Health Equity 360: Over 10 Years of Health Equity Progress

• By:  Dr. Rhonda Johnson
• Posted:  April 29, 2016
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Recently, Highmark Inc. was one of three U.S. health insurers selected for a case study by a large purchasing organization, whose identity I can't release at this time. When it's published, the study will show what organizations like ours are doing to integrate health equity and health-disparities-reduction strategies into standard operating practices.

In her paper “What Are Health Disparities and Health Equity? We Need to Be Clear” Paula Braveman, MD, MPH, explains how health equity and health disparities are intertwined. “Health equity,” simply stated, is the possibility to be healthy — even if you belong to a group that has been economically and socially disadvantaged. These groups include minorities, women, the LGBT community, and people with disabilities and lower incomes. “Health disparities” are what we track to measure how well we're achieving health equity.

Disparities Persist in the U.S.

Despite the efforts of health organizations across the country, the U.S. has a long way to go in eliminating health disparities.

The National Healthcare Quality and Disparities Reports are annual reports to Congress, which since 2003 have noted the nation's progress in eliminating disparities. The 2014 report, based on data through 2012, includes these discouraging findings:

• Few disparities were eliminated. Disparities in both health care quality and health outcomes by income, race and ethnicity are large, persistent and not improving substantially.
• People in poor households received worse care than people in high-income households on more than half of quality measures.
• Blacks received worse care than whites for about one-third of quality measures.
• Hispanics, American Indians and Alaska Natives, and Asians received worse care than whites for some quality measures — but better care for some measures. For example, one of the health care quality measures that worsened was for Hispanic adults over age 40 with a diabetes diagnosis who received two or more hemoglobin A1c measurements in the calendar year.

For example, recent interventions to close diabetes care gaps in our Hispanic members resulted in a 31 percent increase in eye exams, a 39 percent increase in hemoglobin A1c tests performed, and a 41 percent increase in screening for kidney disease.

Having members' demographic information also has helped us to make strides in flu prevention. Our Health Equity and Quality Services (HEQS) flu intervention helped 1,617 African-American and Hispanic members to get the flu vaccine, representing potential medical cost savings of $6,468,000 for our members who received it.

Decreasing Language Barriers to Improve Care

In 2015, Highmark's Member Service department received 57,534 calls from members who needed interpreter services; most of these callers used Spanish and Chinese interpreter services.

Highmark offers free training and other tools to physicians and other providers to help them provide accessible language services to their Highmark member patients. Thousands of in-network practitioners from all of our regions have taken advantage of our free training to improve their knowledge of cross-cultural health issues, such as:

• Defining the social and cultural issues most relevant in the care of diverse populations
• Improving communication with patients who have limited English proficiency
• Understanding medical disparities that result from globally mobile populations

There are many ways we educate members and physicians about the relationship of health literacy and health outcomes, including through newsletters, community and educational events, and physician meetings. For member communications, Highmark invests in electronic readability tools and staff training for those tools.

Addressing Health Equity and Health Disparities: The Business Case

One of the questions that I hear over and over is, “Why does Highmark focus on health equity and health disparities?”

The answer is that Highmark's senior leaders “get it.” Improving health for all is part of our corporate mission and vision. The persistence of racial and ethnic disparities in our current and future customer base, which is increasingly diverse, creates a compelling case for continued investment in these efforts.

Highmark's health equity strategy has evolved over these past 10+ years. Our staff has changed, our organization has changed, and the health equity focus has expanded to include other vulnerable populations — rural, veteran, lesbian, gay, bisexual and transgender people; Highmark members insured in government-sponsored programs; and our partnerships, which now include community- and faith-based organizations.

Continuing to pursue health equity means striving for the highest possible standard of health for all people. At the organizational level, it comes down to leadership, data, mission, strategy, passion, execution and reframing for long-term results.

Our health equity team is committed to improving quality and creating a better health care experience for all of our members. Our strategy is inclusive of our geography, and we have created partnerships with institutions in our communities in West Virginia, Delaware and Pennsylvania.

Read my Health Equity 360 blog series for more information on how Highmark is working to achieve health equity. You can also visit Highmark's Health Equity & Quality website.