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-range 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.
There are three reasons from the employer side:
- Many employers are ignorant of the problem.
- Employers are concerned about the legality of collecting and sharing race and ethnicity data.
- Businesses don't want to face the administrative burden and cost of collecting that information.
Patricia Collins Higgins, co-author 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., 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 those 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 both 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 nothing beats having direct data from the individual. 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. This means that employers already have the race and ethnicity information. It's just a matter of businesses and health insurers working together to share the information.
Though 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 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 such areas as health information technology adoption, communications, 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:
- Health insurers must educate employers about the importance of the problem and the associated costs of the disparities.
- Health insurers must educate employers about the legality of collecting data and sharing it with insurers.
- Employers must understand the added up-front financial burden of surveying the data, but appreciate the long-term financial benefits associated with closing the health disparities gap.
- National leaders must encourage more employer participation in programs that target racial and ethnic disparities.
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 this nation continues to change.
"Until employers recognize the business case for reducing disparities—lower healthcare costs and potentially a more productive workforce—employer interest is unlikely to gain serious traction," says Higgins.