Payers Driving Health Equity Through Quality Improvement

At a session during the America's Health Insurance Plans Institute & Expo, panelists representing insurers discussed the actions taken by their organizations as they strive toward health equity.

Nearly 9 in 10 Americans have difficulty understanding health information, which is why Blue Cross Blue Shield of North Carolina has implemented a language simplification strategy aimed at those with low health literacy. Ingrid Morris, MPH, a healthcare program developer who leads the strategy, explained how that statistic helped her to convince senior leadership that such an effort was necessary both from a business perspective and as the right thing to do. Her team secured buy-in from leadership and the legal and compliance departments of the large insurer, which was the essential foundation for the next steps.

By treating the effort as the “new way we do business,” not just a special project, the team was able to conduct a baseline assessment of the current materials’ reading level and set targets for simpler language across all of the insurer’s communications and platforms. Then, all departments were engaged in the effort and empowered to make improvements, Morris explained.

Changes included revising all communications to be simpler, making language assessment part of the development process for any new web page, and surveying customers on understandability. Three years later, the average reading level of their materials is approaching the target range of a sixth- to eighth-grade reading level. Her takeaways from the initiative are that “collaboration has been key,” as well as “maintaining leadership support and employee engagement.”

Next, Derek J. Robinson, MD, MBA, vice president of enterprise quality and accreditation at Health Care Service Corporation, described how he needed to gain buy-in from leadership to advance the goal of health equity, which is when each person has the opportunity to attain his or her full health potential.

In Robinson’s organization, a large insurer serving over 15 million members, equity was already recognized as a key aim for quality improvement, but the real question was how they could “address some of the social determinant barriers our members are facing in the framework of quality improvement” and in a way that’s scalable across multiple markets.

Some core principles of Robinson’s approach are to “meet the members where they are, one determinant at a time” and to integrate socioeconomic disparities into advanced data analytics platforms. When sitting at the negotiating table with providers, he noted, it’s important to have granular data that can open their eyes to some of the implicit bias and systemic discrimination that leads to health inequities. With those insights, there will be accountability around performance for providers and insurers alike.

The final panelist, U. Michael Currie, MPH, MBA, vice president of health equity services at UnitedHealth Group, echoed some common themes from the earlier presentations: collaboration across departments and senior-level buy-in are essential for change. For UnitedHealth Group, understanding the social determinants of health was not as difficult as learning the best ways to engage populations and build trusting relationships to influence better health.

The pillars of his health equity strategy include creating scalable approaches, integrating equity into care management processes, and leveraging rich data and analytics. Still, although a payer can learn through claims data what healthcare services its members need and when they need them, they are less equipped to grasp how the members want to receive care, where it happens, and from whom they receive it. Those questions need to be viewed through the lens of equity and may not even be best answered by the insurer.

“Sometimes it’s not the message, it’s the messenger,” Currie explained “And as health organizations, maybe we have the right message, but we need to enlist community partners, other stakeholders, local hospitals … to help deliver the message.”