Health plans can help advance the goal of achieving health equity.

The racial and ethnic differential seen in response to COVID-19 related infections, deaths, and rates of vaccination spotlighted longstanding, pervasive health inequities in the United States. It catalyzed renewed interest in and focus on advancing health equity, on advancing in practice, the idea that everyone should have fair access to health and a fair opportunity to achieve their best health[1]. To advance health equity requires addressing systemic barriers like poverty, discrimination, and lack of access to health care—barriers that produce differences in health that are avoidable, unfair, and unjust[2]. Though the entire health care ecosystem plays an important role in advancing health equity, health plans are uniquely positioned to advance it in alignment with existing efforts that aim to improve member health and drive health plan performance.

Health plans share in the economic consequence of health care costs that arise from health disparities, key indicators of progress toward reducing health inequity. Much of the costs are avoidable, include medical expenses related to preventable chronic diseases and overutilization of high-cost health care resources, and disproportionately reflect health care spending for the very populations most likely to encounter social and economic barriers that limit fair access to health[3]. Health plan efforts to improve member health and plan performance and the strategies that are effective for addressing the social determinants of health that contribute disproportionately to health inequity are two sides of the same coin that impact overlapping populations[4].

Effective member engagement and outreach Is personalized and member-centered

Purposeful, member-centered engagement and outreach make it easier for members to take actions that promote and are beneficial to their health. It can provide visibility for health plans into gaps in care, barriers to access and unmet needs and drive health plan resources toward programs and benefits better tailored to address those needs. As a first pass, this approach to member engagement and outreach is a vehicle for getting to action. It aims to ensure that members are aware of available services and understand the reason those services are critical to their health. Leveraging data, it can also help health plans understand member choice and preferences and the behavioral factors that motivate their decisions.

Effective member engagement and outreach can address barriers to health

Looking more closely and acting more intentionally, member-centered engagement and outreach moves beyond a call to action and inspires two-way plan and member action.

An illustrative example of this concept is evolution away from in-home assessments (IHAs) as the primary strategy for the provision of member choice and closing member gaps. At their best, traditional IHAs can be a member-centric service to provide coaching, answer member questions, and guide members to resources to help them better manager their health. At their worst, IHAs can be a health-plan centric, gap closure exercise with little regard for what a member truly needs to promote and improve their health.

Pre-pandemic, there was a trend toward enhancing IHAs with program additions such as point of care labs (e.g., hemoglobin A1c or diabetic retinopathy screens). As the country went into isolation and IHAs necessarily ceased, telehealth visits emerged as a substitute for traditional IHAs and PCP visits and as a way of engaging isolated members to conduct screening for depression or dementia. While the surge in telehealth activity generated tremendous health plan value and member satisfaction, it also exacerbated health inequity and barriers to access for underserved members and those geographically difficult to reach. An internal analysis conducted by Inovalon found that 35 percent of Medicare Advantage and 24 percent of Managed Medicaid health plan members did not have access to the technology needed to participate in a telehealth visit. To address this barrier to access, health plan members were given the option of being shipped a web-enabled device through a program called Device on Demand, allowing members to access needed services and complete supplemental member encounters from the convenience of their homes. Through the first five months of 2021, telehealth visit completion rates for members participating in the Device on Demand program stood at 74 percent, reflecting additional reach to (and access for) a subset of members that otherwise would not have been able to participate in a telehealth visit. 

By moving beyond the walls of traditional health care and into communities where members live, work, learn, and play, health plans can address barriers to health that exacerbate health inequity through programs and plan benefits that more deliberately target the roughly 80 percent of health outcomes driven by social determinants.[5] As we emerge from isolation, it has become more clear that member centeredness and efforts to meet members where they are in order to drive improvements in health will only increase. Services such as in-home meal delivery, fall risk mitigation, digital enablement, and transportation to appointments when in-home services will not suffice will play an expanding role in health plans’ efforts to improve member health and run operations more efficiently.

Health plans that embrace this more holistic view of health and innovate to offer member programs and benefits that address social determinants of health will be more successful at driving improvements in health for its members, delivering better health care experiences, and getting to greater health care value, faster. Those that do not risk shrinking enrollment, loss of competitive advantage, and rising avoidable health care costs. The example of IHAs and the rise of telehealth and novel programs like Device on Demand demonstrate what is possible and foreshadow where health care is headed. By emphasizing a purposeful, intentional, and personalized approach to member engagement and outreach, health plans can advance the goal of achieving health equity through programs and initiatives already in place. Doing so is not only a public health good; it’s also good for member health and good for health plan performance.

[1] American Public Health Association. Topics and Issues: Health Equity. https://www.apha.org/Topics-and-Issues/Health-Equity. Accessed May 6, 2021.

[2] Whitehead M. The concepts and principles of equity and health. Int J Health Serv. 1992;22:429–45

[3] Astho.org The Economic Case for Health Equity. https://www.astho.org/Programs/Health-Equity/Economic-Case-Issue-Brief/. Accessed March 17, 2021.

[4] Centers for Disease Control and Prevention. National Health Statistics Reports. Available at: https://www.cdc.gov/nchs/products/nhsr.htm. Accessed April 20, 2021.

[5]National Conference of State Legislators. Racial and Ethnic Health Disparities What State Legislators Need to Know, National Conference of State Legislators. http://www.ncsl.org/portals/1/documents/health/HealthDisparities1213.pdf

About the author

James (Jim) Clement, vice president, products and services, Inovalon leads Inovalon’s quality interventions and integrated risk score accuracy programs which includes prospective, retrospective, and submissions. These solutions enable Inovalon’s client partners to drive meaningful improvements in risk score accuracy, member engagement and retention, quality, and financial performance. Clement maintains end-to-end responsibility for these products, from analytics and intervention strategy to intervention execution, data collection, and reporting. He has nearly 25 years of experience working in the payer and provider sectors. Prior to this role, Clement served as senior director and general manager of Inovalon’s quality improvement and integrated prospective risk adjustment solutions, where he maintained end-to-end responsibility for these products, from analytics and intervention strategy, through intervention execution, data collection, and reporting. He previously served as senior director of intervention strategy integration at Inovalon, where under his leadership Inovalon built new intervention channels including Inovalon-owned member centers, as well as retail clinics nationwide and expanded operations to a nationwide footprint. In addition, Clement led the planning and development of Inovalon’s market-leading member engagement program.

Prior to joining Inovalon, Clement held various management consulting leadership roles at Booz Allen Hamilton, PricewaterhouseCoopers, and Accenture, where he oversaw teams providing strategic advisory services to large health plans, provider organizations, and government agencies. Clement has also served in various operating and strategic planning roles in large, integrated delivery systems including Johns Hopkins Medicine and Children’s Hospital Boston. He earned a master of business administration from the University of Pennsylvania, Wharton School of Business and a master of public health from the Harvard University School of Public Health.