There are two stakeholders who hold enormous potential in reducing or eliminating racial and ethnic disparities in healthcare, and they’re not physicians, nurses, or policymakers. Health insurers and employers have an opportunity to improve patient outcomes. This is more than a moral issue. By focusing on racial and ethnic disparities, there is also an opportunity to lower long-term health costs.
The way to do this is by working together to take the financial leap and invest in programs that focus on collecting and surveying vast amounts of patient ethnic and racial data, which would help insurers and employers know how to tailor programs to reach at-risk populations.
That’s what they could do, but few employers and insurers are working together to tackle the issue for the following reasons:
Patricia Collins Higgins, coauthor of the recent brief, “Reducing Racial and Ethnic Disparities in Health Care: Partnerships Between Employers and Health Plans,” and a researcher at Mathematica Policy Research, Inc., in Princeton, NJ, says employers have so many competing priorities, especially in this economy, that they often don’t see the connection between racial and ethnic disparities and the company bottom line.
But the connection is clear. Minorities are experiencing worse health, and their health costs are being transferred to payers. By examining where disparities exist, employers and health insurers can understand the problem and, in turn, create targeted programs that reach those members.
Instead, only 3% of employers say they are examining disparities in their workers’ healthcare quality, according to Mathematica. The few health insurers and employers that have worked together on bridging the disparity gap have found they need to collect data through direct and indirect methods. Direct methods include self-reporting of race and ethnicity during enrollment or clinical interactions and via Medicare and Medicaid. Indirect methods include collecting information through geocoding and surname analysis.
The indirect methods have become more sophisticated, but having direct data from the individual is ideal. The problem is that many health plan members don’t want to give personal information to their insurers because they think the company will use it against them. In fact, Mathematica said only about 30% of health plan members provide that information. This is where employers come in. Unlike health insurers, employers are required to collect race and ethnicity data from their employees under the Civil Rights Act of 1964, so it’s simply a matter of businesses and health insurers working together to share this information.
Although the vast majority of employers are not keyed into the problem, more employers are now asking how health plans are dealing with health disparities as part of requests for proposals.
There are some employers and insurers that have already started to work on the problem. The National Business Group on Health and Office of Minority Health have joined forces to promote the issue and Cigna is collaborating with a large employer to improve breast cancer screening.
Employers are also using evaluation tools, such as eValue 8, to assess how health plans are tackling health disparities. The survey tool allows employers to look at health plans’ performance in areas such as health information technology adoption, communication, disease management, provider performance, and patient safety.
eValue8 also includes questions about how health plans are dealing with disparity-related activities, according to Mathematica.
Although there have been advances, most employers are still not aware of the problem. Higgins suggests four ways to reverse the trend:
Addressing these problems is not just a feel-good issue. This is a bottom-line problem that the healthcare system will need to address as the face of the nation continues to change.
“Until employers recognize the business case for reducing disparities—lower healthcare costs and potentially a more productive work force—employer interest is unlikely to gain serious traction,” says Higgins.