Home Technology Can Health Plans Lead Us Towards Data-Driven Health Equity?

Can Health Plans Lead Us Towards Data-Driven Health Equity?

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Jessica Bonham-Werling, Payer and Provider Solutions Marketing at Redox

The Institute for Healthcare improvement indicates that twice as many healthcare organizations cite health equity as a top priority today when compared to 2019. It may feel like the COVID-19 pandemic just made us collectively realize that health disparities exist, but they have been acknowledged in academic, government, and philanthropic spheres for over 4 decades. While I would love to debate if our collective realization was blissful ignorance or intentional avoidance, I will save those fireworks for another time and focus on the good news here –  finally, we see these disparities, and finally, private organizations are making real commitments to more equitably allocate resources across communities, races, and classes. Among these committed organizations, health plans are uniquely positioned to drive real change. 

I know, I know, the mere mention of insurance companies likely draws an eye roll, but hear me out. Americans see a myriad of physicians and caregivers who only have a part of their story, but their health plan (eventually) sees the full view as claims roll in for the services and treatments they received. Further, the health plan ultimately assumes the risk for their members’ health and wellbeing and as such, they have a real, tangible financial interest in giving each of their members the best possible opportunity to be healthy. Have we finally found a place where doing the “right thing” is also profitable? I think we may have! 

Health plans are finally investing, not just in health care services, but in addressing the social determinants of health (SDOH) – providing access to healthy meals, reimbursing transportation, and supporting local community organizations that are focused on driving health equity improvement. America’s Health Insurance Plans (AHIP) recently assembled a truly impressive list of what health plans across the nation are doing. There are so many examples of good work and generous investments in this list, but as a former Kaiser Permanente girl (and still a huge cheerleader), I will highlight their $25 million commitment to supporting racial equity and economic opportunity in communities hardest hit by the pandemic.

This is a start! But, you guessed it, much more is required. As a current Redox girl, I feel deeply that the work ahead must begin with addressing data – without the right data, it is nearly impossible to truly quantify the breadth or depth of health disparities or establish in-depth plans to take action. The absence of data perpetuates an environment where we can return to blissful ignorance and/or intentional avoidance. 

There were recently some huge steps in pushing this forward. On April 20th, CMS outlined a strategy to advance health equity which included a call to standardize the collection of and use of SDOH data across CMS programs. The following week, Blue Cross Blue Shield Association (BCBSA) and Blue Cross and Blue Shield (BCBS) released a paper calling for the healthcare industry to adopt national data collection standards to advance health equity. They asked for healthcare leaders to “ensure the data needed to measure and address those disparities is standardized across all systems.” BCBSA is a founding member of the Gravity Project which is working to develop data standards to represent individual-level SDOH information in digital platforms and ensure they are used consistently across the healthcare industry.

CMS strategies and the Gravity Project are likely the right vehicles to get us there – industry-wide agreement and adoption are the only way to get to a place where we have and can trust SDOH data. These efforts are monumental and will take time.  What my 3-year-old might call  “a long, long, long, long time”. So in the meantime, what can be done? Health plans should maximize real-time interoperability with providers, third-party vendors, public health entities, and other payers to build the most comprehensive, actionable view of their member’s demographics, health, and care journeys. Building this view will overcome problems with claim data latency and also open new opportunities to recognize health disparities, take action to close gaps, and unleash innovation that leads us toward health equity. 

While I have a ton of faith in the power of health plans (many would argue too much), it’s important also to acknowledge that health plans alone cannot fix this problem. The chronic underfunding of public health in this country and issues of systemic racism must also be addressed to truly achieve lasting health equity. All of these things can be done so long as we resist the pullback into blissful ignorance or intentional avoidance.


About Jessica Bonham-Werling

Jessica Bonham-Werling is a Sr. Manager of Payer and Provider Solutions Marketing at Redox, an interoperability platform that is connecting healthcare and making data useful. Jessica has 18 years of health and healthcare experience as a consultant, marketer, and builder, focusing her efforts on using data and technology to expand access to care and improve health equity. Jessica holds an M.B.A. from the University of California – Los Angeles and a B.S. in Management Information Systems from the University of Arizona.

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