Leveling up: a role for health plans in improving health equity in New York
- Collection:
- Health Policy and Services Research
- Author(s):
- Newell, Peter, author
- Contributor(s):
- United Hospital Fund of New York, issuing body.
- Publication:
- [New York, New York] : United Hospital Fund, May 2023
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Cultural Competency Delivery of Health Care -- organization & administration Health Equity Racism Role Social Determinants of Health New York United States
- Genre(s):
- Technical Report
- Abstract:
- Anniversaries of seminal works on inequities in the U.S. health care system keep piling up lately, but progress toward equity has been distressingly slow. This disparity was underscored by the outsized impact of the COVID-19 pandemic on Black and Latine Americans, who died at twice the rate and were hospitalized at three and four times the rate of white Americans. Still, the COVID toll, along with the demand for justice that followed the tragic murder of George Floyd just months after the pandemic took hold, has engendered a renewed focus on health equity. This report surveys the efforts of health plans in New York and other states--and the regulators and policymakers who set the rules for plans--to highlight specific and wide-ranging opportunities to improve health equity. Making progress on health equity will certainly require an all-hands-on-deck approach--government, educators, artists, activists and community-based organizations, employers, researchers, health care providers and systems, and foundations all have important contributions to make. But health plans are uniquely situated to play a critical role in eliminating health care disparities and addressing the underlying drivers of inequity. For starters, health plans are large employers in their communities: they control vast resources through premium payments by government, individuals, and employers; they invest those premium dollars; and they spend billions of dollars on goods and services. Major health plans providing comprehensive health coverage in New York in 2020 reported about $50 billion in revenue, $15 billion in invested assets, and $6.5 billion in administrative expenses, including $2.8 billion in salaries and hundreds of millions more on auditing, actuarial and other consulting services, marketing and advertising, and equipment. Viewed one way, health plans are the stewards of these vast resources, including the estimated $93 billion spent annually in excess direct medical costs attributable to racial disparities. This review follows the “river” of interventions health plans are positioned to make--upstream, mid-stream, and downstream--with examples from New York and other states, across Medicaid, Medicare, and commercial insurance. The areas of opportunity highlighted in this report include diversity, equity, and inclusion efforts among insurers; insurer investments and procurement programs in communities; provider networks and consumer information; benefit design; utilization review; the employer-sponsored insurance market; data needs; and reporting and transparency. New York policymakers, regulators, and health plans face many daunting tasks in the effort to build a more equitable health care system, not the least of which is scrambling to fill huge voids in the data needed to guide and measure progress, a problem identified decades ago. But New York also has some valuable assets in its work toward equity, including a longstanding commitment to coverage, engaged state agencies, strong advocates, and a pending Medicaid waiver that (if successful) could bring important resources and infrastructure into the game. The task at hand is best described as “leveling up”: encouraging investment by insurers to improve economic opportunities and address community needs; exporting a positive intervention from one market segment to another, and from one health plan to another. Alignment and focus will be critical; policymakers and regulators must also look for opportunities to emphasize how urgent the need for change is. As a group of Black leaders noted in a recent opinion piece on how best to plot a course back from the pandemic: “Everyone keeps saying ‘We can’t wait for things to get back to normal,’ and we say, ‘We’re not going back to normal. We died in normal.’”
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)
- Extent:
- 1 online resource (1 PDF file (46 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918716486906676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918716486906676