What employers can do to tackle racial and ethnic disparities in health care

In my previous article on the topic of employers’ concerns over racial and ethnic disparities in health care outcomes, I explored the well-documented fact that in America, people of color suffer and die from treatable illnesses more often than the rest of the population. These disparities persist because of systemic and structural inequities in our health care system that impact the health, well-being, and daily lives of Black, Asian, Latinx, and Native Americans.

Motivated by both the moral imperative and high cost of health disparities, U.S. employers increasingly are taking action to close the gaps. At the Health Transformation Alliance (HTA), a cooperative of nearly 60 employers representing more than 4 million lives and $27 billion in annual health care spending, we are making a difference by leveraging the power of data and collective action. Here are three ways our member-owner companies are improving health outcomes for employees and their families who are people of color:

1. Health care coverage that improves outcomes for all

One hundred percent of our member companies’ full-time employees receive health care coverage, benefits, education, and programs designed to meet their specific needs. We help our members accomplish this by providing aggregated claims data and tools that enable them to analyze the data in multiple ways, including by employee population.

Recent news reports suggest that in some cases the use of analytics in health care may have exacerbated racial disparities in health outcomes. Our objective is precisely the opposite: we deploy data to erase such disparities. To be clear, the data we use does not identify the identity, race, or ethnicity of specific individuals. Rather, we use the first three digits of the zip codes of areas where employees live, which are often a close proxy for race.

Armed with data on the health needs and outcomes of people of color, our members can identify and close gaps through targeted interventions. For example, they can guide employees to health care professionals and institutions with expertise in the health issues of people of color and a track record of providing diagnoses, treatment, and support free of the biases—unconscious or not—that create racial and ethnic inequities in the first place. Plus, they can negotiate and enforce payment strategies and contracts that reward providers for better outcomes for all their employees, including people of color.

2. Access to needed care

One of the most egregious disparities in our health care system is lack of access to needed care for people of color, even for those who have health insurance. For example, while the high cost of prescription drugs burdens everyone, it disproportionately affects racial and ethnic minorities because they can make out-of-pocket costs for needed drugs unaffordable for lower income families. To mitigate these rising costs, we negotiated contracts with pharmacy benefits managers (PBMs) to ensure guaranteed pricing in each contract year and provide member companies and their employees with rebates and discounts on drugs.

One of the PBMs we have a contract with is CVS. We chose CVS because even with its recent announcement of some store closings, the company will still have locations all over the country in all kinds of neighborhoods. At present, 85% of Americans live within 4 miles of a CVS store. In addition, many CVS stores will soon have enhanced in-store care clinics. In many parts of the country, CVS stores are located near supermarkets where people can purchase healthy foods at reasonable prices, including fruits and vegetables. CVS’ brick-and-mortar strategy, including where the company chooses to locate its stores, helps ensure people in lower-income neighborhoods have greater access to affordable prescription drugs and primary health care.

Another area where gaps in access to care exist is in behavioral health. America is currently experiencing a behavioral health crisis, worsened by the COVID-19 pandemic. More than 40% of Americans report symptoms of anxiety or depression. In 2020, 45,000 Americans lost their lives to suicide. People need access to behavioral health professionals more than ever, yet even those with health coverage often must wait for months to get treatment, if they can get it at all.

Behavioral health issues affect everyone. However, even though the American Psychiatric Association reports that most racial and ethnic groups have similar or even lower rates of mental illness, they often have poorer outcomes due to lack of access to mental health services.

To help our member companies provide greater and more equitable access to mental health care, we formed a partnership with Lyra Health, a digital mental health company. Lyra offers a curated network of more than 3,000 evidence-based mental health providers who offer virtual services. Research shows that when health care professionals and patients share race or ethnicity, patients feel more comfortable and implicit bias is decreased. A major driver of our choice of Lyra is that one-third of the mental health professionals in its network are people of color.

3. Tools and programs to combat specific health issues that disproportionately affect people of color

America has the highest maternal and infant mortality rates among comparable developed countries. However, as reported by Kaiser Family Foundation, Black and Native American and Alaska Native women have pregnancy-related mortality rates more than three and two times higher, respectively, compared to the rate for white women. Even worse, many of these deaths are preventable.

To help our member companies address maternal and infant health, we are developing a predictive model to help identify which moms and babies are more likely to end up in an ICU due to pregnancy complications. The model works by gathering easily obtainable population-level and individual health predictor data and producing a single health risk score for women who are pregnant.

This health risk score for pregnant women works much like a credit score: the higher the score, the more pre-natal attention the mother will need during her pregnancy and the birth of her child. If a pregnant woman is identified as high risk based on this score, she can seek out more or more specialized pre-natal care. We expect to make this predictor available to our member companies in the first quarter of 2022.

The problem of racial and ethnic disparities in health care is complex and there is no single answer for solving it. But as the sponsors of health care for 158 million people, U.S. employers are uniquely positioned to make a difference in key areas that expose the issues and hold providers and payors accountable for being part of the solution. This can happen if employers combine forces and leverage their collective power for the benefit of their employees who are people of color.

Disparities in health outcomes impose an unacceptable cost on families, our economy, and the character of our nation. Employers can and must continue to be key players in closing these gaps.

Robert Andrews is chief executive officer of the Health Transformation Alliance (HTA), a cooperative of America’s leading employers that have come together to fix our broken health care system. Prior to the HTA, he served as a Member of the United States House of Representatives for nearly 24 years. President Barack Obama praised Andrews’ service as “an original author of the Affordable Care Act…and a vital partner in its passage and implementation.”