Health disparities are prevalent in the U.S. healthcare system. Although their presence was previously known, the pandemic more widely exposed these disparities. This new exposure renewed the focus on reducing health disparities for Medicaid beneficiaries. Now, Medicaid plans need to determine how to achieve this reduction.
In this post, we will look at the consequences of health disparities and provide tips for how Medicaid plans can address them.
Research supports the presence of health disparities
Here are some documented, well-researched examples of disparities in the healthcare system:
- Black, Hispanic, and AIAN (American Indian and Alaska Native) people are worse off than their white counterparts across most examined health outcome measures.
- Researchers found significant racial and ethnic disparities related to COVID-19 death rates.
- On average, Black and AIAN people experience higher mortality rates than whites and are more likely to die from treatable conditions.
- Many factors contribute to healthcare disparities. Some of these are unaddressed behavioral health conditions. One of the other causes is simply access to healthcare, which is a challenge in many rural and underserved metro areas where many Medicaid plan members reside.
So what are the consequences of health disparities?
Health disparities cause human and financial costs
There are significant impacts from health care disparity. First is the loss of life. In 2018, the life expectancy of white Americans was approximately four years higher than Black Americans. People of color also fare much worse than whites across almost all health measures, including infant mortality, the prevalence of chronic conditions, and overall physical and mental wellness.
Another impact is lack of health care coverage. Without coverage, people are less likely to seek out care like preventive screenings, chronic condition maintenance, and medication adherence. When they eventually seek care, it is often at the highest levels such as emergency department or inpatient care., They may have more negative outcomes, and the cost to the system is much greater. Research suggests that health care disparities account for approximately $93 billion in excess medical care and $42 billion in untapped productivity each year.
Healthcare disparities are prevalent, but Medicaid plans can leverage strategies to reduce these issues.
How Medicaid plans can address health disparities
The federal government has identified health disparities as a problem and recognizes that efforts to reduce these disparities should involve Medicaid. The initial approach was to highlight equity and strengthen Medicaid through executive orders. Individual states are now enacting similar rules to prioritize access and improve outcomes.
A big part of these plans is the collection of disparity data. With this data comes insights and strategies. Here are some ways to use this data and establish new programs to engage Medicaid members and ensure better care delivery:
Communicate access options
As noted, lack of access to providers and prescriptions is a key component of disparity. If members are unaware of how and where to seek treatment, they likely won’t. Communicating regularly with members through various channels and particularly the method of their choice (e.g., email, text, apps ) can increase their knowledge of care delivery.
In some cases, members cannot access specialists in their local area. If that’s the case, offer telehealth options. For medication, encourage members to enroll in pharmacy delivery and mail-order options as well as telepharmacy to improve medication adherence.
Maintain Medicaid coverage and sustain enrollment
As the public health emergency winds down, it behooves Medicaid plans to communicate with their members to recertify their Medicaid coverage in their state. Medicaid Plans that offer market-place plans should inform their members about that option when they are no longer Medicaid-eligible. For those members who will not be eligible for those programs, Medicaid plans can assist members find health care in the community through Federally Qualified Health Care Centers and other community resources.
Addressing SDOH is vital to closing the disparity gap
One of the most critical parts of reducing disparities is to address Social Determinants of Health (SdoH). Those who qualify for Medicaid typically fall into groups where these needs are prevalent. They are low-income households, the elderly, and the disabled. They are also often recipients of other government programs, such as Supplemental Nutrition Assistance Programs (SNAP) and social security benefits. There is almost always a connection between health disparity and SDoH.
When someone deals with food scarcity, homelessness, threats of violence, and can’t meet other basic needs regularly, they aren’t going to think about health care. Regular physician visits, cancer screenings, medication adherence, and any other health needs will not register as a priority for someone fighting for stability. Many states require Medicaid Plans to assess and address SDoH in their contract with the plans
Thus, Medicaid plans must focus on tackling SDoH early in their relationship with the member, as it’s the primary cause of most health care disparities.
Include health disparities as a performance measure
When you measure and track something, you create an easier path to addressing it. Many states require that Medicaid Plans seek accreditation from a nationally recognized entity. These entities have a heightened focus on achieving health equity and reducing healthcare disparities. In addition, many states are requiring Medicaid Plans to report on health outcomes measures by race and ethnicity to ensure attention to the varying impacts on people of color.
Establish programs beyond traditional care
Many factors make it difficult for members to promptly address their health care issues. One of these factors, which is less well known, is the impact of social isolation and loneliness. As with other SDoH needs, if this is not addressed early in the relationship with the member, the member will be less likely to engage with outreach from the Medicaid plan.
Research on loneliness as a health factor suggests that a lack of social connection negatively impacts physical and mental health. Medicaid members that fall into disparity groups may experience more social isolation and loneliness than others, due to lack of transportation and other SDoH impacting their health, outcomes, and engagement. If you can address loneliness, you may have a better chance of addressing disparity.
