How health plans can reduce healthcare inequalities
The COVID-19 pandemic has put inequalities accessing the healthcare system in the spotlight. Jim Clement, Vice President of Product & Services at cloud provider Inovalon, tells us that health plans play the most integral role in advancing the health equity movement.
Why did it a global pandemic to highlight the issue of healthcare inequities?
Health inequity in the US has been well understood by healthcare professionals for many years, but it has become more evident due to the COVID-19 pandemic. It wasn’t until the racial and ethnic differential seen in response to COVID-19 related infections, deaths and vaccinations that many Americans became acutely aware of the health inequity due to sociodemographic factors such as race, geography, education and income.
Fortunately, there’s now a growing health equity movement afoot in America which aims to improve public health and achieve equity in health status for all people by ensuring opportunities are available to attain the highest level of health. While the entire healthcare ecosystem is important to this transformation, it is health plans that arguably play the most integral role.
How can health plans help?
Achieving health equity means obstacles to health must be removed, including poverty, discrimination, powerlessness, and lack of access to the basics like physicians, hospitals, medicine, technology, and health education. This is not only a social justice initiative, but also a clear call to action for health plan organisations that are bearing the economic brunt of the costs due to health disparities.
Health plan organisations that recognise the alignment between efforts to improve health equity and broader member engagement initiatives will be in the best position to move the needle. Plans must also understand that the provision of medical services within hospital walls, physician offices and other health services providers is necessary, but not sufficient.
By recognising that health inequity also includes non-medical factors such as employment, income, housing, transportation, childcare, and more, plans will be better equipped to ensure their members are set up for success.
What do healthcare providers need to do generally to address inequities?
Outreach by both health plans and providers is critical to ensuring people have knowledge of available services, the reason those services are critical to their health, and options to access those services based on their unique circumstances. With both stakeholders beating the same drum, progress can be made quickly.
Given the impact of social determinants of health (SDOH), should healthcare providers take a more active role in addressing these, or other agencies?
While communicating with patients is critically important, what is truly required to address inequalities is helping patients take medical actions – like regular PCP visits, monitoring A1C and accepting health coaching – that are necessary to maximise their health, along with non-medical actions –like availing themselves of community resources that address homelessness, food insecurity and employment services.
The most progressive providers and payers have or are putting in place programs to address these non-medical issues. In addition, non-medical tools such as transportation services can certainly help drive the effectiveness of medical services.
How important is it to educate patients about their health and how can this be done?
Education is a social determinant of health and a key lever to be used to drive health equity. Patients who do not understand their medical conditions or the consequences of non-compliance with their treatment plans are prone to poor outcomes.
For health plans, understanding member needs is one of the biggest drivers of quality care. A continuous cycle of engagement through feedback and appropriate responses will provide health plans with an opportunity to uncover, discuss, and resolve problems faster.
Improving member outreach and engagement can be made easier with a programmatic approach involving four stages of intentional outreach: Getting to know your members, educating members, seeking feedback from members and gaining member loyalty. Each stage not only contributes to a better member experience but also to improved outcomes and higher satisfaction scores.
Now that the issue has come to the fore, what do you think things will look like in 5 years or so?
I predict that health plans that get member engagement, education and equity right will achieve better health and greater value, faster. Those who get it wrong or delay will suffer the consequences of competitive disadvantage and pay a larger share of the rising costs associated with health inequity.
Advances in health "must ensure self-sovereign identity"
The UK government has announced that from September onwards COVID-19 vaccine passports will be necessary to gain entry into places with large crowds, such as nightclubs.
This has reignited the debate between those who believe having proof of vaccinations will enable people to gather in public places and travel safely, and those who view the digital certificates as an attack on personal freedom.
The arguments have increased in intensity since the recent announcement to drop COVID-19 restrictions in England, in a move to reopen the economy that has attracted fierce criticism both domestically and overseas.
Cross-party ministers are set to defy the government’s latest plans to introduce vaccine passports over civil liberties concerns. A number of MPs have already signed the Big Brother Watch declaration against “Covid status certification to deny individuals access to general services, businesses or jobs” in recent months.
However Mark Shaw, CEO of Tento Applied Sciences, says the Big Brother Watch campaign is based on false assumptions. “Big Brother Watch puts forward a compelling argument based around civil liberties, but some of the assumptions they make are simply incorrect” he says.
“For example, the BBW campaign claims that all Covid passes are discriminatory, counterproductive and would lead to British citizens having to share personal health information with anyone in authority, from bouncers to bosses. However, there are already privacy-first digital wallets that give individuals the freedom to store and share anonymised medical documents, work credentials and other types of documentation quickly, simply, and securely.
“I wholeheartedly agree that individuals should not be required to share their own personal health information with unknown third parties or with anyone in authority who demands it" Shaw adds. "But I strongly disagree with the suggestion that ‘events and businesses are either safe to open for everyone, or no one’. It creates a false dichotomy that either everyone is safe, or nobody is safe. If employers or event organisers don’t take action to properly manage workplace or venue safety, then they risk curtailing the safety and freedom of movement for the majority."
The subject of personal health data is under scrutiny in the UK at the moment, following controversial plans for the NHS to share patient data with third parties. These have been put on hold following public criticism.
Meanwhile a new report has found that the majority of the British public is willing to embrace digital healthcare tools such as apps and digital therapies prescribed by a trusted healthcare professional.
Shaw adds: “The vital point to make is this: innovations in health technology must ensure self-sovereign identity. This means the data held about an individual is owned by the individual and stored on their device. And, in the case of medical data, that data can be delivered from healthcare professionals to the device in an encrypted format, and the user chooses how they share their information."