Consumers Speak: SDOH, Instability in Health Insurance and Humanizing Providers
Improving people’s health requires looking at more than just their medical history, how they eat and the exercise they get. Where people live, their income levels, education, race, environmental factors, access to health services and employment status are all factors in health and effectiveness of care. In fact, nearly 90 percent of U.S. physicians say at least some of their patients have a social condition that poses a serious impediment to their health. Last week, we had the pleasure of participating in a workshop on this topic at a health care conference in Boston.
The session, “Tailor the Consumer Experience to Capture Diverse Market Segments While Addressing Health Disparities and Social Determinants of Health,” featured two health plans that are doing some pretty amazing work to improve the health and wellness of the diverse communities they serve. And it also featured a panel of five Boston-area residents whom we recruited to share their experiences and opinions about health care. At HealthSparq, we’re committed to driving change in health care and core to our effort is amplifying people’s voices and stories. [Related: What’s the Fix?]
Addressing Unique Community Challenges
The workshop was kicked off by Juan Lopera, Corporate Business Diversity Officer for Tufts Health Plan. Juan shared a few of the driving factors for why Tufts has made a commitment to better serving diverse communities and addressing the social determinants of health (SDOH). First, disparities based on factors such as race and economic status affect all aspects of life in this country, including health care. In fact, Juan pointed to a Boston Globe report on race that found the median net worth for African-American households in Boston was $8 compared to $247,500 for whites.
Tufts own research showed that consumers perceived that Tufts was a health insurance plan only available to wealthy people. Tufts knew they would need to address both the perceptions and realities of members of the community, so leaders made a business case for connecting diversity and inclusion efforts into the plan’s overarching business strategy. Today, the results are proving positive in the areas of health outcomes, staff and leadership diversity, supplier diversity and more. Juan said it’s taken relentless persistence to make change but the results are clearly significant.
Berny Gould, Senior Director of Quality and Equitable Care for Kaiser Permanente, shared how her organization is improving quality by addressing health disparities. Berny, a registered nurse, explained how Kaiser has been working for many years to eliminate disparities and implement strategies that support equity in health nationwide. She provided some examples of place-based initiatives in South Los Angeles, Oakland and Baltimore, where Kaiser Permanente was able to integrate community health strategies and investments to meet the unique needs of the communities. Key components of successful programs included cultural competency training, community partnerships and robust data to guide interventions and program direction. Berny praised the leaders of Kaiser Permanente for having the vision and persistence to make headway into such a complex and embedded issue in our country.
Listening to People’s Experiences
There was no shortage of opinions within our diverse group of five Bostonians! We have hosted numerous consumer panels at various health care conferences and the feedback is always positive – people who work in health care want to hear directly from consumers, they just don’t often get the opportunity to do so. And, as our first panel on the topic of disparities in health care, we made sure to recruit people of various races, health conditions, financial means and ages to share their experiences. Alison Greco, a trained psychologist and Director of Research and User Experience at HealthSparq, moderated the panel to really dig into the challenges faced by our panelists and how they believe the health care system could be improved.
A Pair of Social Determinants: Addiction and Income
Larry, a recovering addict, shared how his addictions impacted the care he received. He found that, even in the medical community, judgement about his illness prevented him from getting access to care and he experienced a lack of compassion in the care he was able to receive, even for illnesses not directly related to his alcoholism. He felt the medical community was failing in its mission to care for everyone.
Elizabeth, age 64, explained that she’s always scared she’s going to lose her insurance (Medicaid).
“I want to make more money, but if I make more money, I could lose my insurance,” she explained. “It’s a constant worry that keeps me up a night sometimes. I would love to see a system where everyone has health care. I don’t want to worry that I will make $1,000 too much and lose my insurance. Make health care equal.”
Elizabeth’s experience was a clear 180-degree turn from Joseph’s, a veteran and ex-postal worker, who has excellent health care coverage based on his career choices.
“As military, my health care has been pretty good,” said Joseph. “Co pays go up a bit but everything goes up except our salaries! That said, I see the people in my neighborhood really struggling. People have a hard time affording the medications they need and getting rides to appointments. I see people with addictions and mental health issues who do not get the care they need. And why do politicians get their health care for free – it’s frustrating!”
Combating Confusion and Humanizing Providers
Deborah, age 62, has experienced racism as a black woman, been homeless and on the other side where she’s been able to help people needing assistance. Dealing with a number of chronic health conditions, one of her primary complaints about the health care system is its complexity and the feeling of powerlessness.
“I feel like I’m not part of the game,” she explained. “Health insurance pamphlets are so confusing. I just want to talk to someone. Then I have to wait on hold forever. And there’s the process of referrals that is so much to be put through when you are feeling sick. I’ve felt judged by providers and I just want to talk to someone who understands me. I want a human connection again.”
Jorge, our youngest panelist at age 32, agrees that health care is too complex.
“Even the people billing you are confused. I’m educated and work in software and I get confused all the time,” said Jorge. “Why can’t it be simpler? I had a procedure once where they said it’s $100 if you do it one way or $5,000 for a different way. How is that even possible? I suggest a website that provides clear charges. Get rid of all the fine print and long tables. Just tell me, if you do this, you’ll pay X.”
In the end, the panel provoked some excellent questions from the audience and got people thinking about how the system can and should work better for people. That’s a win in our book. Addressing the health of people takes more than just patients and their doctors. Plans have a major opportunity to get closer to the communities they serve, help members and reduce costs by addressing SDOH and helping people navigate a stressful and confusing health care system. There’s a long way to go but it’s inspiring to see many people and organizations heading in the right direction!