to gather crucial feedback from members? Do all employees feel heard? Are you gathering diverse perspectives (office vs. manufacturing staff, differently abled employees, LGBTQ workers, etc.)? Do you get feedback all year long, or just during Open Enrollment? Are your benefits flexible enough to meet everyone’s needs?
These are just a few questions benefits managers, benefits brokers, and consultants can ask themselves as they evaluate health equity within their benefits plan. Healthcare analytics is crucial for each of these health equity tactics, as it will enable benefits teams to get a holistic view, evaluate population health, and plan data-driven health interventions for employees and their families.