The journey toward health equity takes all of us

America’s health equity crisis is unconscionable and devastating to many people. We need better outcomes. Better representation. A better way. Blue Cross and Blue Shield companies are leading the charge, but it will take all of us to get there—healthcare partners, employers, communities and more. Consider this your invitation to a life-bettering, life-saving movement for your entire workforce.

For us to have meaningful conversations around creating more equitable health, we must first define key concepts that are core to the discussion.

Know these terms:

• HEALTH EQUITY is the absence of unfair
• HEALTH DISPARITIES are preventable differences

Consider this critical distinction:

• Equality is the idea of making sure everyone has the same tools and resources.
• Equity, on the other hand, is based on the idea that “the same tools and resources” don’t work for everyone.

Your health shouldn’t depend on the color of your skin or the neighborhood you live in. While BCBS companies have made great strides in addressing racial health disparities in our local communities, there is so much more to be done.

– Kim Keck, President and CEO, Blue Cross Blue Shield Association

Health equity: scale of impact

Identifying areas where health equity is suffering most, and what it’s costing employers, are the first steps in addressing what employee populations might be up against.

Throughout America, health disparities exist across key conditions that prevent oppressed and marginalized populations from receiving the care they need, causing and exacerbating a range of health issues.

• MATERNAL HEALTH: 3X HIGHER
• BEHAVIORAL HEALTH: 55% LOWER
• DIABETES: 60% MORE
• CARDIOVASCULAR HEALTH: 70% MORE
• CANCER: 14% HIGHER
• COVID-19: 2.5X MORE

Impact on the workplace

Addressing health equity isn’t just better for employees—but also for businesses.

• Medical care costs: $93B
• Lost productivity: $42B

Revealing key influencing factors

There are many dynamics impeding health equity. Below are some overarching factors that are critical for employers to understand and address.

STRUCTURAL RACISM & DISCRIMINATION: These long-standing factors impact access to care and the kind of care received when oppressed and marginalized populations seek services. In fact, a recent study found that white Americans receive a disproportionate share of U.S. healthcare dollars when compared to those who identify as Black, Asian or Hispanic.

PROVIDER BIAS & INEQUALITY: A lack of cultural understanding of certain populations can affect the seeking of and quality of care.

ZIP CODE: Evidence suggests that living in certain geographic areas or neighborhoods—a key social determinant of health (SDoH)— can come with particular health equity challenges. Those include access to physicians, quality care, pharmacies, healthy food and safe and affordable housing. Though 1 in 5 Americans live in a rural community, fewer than 10% of physicians practice there and 80% of rural counties don’t have a psychiatrist. Many studies have shown that residential segregation contributes to cancer and related racial

LACK OF PREVENTIVE CARE disparities even after controlling for socioeconomic status and Lack of trust in providers can health insurance. According lead minority communities to the U.S. Department of to avoid seeing physicians Agriculture (USDA), more than regularly, which may result in 17% of Americans have little to significant health challenges.

PROVIDER REPRESENTATION The Association of American Medical Colleges found the diversity of physicians does not reflect that of the country. In 2019, only 3.8% of doctors identified as Hispanic, Latino or of Spanish origin, the nation’s fastest-growing population. And, although 13.4% of the U.S. population is Black, only 5% of actively practicing U.S. physicians are Black. This lack of diversity can lead providers to operate within a single ethnic lens and set of values.  It has also been shown to lead to missed and/or misdiagnoses.  According to the National Alliance no access to supermarkets and on Mental Illness (NAMI), only Provider bias, both conscious and 96% of those in food deserts were Latinos and other communities.

Uncovering stigma that fuels behavioral health disparities

Many cultures associate mental health challenges with weakness or shame, which in turn creates a barrier to treatment.

Diving deeper into SDoH

As we continue breaking down the factors that contribute to people’s health and the care they receive, it’s imperative to look at SDoH— conditions in the environments where people are born, live, learn, work and age that impact a range of health, functioning and quality-of-life outcomes and risks. SDoH can be just as dangerous as serious medical conditions, and can have severe negative impacts on mental health, blood pressure and cholesterol. Achieving health equity requires advancing SDoH along with more equitable benefits, support and care.

The health of employees is tied to many of the following factors. That’s why 83% of employers believe SDoH will be essential to their health and well-being strategies over the next three years.

60% of an individual’s health outcomes are driven by social determinants of health.

IN ON HEALTH EQUITY: Taking on SDoH

Blue Cross and Blue Shield of North Carolina has dedicated $3.2 million for a groundbreaking clinical research study to address food insecurity among its at-risk members who also have hypertension/ high blood pressure. The study will measure how to best help people who are food insecure achieve better health outcomes by comparing two different types of healthy food interventions with and without nutrition education.

Implementing a National Strategy to advance health equity

Blue Cross and Blue Shield companies have set a goal: TO REDUCE RACIAL HEALTH DISPARITIES IN MATERNAL HEALTH BY 50% IN FIVE YEARS.

Blue Cross and Blue Shield companies launched a multi-year National Health Equity Strategy to tackle health disparities in local communities across the country. This commitment includes:

• Collecting data to measure disparities

• Scaling effective programs

• Working with providers to improve outcomes and address unconscious bias

• Activating partnerships at the community level

We’re starting with a focus on four conditions that continue to be top challenges for many workforces. These conditions also tend to disproportionately affect communities of color:

• MATERNAL HEALTH
• BEHAVIORAL HEALTH
• DIABETES
• CARDIOVASCULAR CONDITIONS

We recognize we cannot do this alone. With your input and partnership, we’ll continually improve our local programs and scale the best initiatives nationwide to accelerate health equity across the care continuum. Visit BlueHealthEquity.com to learn more.

What we can do together

Critical to establishing better equity are network and benefit design. To drive this, health plan partners and employers can work together. Health plan partners need to assure a variety of quality health providers are available to address healthcare deserts and help alleviate the challenges of accessing care that exist in many communities. Employers can ask their health plan partners to focus on provider enhancements and incentives that improve health disparities and help every employee access higher-quality, lower-cost care.

For network strategy, there isn’t a one-size-fits-all approach

Employers can rely on their health plan partner as an expert advisor to help design the right strategy and achieve the right balance of savings and access for your employees. A thoughtfully designed employee benefits program prioritizes wellness, prevention and equitable care while removing barriers standing between employees and the healthcare they need. Consider:

• Collaborating with your health plan partner to explore ways to improve the affordability of care, such as lowering or removing copays and ensuring broader access to preventive screenings Look to virtual care resources—but with the right context and support Virtual care can help connect people with the right clinicians for their needs. However, not all employees are digitally literate or have access to high-speed internet. To support employees’ use of such programs, consider having a place and time during the workday where they can access digital tools.

• Creating flexibility around time off for health needs like vaccinations, preventive screenings, doctor visits and behavioral care

• Addressing transportation barriers by evaluating benefits like bringing clinicians on-site or offering transportation subsidies

Where employers can lead the way

To ensure that everyone has the access and support they need, our healthcare system and workplace cultures need to be proactively inclusive. We must work together to operationalize more culturally competent strategies—a practice of listening to, understanding and responding effectively to the unique backgrounds, needs and challenges of your employee population.

Promoting a culturally competent workplace

Cultural competency requires programs that are sensitive to and respectful of varying populations and equitable benefits out of for all employees and their families. That means:

• Fostering cultural humility—embracing an ongoing willingness to learn, and an environment where senior leaders speak openly about the importance of health equity

• Offering education around diversity, equity and inclusion (DEI), including implicit bias training across the workforce—starting with your leadership

• Meeting with and listening to diverse groups of people and/or Employee Resource Groups (ERGs) to better understand needs and address barriers to care • Evaluating and evolving programs and communications to ensure they are culturally and linguistically appropriate.

• Asking your health plan partner if they are pursuing initiatives to address provider challenges including representation, bias and cultural competency

7 out of 10 employers indicated they plan to promote DEI-related aspects of their benefit and well-being programs over the next three years.

IN ON HEALTH EQUITY: Undoing maternal health bias

Blue Cross and Blue Shield companies have developed a national partnership with March of Dimes to expand access to its implicit bias training program— Dismantling Bias in Maternal & Infant Health—across the communities we serve. The training program’s unique learning experience is designed to reduce implicit bias among healthcare professionals caring for women before, during and after pregnancy.