Health Equity by Design

Listen to Darrell Gray II, MD, Chief Health Equity Officer, talk about how whole health is anchored in advancing health equity.

I'm Dr. Darrell Gray II, and I have the pleasure of serving as Chief Health Equity Officer here at Elevance Health.

It's an incredible time to be in healthcare. We're seeing a recognition of the need to address social factors that impact health and advance health equity, and that's leading to measurable advances in both areas.

While our state, federal, and commercial customers are seeking innovative solutions, Elevance Health is leveraging the work that we've done foundationally already in both areas to leap ahead of the industry in meaningful ways.

Health equity means that everyone has a fair and just opportunity to be as healthy as possible. This isn't true today. Without health equity, we know that some people are unjustly experiencing poorer health outcomes than others. Let's take, for example, maternal health. This is one area where the inequities are clear and stark.

The CDC reported in September 2022 that more than 80% of pregnancy-related deaths are preventable. And more than half happen up to one year after delivery. Black women are three times more likely to die from a pregnancy-related cause than white women. To close gaps like this, we have to look at where health inequities exist and remove obstacles. These include factors within and outside of the walls of clinics and hospitals and emergency departments. We need to identify and mitigate biases in clinical algorithms and in patient-provider interactions.

We also need to ensure access to high-quality, culturally responsive care. And that includes other factors, including building trust to successfully navigate beyond barriers imposed by environmental and social factors.

At Elevance Health, this means advancing health equity so that everyone receives quality, individualized care. To achieve this, we are designing for the outcomes we aim to achieve. Our health-equity-by-design approach extends beyond a race-exclusive view of health equity to optimize health at the individual level for all, regardless of race, ethnicity, sexual orientation, gender identity, age, disability, or where you live.

We know the healthcare system does not support everyone equally. From a business imperative standpoint, we see this, for example, as we look across the nation and the cost of inequities. Disparities amount to approximately $93 billion in excess medical care costs and $42 billion in lost productivity per year. Health inequities are expected to exceed $1 trillion in spending by 2040 if we do not change course.

Together, we have to take action and understand that the core of a strategic whole-health approach has to be designed for advancing health equity. By taking a whole-health view, and therefore, a more personal approach, you begin to design a system that sees and supports advancing health equity. These issues cross all key drivers of health: physical, behavioral, and social. But we know social drivers impact up to 80% of health.

There's certainly more we, as a health insurer and partner to care providers, can do as a system to advance health equity. I return to a public health narrative of the stream. Upstream, we work to improve laws and policies that shape community conditions to address social and institutional inequities. Midstream, we work on addressing individual social needs like housing, transportation, food insecurity, and bridging the digital divide. And downstream, we work to address chronic diseases, mental health, substance use disorder, and COVID-19 deaths.

As a company, we're looking at all of these things and designing for advancing health equity in all that we do: how we support the health of our employees, greater diversity in our networks, partnerships, products and policies, as well as quality performance measures, programs, and accreditations.

Partnering with care providers is critical, and we're doing that through value-based payments, network diversity efforts, and continuing education and training. We're committed to partnering with care providers in all that we do.

Defining Health Equity

Contributing expert: Darrell Gray II, MD

Any effort to advance whole health begins with a commitment to advancing health equity. Our name, Elevance Health, was formed out of the concepts of "elevate" and "advance," signifying our vision to elevate the importance of whole health and advance health beyond healthcare. Critical to realizing this vision is the imperative to design for the outcomes we seek. Health equity, therefore, cuts across four strategic components: whole health, exceptional experiences, care provider enablement, and digital platforms.

Importantly, equity is distinct from equality. Equality, as a process, is a one-size-fits-all approach in which everyone receives the same resources with the hope that they will each achieve the same optimal outcome. In contrast, equity is a personalized approach, recognizing that needs vary based on demographic and health-related attributes.

Equality

One-size-fits-all approach

Equity

Personalized approach

Advancing health equity requires removing barriers from an upstream, midstream, and downstream perspective — and being intentional at each stage:

Upstream

Improving laws and policies to address social and institutional inequalities, including addressing poverty, racism, discrimination, classism, ableism, and sexism

Midstream

Addressing social needs and living conditions, such as housing and transportation, violence, good jobs and education, exposure to toxins, income inequality, digital divide, and food insecurity

Downstream

Addressing health outcomes, such as poor nutrition, chronic and communicable diseases, toxic stress, infant mortality, mental health, life expectancy and substance use disorder

Health Equity by Design Podcast

Listen to Darrell Gray, II, MD, inaugural Chief Health Equity Officer for Elevance Health, talk more about how we can advance health equity together on the Reach Out and Read podcast.

Listen to Podcast

While we have comprehensive, long-term goals to advance health equity, in the near term, we have prioritized five areas to drive more immediate progress:

Health-Equity-by-Design Framework of consumer data, culture of health equity, access and affordability, care provider enhancements, and health outcome improvement.

Identify and scale best practices for health outcome improvement.

Enhance care provider capacity, incentives, and accountability to deliver on advancing health equity.

Expand and standardize the collection, analysis, and reporting of consumer data (preferences, demographics, and attributes).

Cultivate and sustain an enterprise culture of health equity.

Innovate to drive improved access and affordability.

Delivering on each of these commitments further accelerates our progress in addressing crises across our consumer population and nation, including, but not limited to, disparities in:

Maternal and infant health.
Behavioral health.
Chronic conditions.
Unmet social needs.
Access to evidence-based treatments.

We have identified these disparities as some of the most crucial to address because of their enormous impact on the people and communities where we live and work. For example, each year about 700 people in the U.S. die during pregnancy, with another 50,000 people experiencing severe complications during pregnancy.¹ Black people are three times more likely to die than white people from a pregnancy-related cause,¹ and more than 90% of pregnancy-related deaths among Indigenous people were preventable.²

Because of their dedication to advancing health equity, 21 of our affiliated Medicaid plans were the first in the nation to earn a full three-year accreditation for health equity from the National Committee for Quality Assurance (NCQA).³

This accreditation confirms our commitment to addressing the whole-health needs of entire communities of people who have been historically marginalized, economically and socially.

Badge of accreditation for health equity from the National Committee for Quality Assurance (NCQA)

To make a difference in maternal health and address the other disparities we know exist in our communities, we will continue to partner with care providers — as well as those outside of the industry — enabling them to better deliver on advancing health equity and whole health. We're focused on enhancing care provider capacity, incentives, and accountability by:

Embedding health equity in network measures.
Integrating health equity measures in value-based programs and reporting.
Enhancing transparency into the diversity of competencies, skills, and demographic background of care providers within our network.
Optimizing education and training, including continuing medical education (CME) that covers:
- Health equity.
- Cultural humility.
- Implicit bias.

Using maternal health as an example, we are pursuing a suite of programs, all with the aim of improving outcomes for pregnant people and babies.

Empowering Care Providers

Care providers, whether they are in our networks or not, can also leverage our mydiversepatients.com site to access courses that offer CME credits. The site is a collaboration with Training Systems Design, LLC, to expand the way we think about healthcare and help close care gaps due to inequities.

To learn the latest on what Elevance Health is doing in partnership with care providers to advance health equity in our communities, visit our Stories page on our website and filter by topic #HealthEquity.

Forward Together

Our health-equity-by-design approach facilitates growth and realizes our role in a more equitable health and healthcare ecosystem. This approach will only succeed, however, with a strong, collaborative partnership between us and the care providers we work with. Together, we need to look beyond the traditional race-exclusive view of health equity to optimizing health at the individual level for all — regardless of age, geography, race, ethnicity, sexual orientation, gender identity, and disability — by prioritizing efforts and investments that deliver on that outcome and elevating our consumers and communities that are socially and/or economically marginalized.

Elevance Health partners with national organizations to address health equity in communities nationwide. We strive to promote health where people live, learn, work, and play, including literacy, cancer screenings, behavioral health, recovery from substance use, and support for caregivers.

¹ Centers for Disease Control and Prevention, Working Together to Reduce Black Maternal Mortality (April 6, 2022): cdc.gov/healthequity/features/maternal-mortality/index.html. ² Pregnancy-Related Deaths Among American Indian or Alaska Native Persons: Data from Maternal Mortality Review Committees in 36 US States, 2017-2019: Trost SL, Beauregard J, Njie F, et al. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2022. cdc.gov/reproductivehealth/maternal-mortality/docs/pdf/Pregnancy-Related-Deaths-AIAN-Data-MMRCs-2017-2019-H.pdf. ³ Elevance Health press release, Twenty-one Elevance Health Medicaid Plans Receive NCQA Health Equity Accreditation (November 28, 2022).

Measuring Health Matters

Discover how we're measuring and promoting whole health