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How Payers are Supporting Health Equity and the Role of Technology

Authored by: Angie Adams

According to the Robert Wood Johnson Foundation, addressing health equity “…requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.”    

The complexity of health equity makes it a challenge, and while it’s not a straightforward fix, any effort by medical providers to improve health equity requires payer support.   

 

Underscoring the need to encourage payers to rethink their reimbursement strategies, the Centers for Medicare and Medicaid Services recently prioritized health equity in their Star ratings. In 2019, just 25% of health systems surveyed identified health equity as a top priority. Now, it’s more than half.  Additionally, 30% of those surveyed said that payers should reconsider how benefits are designed to support reimbursement and access to care.   

Creating specialized programs to promote equity  

By proactively working to create initiatives, payers have begun to chip away at ever-complex health equity challenges. For example, many health plans have specialized opt-in programs for members who need more support, such as those with chronic health conditions. In addition, plans offer dedicated phone lines – staffed with nurses and created specifically for members who need pain management support, diabetes support, or other personalized assistance – to help them get the care they need.   

 

Health providers, too, are proactively working to identify health disparities and the populations with the highest needs, publishing peer-reviewed studies that offer insight into which programs help which populations. Payers have an opportunity to use this insight to make more informed decisions about what to integrate into benefits offerings.   

Bridging the equity gaps with technology  

Technology helps bridge equity gaps. A few examples of how technology supports health equity include:   

  • Telehealth. While telehealth rapidly accelerated during COVID-19, the increased use (and reimbursement) of this method of care during the pandemic served to overcome some health equity challenges. Now, a plan member in a rural community located far away from a medical specialist can access care remotely, such as mental health services, post-surgical follow up, physical therapy and more.  

 

  • Integrated care and technology. By partnering with technology providers, payers are helping connect people to the resources they need. For example, wearable devices to monitor blood pressure or glucose levels or a mental health app to reduce stress.  

 

  • Expanding community-based programs. With community-based programs that increase both coverage and access and the use of technology, such as telehealth, payers have expanded levels of care for high-risk populations.  

 

  • Reduce inherent bias. Rather than relying on the medical provider’s discretion, healthcare organizations can build rules into their EHR system to trigger specific actions, i.e., prompting care givers to ask follow-up questions each time a set of certain conditions is met or to screen for depression or anxiety in all patients.   

As you look for technologies that can help create greater health equity, consider the areas of implementation, flexibility and the ability to adjust algorithms. And above all, whether it’s a new initiative or new technology, keeping the patient at the center of everything is the first step in providing more equitable care.   

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