Improving Health Equity: How Payers Can Support Providers

Rachael Jones, senior vice president of performance analytics and quality, Cotiviti, shares how payers can use analytics, education, and incentives to support providers in improving care access and outcomes for vulnerable populations.

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My name is Rachael Jones. I am the senior vice president of performance analytics and quality at Cotiviti. In my role, I'm focused on operating and creating solutions that solve challenges for managed care plans and provider systems, particularly as they influence health risk status, improve quality, and understand and influence provider and member behavior.

My background is comprised of leadership roles at health plans and tech firms, most recently at Anthem, where I was responsible for the analytics and operations of Anthem's value-based care programs.

The pandemic has further exposed disparities in care. How would you describe true health equity?

The term ‘health equity’ is a recent buzzword in the industry. However, inequality in health care is not a new concept. The pandemic certainly shined a light on disparities in care, but health equity challenges are not new.

I think the best description I've seen for the term ‘health equity’ is from the Robert Wood Johnson Foundation. They have a great infographic that shows the difference between equality and equity. You'll see 4 individuals who are very different, but they're all given the same bike—same color, same size, same make and model.

Equal, right? That seems fair. But the problem is, much like health care, one size does not fit all. A taller person might need a larger bike, a smaller person might require something smaller, and what have you.

Essentially, when I think about health equity, I think about targeting and solving health care problems at the individual level to increase opportunities for everyone to live the healthiest life possible, no matter who they are, where they live, or how much they earn, because health equity is crucial to creating a culture of health.

How can payers support providers in improving health equity?

Payers’ main focus is to organize and manage care. I think about 3 ways payers can support providers: education, analytics, and incentives.

Education means raising awareness about what a practice rooted in health equity looks like, offering guidelines on how to approach this practice, understanding a patient's ability to afford prescriptions, or learning about patients’ living conditions.

Analytics can be used to summarize population health data, and trends on social, environmental, and economic conditions. And then health plans can provide those meaningful insights to help guide the next best action for intervention to avoid a worsening outcome.

Finally, payers can support providers by creating incentive programs around reimbursement that enable investment in evidence-based intervention, such as medically tailored meals for patients with diabetes, longer office hours or mobile outreach for areas where transportation might be lacking, or healthy food programs.

How can stakeholders identify sources of inequity?

It sounds overly simple, but scanning the communities where people are born, live, work, play, worship, and age often provides the greatest clues into how the conditions of these environments affect a wide range of health, functional, and quality of life outcomes and risks.

As you look at the community level, you can think of 2 kinds of factors: neighborhood factors and individual factors. Individual factors, such as age and risk and gender, certainly play a role in health inequity, but so does the community that folks live in.

You can look around and gather data on how close people are living together. What is the dropout rate or the absenteeism rate? How close is the nearest grocery store with access to fresh produce and healthy options? What's the crime rate? Do most of the people in the community depend on bus and train for transportation? And what about the cultural makeup? Is English a second language?

All these factors complement each other. And these are just a few examples, but as you begin to look at the population and examine these trends, you can see the interconnected factors that contribute to poor health outcomes.

How can data be used to help at-risk and under-resourced populations?

I've always felt that data—when it's credible and meaningful—is the key to unlock awareness and spur action. When community leaders partner with government and private entities, such as payers and provider systems, they can use findings from the data to direct resources toward where they can be most effective.

Think about the pandemic, right? We know from CDC data that COVID-19 hit communities of color at a dramatically harder rate than other communities, with death rates that were 2x-3x higher for Black, Latino, Hispanic, and Native American individuals. We also know these communities tend to be at higher risk for untreated chronic conditions, such as diabetes and asthma, that can lead to poor outcomes from COVID-19.

So if you're trying to increase vaccination rates, for example, you can look at socioeconomic data and understand that, for certain communities, maybe getting paid time off to make an appointment is challenging, or getting safe transportation to a vaccination site after hours may be an issue because of poor running bus or train schedules. A private entity like a payer or a provider system can partner with a community and offer extended office hours or perhaps partner with a Lyft or an Uber service to get folks to the clinics.

Another example is housing. We know that unsafe housing data can show us where opportunities are to address things like allergens and mold. Joblessness data can help drive job assistance programs. The key is identifying what those specific challenges are that impact people at the individual level, and then pulling up to assess how many individuals have that same challenge who can benefit most from the intervention or resource.

I think data can help drive the right analytics to lead to the opportunities for positive change.

Beyond patient outcomes, what else does health equity impact?

I love this question because I almost want to say everything, but maybe that’s a little too hyperbolic.

I think healthy communities are vibrant communities. When we improve health outcomes, we see better productivity, lower absenteeism at school, better management of chronic conditions, increased focus on preventive care, and all those wonderful health outcomes. But perhaps the most beneficial impact of health equity is the sense of dignity inherent in treating individuals for their unique needs, in a way that is aware of their specific challenges and committed to helping to improve their health condition.

I can't think of a higher, more compassionate way to provide care. To me, that's what health care is all about.

Is there anything else you would like to add?

Hopefully we covered a lot, but as I think about the industry, we're at a pivotal point right now where health care is transforming in a way that's personal. That can make a difference in the lives of others.

As health care leaders, we can take actions to advance health equity. We can think about large-scale national programs, but also local programs specific to communities that involve the communities they serve, convening advisory groups, identifying key problems such as Black maternal mortality, brainstorming ideas, and getting community buy-in.

These are all ways you can shape successful strategies, and we can learn from each other and share what we know so we can build a culture of health.