Contributor: Promoting Health Equity Through Primary Care

Managed care organizations (MCOs) are heavily investing in health equity strategies to reduce inequities among population groups defined by factors such as race or ethnicity, gender, education or income, disability, geographic location, and sexual orientation. As noted by the Institute for Medicaid Innovation in the 2021 Annual Medicaid Health Plan Survey, the majority of MCOs employ dedicated staff and/or teams focused on addressing health disparities, health equity, racial equity, and structural racism—with over two-thirds having formal health equity plans in 2020.¹

Most MCOs also have screening tools and processes and offer services and supports to address the social needs of members that can be barriers to health (also referred to as social determinants or social drivers of health or SDOH). Health equity strategies are commonly directed at internal health plan staff, provider groups, and member populations, with the most common population strategies including “pregnant individuals, LGBTQ+ members, children and adolescents, and people of color.”¹

Managed care programs bring value by reducing cost through addressing access to and quality of health care services—with a foundational focus on primary care services for prevention, chronic disease management, and to coordinate testing and specialist care when needed.

All managed care members are eligible for primary care services, and most health plans automatically assign members to a primary care physician if they do not choose one themselves. Yet, many factors contribute to members in identified populations not accessing primary care, such as health literacy, language barriers, cultural beliefs, structural racism/bias, transportation, etc. For example:

• Black/African Americans and Hispanic/Latinos were more likely than White Americans to lack a usual source of care as of 2018.²
• Those living in rural areas are less likely to access care because of fewer health care providers, medical facilities, and transportation options compared with those living in urban areas.³
• People with intellectual and developmental disabilities experience lower rates of preventative screenings.⁴

It is insufficient to have a panel of primary care providers available or even assigned to members. It is critical for health equity strategies to go beyond philanthropy and include population-focused systematic solutions to effectively inform and engage members in primary care delivered by providers trained—both culturally and technically—and willing to meet their needs.

Ideally, strategy is driven by strong national health equity leadership with local clinical and quality teams that are equipped with meaningful data and a shared culture of inclusivity. This enables health equity strategy to be customized to market nuances and maximize effectiveness, delivering solutions that engage and address the concerns of members, primary care providers, and health system stakeholders.

Example of opportunities include the following:

• MCOs can support member engagement by identifying cultural beliefs and aligning communications and outreach strategies, offering language assistance resources, involving trusted community partners that can help increase understanding of population care needs and facilitate care access (such as culturally focused community organizations, LGBTQ+ organizations, disability advocacy entities, family-support programs, etc), customizing member incentives to interests of disparate populations, and addressing transportation and other SDOH barriers.
• MCOs can support primary care providers by providing information on disparities relevant to clinical topics and populations of focus; training on cultural humility, identifying unconscious bias, and improving provider-patient communications; ensuring awareness of appropriate language assistance resources; funding to enhance patient access and experience (accessible equipment for members with disabilities, mobile clinic support, enhanced lab and other testing resources); and providing value-based payments and incentives for health equity activities and outcomes.
• MCOs can support health systems by identifying trusted community resources that can increase understanding of population needs and facilitate care access, investing in SDOH infrastructure, using patient navigators and community health workers to support members with accessing and utilizing care, and supporting capacity development through minority- and disability-focused scholarship and loan forgiveness programs, as well as medical school curriculum and specialty clinic rotations.

Advancing health equity is core to the organizational purpose for Elevance Health in improving the health of humanity. But we are not alone in our understanding of the value that such efforts have in enhancing the quality of care for our members and ultimately impacting the overall cost of care. When I first entered the industry in 2015 after years of public service, I was both excited and skeptical when an enterprise leader told me, “We do well by doing good.” Promoting health equity through engaging members in primary care that is responsive to their needs and preferences is a great example of that motto in action.

References

1. Moore JE, Adams C, Glenn N, Landucci R, Serino N, DePriest K. Medicaid access & care in 2020: Results from the Institute for Medicaid Innovation’s 2021 Annual Medicaid Health Plan Survey. Institute for Medicaid Innovation. Published November 2021. Accessed January 20, 2023. https://bit.ly/3GVMyHZ

2. Hill L, Artiga S, Haldar S. Key Facts on health and health care by race and ethnicity. Kaiser Family Foundation. Published January 26, 2022. Accessed January 20, 2023. https://bit.ly/3GYDFx9

3. Alspach JG. Implicit bias in patient care: an endemic blight on quality care. Crit Care Nurse. 2018;38(4):12-16. doi:10.4037/ccn2018698

4. Escudé C. Advancing health equity and reducing health disparities for people with disabilities in the United States. Health Affairs. Published October 20, 2022. Accessed January 20, 2023. https://bit.ly/3CZWWgQ