December 2019
Adding Value: Addressing Health Equity in the HMO
Research has shown that ZIP code has a greater impact than genetic code on health outcomes.1 Many people across the country are affected by health inequities. Health inequity is identified as differences in health status or in the distribution of health resources between population groups. Such disparities can be traced to social determinants of health (SDoH), which are the circumstances in which people are born and live that have an impact on their health. Blue Cross and Blue Shield of Illinois (BCBSIL) is taking aim at these factors by looking at member data at the local level, then tailoring programs and partnerships to help meet communities’ needs.
Providing resources to help reverse health inequities can improve clinical outcomes while also having a positive impact on member experience with Population Health Management (PHM) programs. It’s important to have a cohesive plan of action for addressing member needs across the continuum of care. For BCBSIL’s HMO plans,* an annual population assessment is conducted to help ensure that the member population and subpopulations have access to all needed services and community resources. This assessment also looks at the impact of SDoH. It focuses on members who have lower incomes, coverage under federal and state programs, multiple chronic conditions or severe injuries, as well as those who may be at-risk from being in potentially under-served ethnic, linguistic or racial groups.
Beginning in 2017, BCBSIL initiated discussions on SDoH and in 2018 addressed health inequity with HMO providers within the structured annual Utilization Management (UM) and PHM plan. Medical groups were tasked with collecting and analyzing data that adequately describe the member populations they serve. They were also asked to establish community resources and help improve member engagement by informing members about available PHM programs. BCBSIL incentivizes medical groups in recognition of assessing SDoH in members enrolled in Case Management programs.
In 2019 we now see medical groups addressing SDoH in their PHM programs through initial assessments and discharge planning. BCBSIL’s Quality Department provided free access to two 60-minute online training modules for primary care providers (PCPs) on the subject of physician bias through the HMO 2019 Health Equity Continuing Medical Education (CME) Project. In addition, the BCBSIL HMO Population Health Academy Day and Administrative Forum provided useful tools and information to reinforce core population health principles and highlight ways to help advance health equity. Presenters emphasized that all BCBSIL plans offer opportunities to help our members live healthier lives. These opportunities may include no-cost education, discount nutrition and fitness programs, and discounted health and wellness merchandise (including items like fitness equipment and activity tracking devices). Members can learn more via Blue Access for MembersSM.
Looking to 2020, we remain steadfast in our goal to help improve our members’ lives by continuing to address health equity through our work with providers. We will be asking medical groups to set disparity reduction goals for clinical programs for all members, and we’ll be asking that medical groups educate their staff on potential biases and stigma related to SDoH and health equity. We are adding new initiatives to our PHM program and plan to continue to prioritize member needs by providing formal and informal educational opportunities related to those needs. These initiatives will focus on helping to identify and address some of the root causes of rising health care costs that may be associated with SDoH.
For more information, HMO medical groups may refer to the newly released 2020 UM/PHM Plan, participate in educational webinars and workshops, or reach out to their designated HMO Nurse Liaison for assistance. Also, be sure to visit our new Health Equity and SDoH page for helpful links and related resources, such as hypertension and diabetes toolkits.
Would you like to share the ways you are advancing health equity in your PHM programs? You’re welcome to email our Blue Review editor with feedback.
1 Healthcare Information and Management Systems Society (HIMSS). Sept. 16, 2019. Social Determinants of Health: Can ZIP Codes Define Health Outcomes?
*Refers to: HMO Illinois®, Blue Advantage HMOSM, Blue Precision HMOSM, BlueCare Direct HMOSM and Blue Focus Care HMOSM.
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. References to third party sources or organizations are not a representation, warranty or endorsement of such organizations. Any questions regarding those organizations should be addressed to them directly. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit. Not all benefits are offered by all benefit plans. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. For more complete details, including benefits, limitations and exclusions, please refer patients to their certificate of coverage. If you have any questions, please call the number on the member’s ID card. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.