Take Action
Payers
1. Commit to Acting for Equity
Activities
1. Sign up to Join the Coalition
Activities for Payers include the Roundtable sessions, optional 30-minute group coaching, and Pillar resources to be shared following each call. It is expected that payers will engage in activities between calls to advance equity efforts towards one (1) Rise to Health Coalition activity below.
Participants are encouraged to take a foundational quality improvement science course (QI101 and/or QI102) via the IHI Open School. These are optional trainings to help participants learn how to use, test, and refine small tests of change.
2. Get Grounded
Activities
PROFESSIONAL DEVELOPMENT FOR HEALTH EQUITY
• Provide educational and professional development opportunities that equip health plan staff to advance racial justice and health equity.
• Examine and identify historical and contemporary examples of inequitable harms in national, local, and organizational policies and practices, including reviewing organizational archives. Include specific education on the history of health insurance inequities and examples of how insurance and benefit design can advance equity.
• Identify how the health plan has advanced social justice.
Equity Matters Video Library, ACGME
Impact of the Social Determinants of Health on Health Equity and Their Root Causes, AHIP
The burden of medical debt in the United States, Peterson-KFF Health System Tracker
Roots of Health Inequity Web Course, NACCHO
ORGANIZATIONAL CULTURE OF EQUITY
• Survey staff to learn how your health plan’s physical spaces and/or operating structure promote well-being (e.g., reconsider who is pictured on the website, and how accessible is your infrastructure?).
• Write and publish a statement detailing the health plan’s (or health insurance industry writ large) policies and practices that have caused harm and contributed to health inequities, accompanied by specific organizational commitments for redress.
6 Ways That Health Plans Can Influence A State’s Health Equity, Health Payer Intelligence
3. Make Equity a Strategic Priority
Activities
LEADERSHIP STRATEGY
• For C-suite leaders: know your workforce (equity) data.
• Develop goals, strategies, processes, and policies (e.g., charters) to ensure leadership (e.g., board of directors, board committees) are representative of the full diversity of the community served by the organization.
• Ensure senior leadership and board membership reflect the broad diversity of the community served by your organization.
• Make organization data on senior leadership diversity publicly available and easily accessible.
Tools & Resources, Government Alliance on Race and Equity
COMMUNITY ENGAGEMENT
• Identify and engage key community-based organizations as partners to inform initiatives around shared goals that are designed to address social and structural drivers of health and advance health equity.
• Develop and use standard processes for partnering with communities, including educating health plan staff on community engagement.
Countering the Production of Health Inequities: Ensuring the Opportunity for Health for All, Prevention Institute
BUDGETING TO ADVANCE EQUITY
• Create and/or revise incentives for staff, including the board and executive leadership, to meet organization’s goals for equity, including diversification of the workforce.
• Assess the organization’s budget model and ensure it will advance health equity.
• Set and align a subset of performance incentives to organizational equity goals.
• Adopt hiring, retention, career advancement, compensation and mediation policies and processes to build and sustain a diverse workforce.
PolicyLink CEO Blueprint, PolicyLink
Promoting Affordable and Equitable Health Care for All, Cigna
4. Identify Opportunities for Improvement
Activities
DATA INFRASTRUCTURE
• Establish shared principles for quantitative and qualitative data collection and analysis to promote measure alignment and minimize burden on communities and individuals who have experienced harm.
• Examine publicly available data about key sociodemographic factors (e.g., REaLD and SOGI) of members and the relevant community that the organization serves (the state, region, or country) and identify any barriers in your health plan’s ability to directly collect and stratify sociodemographic data.
• Explore disaggregating key measures (e.g., HEDIS measures) to inform areas for action or identify gaps in your health plan’s ability to collect and stratify data.
• Collect gold standard REaLD/SOGI and other sociodemographic data of members to inform care and identify disparities.
• Report stratified HEDIS data publicly (Ensure data are sufficient and accurate).
QUALITATIVE DATA
• Gather qualitative data about community strengths, opportunities, challenges, inequities, and needs to inform and guide priorities and foster accountability for impact.
• Report on qualitative and disaggregated quantitative data to increase transparency and accountability for addressing identified inequities (Sample sizes should be sufficient to not allow identification of individuals or to present skewed results).
Closing the Gap Between Needs and Solutions: How Health Plans Can Support the Use of Data to Address Social Needs and Social Determinants of Health, Shruti Kothari, Joe Castiglione, Muriel LaMois, Peter Long
Addressing Social Determinants of Health: Examples of Successful Evidence-Based Strategies and Current Federal Efforts, Amelia Whitman, Nancy De Lew, Andre Chappel, Victoria Aysola, Rachael Zuckerman, Benjamin D. Sommers
5. Align, Invest, and Advocate for Thriving Communities
Activities
ADVOCACY FOR ALIGNMENT AND UPSTREAM CHANGE
• Advocate for reforms to address social and structural drivers of health at the national, state, and/or local levels.
• Advocate for reforms to diversify the health care workforce.
• Collaborate with policymakers, standards developers, public/private coalitions, and others to inform and align industry-wide rules and measures so that they incentivize collaboration across the care ecosystem to advance health equity rather than duplicating efforts and to ensure they are fair and operationally feasible.
Anchor Mission Playbook, Healthcare Anchor Network
Addressing health disparities within your workforce, Cigna
Eliminating Racial Disparities in Maternal and Infant Mortality: A Comprehensive Policy Blueprint
Aligning Payment Policies with Quality Improvement (From: Crossing the Quality Chasm: A New Health System for the 21st Century)
COMMUNITY PARTNERSHIP AND INVESTMENT
• Align around shared goals and priorities with community partners and begin working together on those.
• Make investments that support thriving communities: hire locally and create career pathways to build wealth, invest in built environment, and purchase locally to support marginalized people and businesses.
• Internally publish data comparing key sociodemographic factors (e.g., REaLD and SOGI) of members and the relevant community that the organization serves (the state, region, or country).
Impactful Purchasing and Sourcing Toolkit, Healthcare Anchor Network
6. Take Initiative with Others
Activities
PROVIDER PARTNERSHIPS AND SUPPORTS
• Provide technical support to providers to help address specific identified inequities.
• Invest in accessible and plain-language communications, language interpretation, and translation services.
• Report stratified HEDIS data internally and give anonymized provider reports to provider organizations.
• Actively participate in research designed to establish an evidence base that advances the understanding of the impact of social drivers, environmental influences and other underlying mechanisms that produce disparate health outcomes.
CMS Framework for Health Equity 2022- 2032
National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care, HHS
DESIGNING FOR EQUITY
• Cover telehealth and enable technology for those who don’t have access.
• Provide incentives for health care professionals who engage in educational and professional development opportunities that equip them to advance racial justice and health equity.
• Create and implement payment and risk adjustment structures that center quality, safety and equity; reward systems for reducing inequities.
• Advocate for policy changes that facilitate health plan’s ability to sustainably focus on mitigating social and structural drivers of health and advancing health equity.
• Coordinate with other payers and Medicaid agencies in local, regional or state all-payer collaborations illnesses/conditions that disproportionately impact marginalized communities.
Impact of Provider Incentives on Quality and Value of Health Care, Tim Doran, Kristin A. Maurer, and Andrew M. Ryan
Policies to Support Future Telehealth Innovation, AHIP
Value-based payments to clinicians can help close equity gaps, STAT
Value-Based Payment As A Tool To Address Excess US Health Spending, Health Affairs
What Should Antiracist Payment Reform Look Like?, AMA Journal of Ethics