Achieving health equity has become a central goal for policymakers across the country. It is now widely accepted that we need to break down economic, social, and health care barriers to ensure everyone has a fair opportunity to achieve their highest level of health. To accomplish this, health care fairness must be embraced and targeted efforts deployed. This requires taking action to understand the unique challenges of our communities and the specific barriers that prevent improved health outcomes. A successful strategy involves a neighborhood-by-neighborhood approach. But understanding each community’s situation also requires a commitment to engage with community leaders, organizations, and members and being ready to make continuous improvements to address the factors that contribute to disparities and inequalities.
Two initiatives in New York focus on achieving these results. Several months ago, the City of New York launched HealthyNYC, a campaign to reduce chronic disease and improve the health and lifespan of New Yorkers. Several weeks ago, the State of New York received approval from the Centers for Medicare & Medicaid Services (CMS) to attack this problem as a focal point of their Medicaid waiver. It is now up to health care stakeholders to help make these objectives happen.
New York has some of the country's most economically, racially, and ethnically diverse communities. As a New York-based, nonprofit health insurer, we serve a population that includes employers, union members, essential city workers, and Medicare and Medicaid beneficiaries. These health equity initiatives affect our communities, prompting us to step back, take stock, and launch new strategies to partner with the city and state. Our jumping off point is fourfold:
- We have a close partnership with AdvantageCare Physicians (ACPNY), a primary and specialty care practice with more than 30 locations across the five boroughs of New York City and Long Island. ACPNY focuses on providing high-quality care to underserved communities. ACPNY has maintained the highest level of primary care medical home (PCMH) accreditation, ensuring that minority and low-income communities receive the same high-quality care as more affluent areas. The doctors and their teams live in the communities they serve and represent that racial and ethnic diversity.
- We have EmblemHealth Neighborhood Care sites in New York’s underserved communities to meet the wide-ranging needs of the communities at large and overcome barriers to care. Our 14 Neighborhood Care centers are strategically located in diverse communities throughout New York City and provide free one-on-one support, connections to community resources, and group programming on various health and well-being topics such as nutrition and healthy food choices, social isolation, and mental health support. These Neighborhood Care locations are crucial to our neighborhood-based commitment to health equity. We provide a space where the community can come together to improve their health and wellness. By integrating our resources with those of the community, our Neighborhood Care teams help members and non-members navigate the health care system by removing barriers to getting care and addressing social determinants of health (SDOH).
- We have proudly earned Health Equity Accreditation from the National Committee for Quality Assurance (NCQA) for all our commercial and public sector products.
- We have a dedicated Community Engagement team focused on programs and advocacy priorities that mean the most to our members and the communities where they live. We host and sponsor events that engage members in hard-to-reach communities. We partner with community organizations to address food insecurity, offer preventive screenings and immunizations, provide baby supplies, deliver health education for non-English-speaking New Yorkers, and organize holiday celebrations for children and families. In addition to these events, we host free public seminars on public health issues, such as diabetes, maternal health, and mental health, providing a forum for community members to learn from experts about risk factors and available resources. These community-based efforts are vital to improve population health and health equity among our members.
This experience informs our policy framework to identify and implement neighborhood-based interventions that recognize each community’s challenges and opportunities to improve health equity.
We offer three recommendations for a neighborhood-based framework for health equity improvement:
- A fundamental building block: Using data to identify and target areas for improvement to the health equity strategy
To address health equity, programs need to be targeted. A critical first step is collecting information on individual, social, and demographic characteristics that can affect a person’s health and well-being. Health plans may have some of this information from enrollment forms, including race, gender at birth, gender identification, income, and age. However, this information is often incomplete. Addressing inequities requires understanding other factors, including members’ living conditions, mental health, loneliness, availability of healthy food, and transportation.
Health plans need to work with doctors, nurses, and other medical professionals to collect as much information as possible to take a comprehensive look at the characteristics of the neighborhoods they serve. EmblemHealth is creating questionnaires to assist our medical partners. Other plans and health care professionals are doing similar things. However, they don’t all use the same data collection tools. Several model data collection tools exist, including one created by a coalition of community health centers and community-based organizations (PRAPARE) and another by the CMS.
An important step forward would be requiring all stakeholders to use the same data collection tool for their equity initiatives. This uniformity would reduce paperwork for hospitals, doctors, and community-based organizations. Over time, it also would become familiar to patients. An effort to bring stakeholders together to create the best data template could significantly affect the ability to collect the information that is fundamental to designing a successful health equity strategy.
- Reduce disparities by rejecting a one-size-fits-all approach
Making a lasting impact on health equity requires us to reimagine health care delivery from a one-size-fits-all approach to one that considers all aspects of an individual's life, including their culture, background, and medical and social needs. Involving community-based organizations in these efforts is crucial. And using a data-driven, neighborhood-based approach allows organizations to help identify specific needs and deploy programs and interventions to meet these needs.
This approach requires presence in the community and employing a racially and ethnically diverse staff that represents the communities it serves. It also requires stakeholders to partner with community-based organizations to expand the concept of care to include the whole person (beyond just their physical health) and understand that success will take a neighborhood-by-neighborhood approach. In other words, geography matters.
EmblemHealth is implementing this neighborhood-based approach in New York. The first step is to analyze the data we can collect with the help of our provider and community partners. This data includes the prevalence of chronic conditions, the frequency of primary care provider (PCP) visits, age, disability, SDOH needs, and the availability of community organizations that can work with us to be most effective.
We are also conducting listening tours to hear our members’ health and wellness needs directly from them. These activities will help us better understand population needs, design targeted interventions, and establish ongoing discussions between health care professionals and individuals. Next, we can define the priority focus areas and identify actions and programs to address them. We can then work with doctors and community-based organizations to implement solutions.
By focusing our activities on the neighborhood’s specific needs, we can better target programs that meet members’ needs with the cultural and language sensitivity we know is critical to successfully improve health outcomes.
- Rewarding results to accelerate health equity improvement
Policymakers should incentivize partnerships between plans, doctors, and community-based organizations to improve health equity. New York’s Medicaid waiver proposes value-based arrangements that reward success in addressing social care needs. To address equity, a neighborhood-based approach should be implemented to collect data, identify gaps, implement interventions, and improve outcomes.
Driving Meaningful Change
These policy recommendations require a commitment to uniform data collection and coordinated incentives that prioritize performance. Achieving health equity requires fair resource distribution. Government officials should advocate for a fairness agenda, and stakeholders must collaborate to support these efforts.
