The Health Industry’s Progress Toward Equity and Eliminating Disparities: A Look at Health Plans

August 16, 2023
10:50 am

Throughout the year, this site has been exploring how leaders within various sectors of the healthcare industry – members of the Healthcare Leadership Council (HLC) – have been taking bold steps to advance equity and eliminate health and healthcare disparities in this country.

The pursuit of equity is an important priority for HLC and its member companies. We fervently believe that the United States has the world’s best, most innovative healthcare, but it is critical that the lives of all of our citizens regardless of race, ethnicity, place of residence and other socioeconomic factors are strengthened by accessible, affordable, high-quality care.

Today in this space, we’re going to take a look at what some of the nation’s leading health coverage providers are doing to address health disparities. It is important to note that, in the interests of space, we are providing just a brief summary of some of the actions these companies are taking, not the entirety of their considerable efforts.

Blue Cross and Blue Shield of North Carolina, commonly referred to as Blue Cross NC, is investing in data to learn more about the health challenges of its members and sharing that information across the healthcare system. Blue Cross NC is aligning its member race/ethnicity data with the federal Office of Management and Budget and the Office of Minority Health and will do the same regarding sexual orientation and gender identity once standards are established at the federal level. And in its interactions with providers, vendors and other organizations, Blue Cross NC is encouraging standardization in data exchange.

Other equity priorities for Blue Cross NC including using technology and stakeholder relationships to reduce bias and racial disparities in maternal and child care, working with behavioral health providers to increase diverse representation and their presence in underserved communities, and engaging people across North Carolina in actionable conversations about healthcare affordability and coverage.

Blue Cross NC is also partnering with health systems and other providers groups to pilot approaches developing key equity measures and is tying value-based care to closing health disparities in its contracting with providers and vendors.

CVS Health engages in cross-enterprise initiatives to advance health equity, with a focus on disparities in heart health, mental health, and women’s health. The company advances its health equity strategy by providing training and learning opportunities to accelerate its ability to help every customer, member and patient it serves achieve optimal health, and it uses data analytics to identify inequities and to take action in addressing them. They work to embed health equity principles and practices across the organization through the use of a business unit assessment tool that assesses and then drives intentional action steps to advance health equity within distinct business units.

Aetna, a CVS Health company, helps ensure all Medicaid and Medicare members have an opportunity to be as healthy as possible by coordinating care and providing access to health care providers and quality services in local communities. Aetna’s Medicare Multicultural Initiative improves blood pressure control and depression screenings and care for Medicare members through culturally responsive care management, provider education and engagement.

Aetna’s Medicaid Better Together Social Impact Solutions helps ensure Medicaid members are directly connected to high quality services right in their local communities, and helps providers identify ways to support patients most in need and fill community-level social care gaps.

CVS Caremark is investing in programs that address barriers to care to alleviate inequities for historically marginalized communities. It focuses on three conditions that disproportionately affect people of color – sickle cell disease, HIV and heart disease.

Elevance Health is dedicated to advancing health equity, committing itself to what it calls “health equity by design.” It’s a personalized and intentional approach to ensure that all people, regardless of race or ethnicity, sexual orientation, gender identity, and geographic or financial access can receive individualized care. Elevance has comprehensive long-term goals to broadly advance health equity, such as ensuring that people with disabilities and rural residents can find accessible care. Additionally, in the near term, Elevance is prioritizing three areas to drive immediate progress: maternal health, behavioral health, and access to evidence-based medical therapy.

Also, Elevance is continuing to work with HHS and its affiliated trade associations on policy recommendations to align data collection and interoperability standards. Through its foundation’s financial commitments, it is continuing to strengthen, deepen and diversity its community-based organization partnerships. And Elevance is enhancing partnerships with care providers to advance health equity through a heightened focus on provider incentives, education and value-based purchasing incentives.

Elevance is integrating health equity into its business processes and priorities, and will convene cross-sector leaders, establish partnerships, and exchange best practices in addressing health and healthcare inequities.

A Multisectoral Approach to Patient-Centered Care

August 08, 2023
12:22 pm

The Healthcare Leadership Council (HLC) hosted a webinar focused on how various healthcare organizations have approached value-based care and the outcomes associated with those methods. While, historically, providers have been financially compensated for the volume of services they provide, it has been increasingly recognized that a holistic view of patients’ health includes additional lifestyle factors and results in a healthier population while reducing the cost of care. The panel consisted of four expert representatives from HLC’s membership.

Dr. Adam Solomon, chief medical officer of MemorialCare Medical Foundation, compared traditional fee-for-service (FFS) care to different types of accountable care organizations (ACOs), highlighting the notable difference in relationships between services and payments, as well as outcomes. Lack of coordinated care in a FFS system leads to a separation of clinical data, pharmacy data and claims data, whereas ACOs enable the communication necessary to provide a coherent record of the patient’s medical history. Dr. Solomon mentioned the importance of incentivizing innovative alternative payment models outside of Medicare, and also stated that Congress and CMS should continue to support the migration from Medicare FFS to value-based Medicare Advantage to ensure seniors have access to coordinated care, which improves both patient experience and outcomes.

Dr. Justin Barclay, vice president of consumer insights and analytics at Tivity Health, discussed how his organization partnered with HLC on a study of care coordination perceptions among FFS enrollees, using a nationally representative sample of seniors aged 65 and over who are enrolled in FFS Medicare coverage. Some key takeaways from this study include: seniors in FFS Medicare agree that care coordination leads to better healthcare decisions and increases access to quality healthcare; despite high awareness, only four in ten seniors have experienced care coordination; and seniors who have experienced care coordination place greater trust in their primary care physicians, specialists, pharmacists and health plans over social media and traditional news media. Dr. Barclay recommended further research to examine the differences in experienced care among underserved populations.

Dr. Mark Montoney, chief medical officer of Wellvana, explained the burnout experienced by primary care providers stemming from the burden of administrative tasks and poor work-life balance, while receiving less reimbursement for services than other types of providers. Addressing this dilemma, Wellvana manages three ACOs across 22 states, which provide support to providers in areas such as coding, care management and patient education. Dr. Montoney described how care constantly improves in this environment because ACOs cannot succeed unless patients and providers win first, and better care coordination results in shared savings for the care team through improved outcomes. He shared that ACOs have generated over $17 billion in gross savings for Medicare over the last decade and patients have received elevated care between visits.

Dr. Hirsh Sandesara, the lead medical director for value-based provider engagement at Blue Cross NC, described his organization’s efforts to rapidly build a network of ACOs across the state in order to balance rewards for better health outcomes and lower cost of care rather than incentivizing a greater volume of services. This transition has led to a significant and sustainable long-term impact on quality and affordability. The data for the 1.4 million members has shown increased screening for colorectal cancer, improved management of high blood pressure and a reduction in hospital readmissions. These improvements in quality have translated into reduced healthcare costs, with a cumulative of nearly $500 million in savings since 2019, and over $300 million going back to providers as incentives for maintaining the health of their patients. Blue Cross NC is committed to bringing payers and providers to the same table to collaborate most effectively toward a patient-centric system.

The Health Industry’s Progress Toward Equity and Eliminating Disparities: A Look at Medtech Innovators

July 10, 2023
4:51 pm

Previously on this site, we took a look at some of the initiatives Healthcare Leadership Council (HLC) members in the biopharmaceutical and care delivery sectors are taking to advance equity within our healthcare system and eliminate disparities.

This remains a strong priority for HLC and its membership from all sectors of American healthcare. Our members have formally and repeatedly made clear their commitment to ensuring that all citizens have access to high-quality healthcare and the opportunity to live longer, healthier lives. They are devoting significant resources and innovative spirit to achieving this goal.

Today in this space we’re going to examine what three of the nation’s leading medical technology companies are doing to advance health equity.  Again, it is important to note that we are only providing brief summaries, not the full extent of how these organizations have devoted themselves to this important cause.

Baxter has a long-term, multidimensional, initiative, ACT: Activating Change Today, to fight racial injustice globally and is taking action to achieve meaningful, sustainable change. There are several examples of recent progress, including:

  • Partnerships with several Historically Black Colleges and Universities to provide grants and scholarships to support Black students pursuing health and science degrees. Additionally, the Baxter International Foundation partnered with the Thurgood Marshall College Fund to establish the Baxter HBCU STEM Scholars Program, a three-year, $3.5 million initiative that funds scholarships and mentoring to support students at HBCUs pursuing careers in STEM and education.
  • Partnerships with the National Kidney Foundation of Illinois and The Links, Incorporated to expand the Black Kidney Awareness Resources and Education (K.A.R.E.) program which seeks to raise awareness of chronic kidney disease in Black communities across the U.S. and offers actionable tips and guidance for improving kidney health and managing kidney disease. It has reach more than three million community members.
  • The creation of a Critical Care Racial Disparities Advisory Board to understand why Black patients are disproportionately impacted by health disparities in critical care and identify what actions to take to address health disparities. Baxter also partners with the Congressional Black Caucus Foundation to help strengthen community initiatives that aim to address healthcare disparities affecting Black people, and with the National Minority Quality Forum to address its healthcare policy and equity objectives.

Johnson & Johnson partners with multiple community-based organizations to reach underserved populations and strengthen ties to the community. These include:

  • Working with the National Hispanic Medical Association to develop and strengthen resources and curricula for preparing and equipping physicians for cultural competence in the communities they serve, including a commitment to work with the Alliance of Multicultural Physicians to reach as many communities as possible with culturally relevant resources and materials that support culturally competent care.
  • Engagement with the National Minority Quality Forum to address health inequities through policy. As a founding partner of NMQF’s newly-formed Institute for Equity in Health Policy and Practice, J&J is working with the organization and other community partners to define the policy and structural alignment necessary to build on our system’s strengths for the 21st century and beyond.
  • The Healthy Lifestyle Hub: Bridge to a Whole, Healthy You (BTWHY) Food & Wellness Program is a patient-centric clinical and social care solution for disadvantaged populations. Through a coordinated effort of Johnson & Johnson, Mile Square Health Center, University of Illinois College of Applied Sciences, and Huron Consulting Group, the aim of this program is to improve clinical outcomes and reduce barriers to wellness for Mile Square patients who seek care at the Healthy Lifestyle Hub in Chicago’s Auburn-Gresham Community.
  • A close partnership with the National Urban League and many other community and multicultural organizations to address a number of health equity issues in communities across the country through the “My Health Can’t Wait” platform, through which healthcare professionals have a comprehensive hub of resources to help their patients understand the steps being taken for their safety.

J&J also has a well-established holistic approach to increasing diversity in clinical trials, investing at local and federal levels to improve policies, programs and practices that currently impede full representation and prevent tangible and equitable outcomes. The company has worked with hundreds of partners to enable change through policy. Additionally, its Research Includes Me platform serves to reach underrepresented communities by meeting them where they are on the ground through digital activities, partnering with trusted voices, and addressing barriers to participation in clinical trials.

Stryker is committed to driving evolution in clinical development to support health equity. The company recognizes that increased diversity in clinical trials leads to better patient outcomes. Efforts have begun within its clinical trials to address this need by tracking diversity and conducting outreach to underserved populations. For example, the COVID-19 pandemic led to increased use of pulse oximeters. But emerging evidence from real-world studies suggested that pulse oximeter performance could be impacted by skin tone, creating potential for treatment delay and poor outcomes. In response, Stryker’s Sustainability Solutions reprocessing business completed a clinical study that successfully enrolled a diverse patient population and demonstrated the accuracy of its reprocessed pulse oximeters in adult patients across all skin tones.

Additionally, Stryker considers disease prevalence in patient populations when determining enrollment in trials, and its R&D clinical teams emphasize the importance of diversity of perspective in clinical development. For example, scarcity of care and lack of infrastructure are barriers to stroke treatment in many parts of the world. In response, Stryker’s Neurovascular Division opened a state-of-the-art facility in India designed to accelerate stroke-related innovation in the Asia-Pacific region. Driven to improve patient outcomes, this facility offers a simulated neurovascular catheterization lab and opportunities for hands-on training and collaboration among customers, product development engineers, and other key stakeholders.

The Health Industry’s Progress Toward Equity and Eliminating Disparities: A Look at Healthcare Providers

June 02, 2023
12:33 pm

In an earlier post, we provided a snapshot of some of the actions Healthcare Leadership Council (HLC) members in the biopharmaceutical sector are taking to advance equity within our healthcare system and eliminate health disparities.

This is a priority for HLC and its membership from all sectors of American healthcare. Our members are each committed to ensuring that the healthcare system works for all citizens and they are devoting energies and resources to initiatives aimed at making this happen.

Today, we are going to use this space to examine what several of the nation’s leading healthcare providers are doing to advance health equity, and it’s worth noting that what is summarized in this post only scrapes the surface of the numerous programs these organizations are carrying out.

AdventHealth is working with community-based organizations to increase access to care for underserved communities. These collaborations include partnerships with federally-qualified health centers, houses of worship, and local nonprofit organizations. The health system is advocating for the development and adoption of national social determinants of health data standards. AdventHealth is also developing health equity plans to address potential disparities within its facilities and communities, working to create a diverse, equitable and inclusive environment for all team members, and advocating for policies that increase access to treatment and promote equitable care.

For Ascension, community impact work is focused on leveraging the power of data to understand the unique needs of different communities and inform funding strategies. By gathering social determinants of health data, Ascension can best determine how best to deploy resources and investments to improve access to care and help close the gap on life expectancy. Current priorities for the organization’s community impact work include maternal care, diabetes and behavioral health. Ascension has also established the Ascension Foundation, a national foundation focused on addressing root causes of health disparities in the United States, partnering with organizations that are already making measurable strides toward health equity.

Atrium Health is committed to cross-sector partnerships that are addressing social drivers of health and addressing health equity. These collaborations include a Community Resource Hub, an electronic platform that connects patients to free or reduced-cost services, including transportation, legal assistance, food and more; Feeding Charlotte, a local “food rescue operation that retrieves unused perishable food at several Atrium Health facilities and distributes it to local nonprofit food pantries; investments in affordable housing throughout the Charlotte region; and a partnership with Legal Aid of North Carolina to provide legal advocacy to Atrium patients on insurance coverage, unemployment benefits, unsafe housing and other needs.

Fairview Health is aligning its equity data collection fields between human resources, patient data, and community characteristics to better understand the intersection between healthcare outcomes, diversity, equity and inclusion goals and health equity goals. The Minnesota-based health system has strengthened its engagement infrastructure by building on trusting relationships and enabling community voices to inform and influence both inside and outside the system. This includes local community advisory committees that include community-based organizations, public health and internal stakeholders such as physicians and administrative leaders.

Marshfield Clinic Health System is one of four healthcare systems in the state of Wisconsin to make a formal commitment to eliminate healthcare disparities in the state. It is developing an Ambassador program and Business Resource Groups to promote equity and inclusion in the workplace and has formed a partnership with the Cross Cultural Health Care Program for cultural competency consulting and training. Marshfield is forming partnerships with community-based organizations to address the social determinants of health needs of its patients, and is serving on the Governor’s Health Equity Council and other state and national collaboratives to address equity.

Mayo Clinic is building a health equity dashboard with key metrics that will be accessible to all departments and divisions within the organization. It has created an internal Community Coalition, made up of internal stakeholders that are focused externally with community-facing partners. The goal of this initiative is to align efforts on health equity and look for synergies in respective group activities. Mayo is also building a repository to house and coordinate all of the organization’s health equity activities. A Health Equity workgroup is made up of site liaisons who are partnering with clinical practice areas to collect health equity efforts from each site and share best practices.

To address healthcare access issues, MemorialCare has provided information and enrollment assistance in the Covered California healthcare exchange and other low-cost insurance programs. It also provides transportation support for those patients and families who are not able to access needed care due to a lack of transportation. MemorialCare provides support and services to community residents that removed barriers to care and increased access to healthcare and preventive measures. Health and wellness education classes have covered such topics as healthy eating, stroke prevention, diabetes, heart disease, cancer prevention and stress management.

Mount Sinai Health System maintains an Executive Diversity Leadership Board that includes hospital presidents, senior leadership and trustees and is accountable for leading and developing strategies to address structural and systemic racism; promoting, instilling and demonstrating anti-racist behaviors; driving equitable practices to enhance quality and outcomes centering on marginalized or oppressed groups; and reporting progress on outcomes and implementing recommendations for continuing improvement. The system’s areas of focus in this arena range from data analytics to education and training to supplier diversity.

NewYork-Presbyterian maintains the Dalio Center for Health Justice, which address the health disparities of employees, patients and communities through research, health education and programs that foster equity in clinical operations and enhance the culturally sensitive care provided by NewYork-Presbyterian. It focuses on comprehensive analysis to understand more fully social determinants of health, creating a robust and diverse health equity database to inform the center’s work in developing community-based initiatives, advocating locally and nationally for change, seeking grants, and producing an institutional equity report. It also focuses on examining and addressing unconscious bias in medicine and clinical trials.

NorthShore University HealthSystem is engaged with the city of Chicago in a five-year program to close what is, according to research, the largest life expectancy gap in the country. Neighborhoods just nine miles apart have a 30-year gap in life expectancy. NorthShore is working to accurately capture race, ethnicity and language preferences in its patient community and ensure that all patient perspectives are captured in measurement systems. The system is investing leading practices and new ways to listen to patients and understand social determinants of health and is partnering with like-minded community organizations to close the gap on health disparities across key preventive practices and chronic diseases.

Texas Health Resources’ Community Impact program uses cross-sector collaborative grants to address local community needs in resourceful and innovative ways. This data-driven, outcomes-focused approach pinpoints North Texas zip codes most in need of assistance and drives how Texas Health engages with leaders, influencers and existing resources within those underserved areas. This program is responding to health disparities, eliminating root causes of chronic disease and providing tools that instill lifelong health and well-being. And the health system’s Mobile Health Unit brings cancer screenings and other health services to residents throughout the Dallas-Fort Worth area.

Our next post will take a look at health equity initiatives in the medical technology sector.


Understanding the Role of HIPAA in Healthcare Innovation

May 25, 2023
10:56 am

As the healthcare industry has transformed throughout the years, the use of healthcare data has evolved as well. The Healthcare Leadership Council recently hosted a webinar entitled, “The Past, Present, and Future of Health Privacy Policy,” featuring a panel of legal experts who were able to provide a glimpse into the world of how privacy laws play a role in conducting research and collecting mass amount of data for purposes such as predictive analytics.

Erin Geygan, senior privacy counsel at Johnson & Johnson, explained that the organization is comprised of three segments – pharmaceutical, medtech and consumer health, which have invested $14.6 billion in research and development. Johnson & Johnson’s data privacy and security program identifies federal, state and global requirements around accountability and innovation, cybersecurity included. Erin noted the lack of harmonization with state laws on medical information privacy and other federal laws governing health information outside the scope of the Health Information Portability and Accountability Act (HIPAA). She also discussed the need to address the challenges facing data sharing for innovation, such as technical restraints, intellectual property risks and exclusive access. Johnson & Johnson believes that public policy on data privacy and protection should seek to provide appropriate protection and empowerment to consumers and patients while also ensuring innovation and provision of healthcare products and services are not impaired.

Jessica Kelly, legal counsel at Mayo Clinic, focused on the intersection of research and privacy and confidentiality. The road to research begins with preparatory activities such as recruitment, where data is needed to determine potential candidates for a possible study. Contacting those candidates for enrollment involves use of protected health information (PHI). She went into detail regarding authorizations to use PHI for current and future research as well as the use of waivers of authorization, which can be provided by institutional review boards when consent has not been obtained by the individuals and there is minimal risk to the privacy of those individuals. In closing, Jessica described two methods to achieve de-identification of PHI in accordance with the HIPAA Privacy Rule. Once the numerous identifiers have been removed from the data it is no longer subject to HIPAA.

Amanda Reese, healthcare regulatory and privacy counsel for Epic, highlighted the health grid of services that use data from Epic products across the industry, spanning from real-time prescription benefits, to retail clinics, rehabilitations centers and specialty diagnostics just to name a few. Amanda spotlighted Epic’s new life sciences program working to unify clinical research with care delivery, matching participating providers with clinical trial opportunities and supporting clinicians with point-of-care insights and predictive modeling. Regarding HIPAA, Epic is a business associate of its U.S. customers and therefore designs its software in ways that consider privacy throughout the data life cycle. Epic works with limited data sets per data use agreements and deidentified data through COSMOS, which is a program that involves data from more than 135 million patients used for research, public health and healthcare operations.