Five ways employers can help improve health equity

Health inequities result from unequal allocation of resources – goods, services or opportunities – and manifest themselves in unequal social, economic and environmental conditions, or the determinants of health.1,2 This unequal access may occur along several dimensions such as race, ethnicity, gender, income, disability status or geography.  

Why, despite best efforts, have communities been unable to make progress toward health equity? What can we do differently? 

One explanation is that structural inequities exist beyond the influence of any single institution or sector. Employers often struggle to define their role and responsibility in ensuring optimal health for their employees beyond providing comprehensive health programs, benefits administration and access to care. 

Addressing inequities requires employers to adopt a systematic view that includes changing narratives to embrace health equity as a moral imperative and a goal that must not be compromised. Equity in this context means being treated fairly, and it comes from the idea of moral equality, and offering everyone fair and just opportunity to achieve their optimal level of productivity. It includes offering equal chances to be productive in the workplace, and equal concern for employee health and social needs.

Employers are beginning to recognize their unique potential to promote optimal health for their employees and advance health equity. However many are also struggling to take their efforts from conceptual strategies to meaningful actions. Here are five principles and practical ways employers can, and should, help advance health equity:

1. Know the employee population and build the business case with data.

While the moral and ethical case for addressing health inequities is compelling, making the business case and understanding return on investment is just as important for addressing health inequities. The business case is for the employers to understand their baseline, as well as potential gains from promoting equity (including increase in employee retention, increased satisfaction, work engagement, improved business performance and productivity), and where the employer can be most effective. It should be incorporated as a priority into corporate health and well-being strategies, healthcare data analytics as well as benefits administration.

For example, Blue Cross of Minnesota partnered with University of Minnesota to analyze data to determine how much health inequities cost the state.3 They found that each year, more than 700 lives are lost along with $2.26 billion. By building the case with data, and acknowledging the problem head on, these organizations are striving to give all communities access to healthcare.

2. Understand the social and mental health needs of employees. 

Race, ethnicity and other sociodemographic data including geography and income, have not traditionally been used in population health analyses. This is especially true for private, commercially insured populations, which represent the majority of insured individuals in the United States.4

But this data can help businesses develop strategies around access, utilization and outcomes among their employees – stratified by race-ethnicity, geography and wages – to help them identify gaps and create solutions. Adding social determinants of health to claims and clinical information can help organizations find the insights they need to improve population health.

As purchasers of health services for employees, businesses can also leverage value-based purchasing power to hold plans (and third-party administrators for large, self-insured companies) accountable for collecting this data and using it to reduce disparities. Employers can also assess the cultural competence of a health plan by reviewing their Health Plan Employers Data and Information Set (HEDIS) scores and the Consumer Assessment of Healthcare Providers and Systems (CAHPS), which can provide a basis for comparison and guide selection of plans.

3. Provide employees with resources to maintain optimal health, including personalized programs

When communicating with employees, businesses should consider diverse cultural health practices and preferred languages. Engaging with employee affinity groups can help employers gain cultural insights to better communicate with specific populations.

Evidence-based strategies5 and culturally sensitive programs6 can help strengthen an internal culture of health in the workplace. They can also help address shortcomings within healthcare services that may result in compromised care for racial and ethnic minority groups.

Using race and income data can help highlight disparities regarding healthcare utilization. For example, studies have shown that Black patients who are cancer survivors and on high-deductible health plans, incur more barriers to follow-up care than white cancer survivor patients on the same health plan.7 These social and cost-related barriers often include a need for Black patients to delay filling prescriptions, skip drug regimens to save money or see a specialist for follow-up care. Comparing health plan elections and utilization across racial groups can highlight such differences in health outcomes between white and Black employees. We also know that lower wage-earning employees have different perceptions about their employer’s support of their health and wellness concerns, when experiencing workplace stressors, compared to higher-earning employees.8

4. Invest in environmental, social and governance efforts.

An employer’s investment in their environment, social and governance (ESG) portfolio can be a central factor in measuring not only sustainability, but also the ethical and moral value or impact of the company. Employers can set ESG goals and measure progress and impact of their policies on the communities in which they are located and serve. An organization’s ESG policies can impact individual and population health, as well as sustainability, in the communities where they are located.  

As an example of commitment to transparency and accountability around ESG policies and metrics, IBM tracks and reports progress on how our technology, services and talents are being applied to make a positive environmental and social impact.  

5. Collaborate with community stakeholders in an effort to achieve health equity.

Companies are part of and should understand the broader needs of their surrounding communities. Corporate social responsibility can be a valuable partner in these endeavors to help achieve health and racial equity. For example, IBM’s corporate social responsibility programs help employees engage with their communities, resulting in more than 2 million volunteer hours in 2020.

Collaborating with local organizations and healthcare providers to address social determinants9 and coordinate care options for employees may also help contribute to the delivery of more equitable care. Coalitions could include local public health departments, social services, commerce and community stakeholders.

These five principles and action steps can help employers address health equity, from meeting the individual needs of employees to more broadly contributing to their local communities. By connecting with their stakeholders, businesses can potentially develop more effective responses to health disparities and provide equitable opportunities, especially for employees and families with higher social needs to better access and manage their healthcare.

Hear more from Dr. Dankwa-Mullan at HLTH 2021

(1) https://www.ncbi.nlm.nih.gov/books/NBK425845/

(2) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4816016/

(3) https://www.bluecrossmn.com/about-us/corporate-social-responsibility/health-equity

(4) https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201905.pdf

(5) https://www.cdc.gov/mmwr/volumes/65/su/pdfs/su6501.pdf

(6) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5094358/

(7) https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767589

(8) https://journals.sagepub.com/doi/10.1177/08901171211024416 

(9) https://journals.sagepub.com/doi/full/10.1177/0890117118812822a