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As the COVID-19 pandemic has highlighted, at the core of racial equity and social justice movements are health disparities along racial and ethnic lines. Health inequities can be addressed in the workplace through access to culturally sensitive programs and equitable health benefits for all employees and their families. For employers to provide optimal benefits, for insurers to offer them, and for health care systems to provide equitable quality care, stakeholders must acknowledge that participation in well-being programs and health benefits utilization vary by race and ethnicity, among other factors. Ultimately, for organizations to identify and eliminate gaps in their programs, ensure equitable quality care, and address health disparities, the collection of employee health data by race and ethnicity must be improved.
We propose that race and ethnicity should be included as an essential field in employee and population health data collection. A commitment to racial equity and social justice includes transparently collecting and reporting demographic data, identifying disparities, understanding population needs, and tailoring interventions to close gaps in care. Organizations should expand the use of race and ethnicity data beyond just reporting diversity and equity within their business to better evaluate the effectiveness of their health benefit offerings. Structured analysis of this data must be done to systematically identify and address health and health care disparities unique to racial and ethnic minority populations.
Identifying, understanding, and monitoring progress in achieving racial and health equity is made possible only with the use of race and ethnicity data. Race, as defined by researcher Camara Jones, MD, MPH, PhD, is a social classification based on how one looks that also governs the distribution of risks and opportunities in a race-conscious society. As a socially constructed classification, an individual’s race is associated with their level of exposure to racism. It is racism (not race) that results in higher risks of disease conditions, with resulting disparities in health for certain racial groups. For example, ongoing racism and discrimination experienced by Black women has been suggested as one driver of racial disparities in maternal mortality and infant health. Race is a predictor of exposure to health risks posed by social, environmental, and institutional factors, including the health risk of racism itself. While ethnicity reflects cultural origin and identification and race labels are constructed by society and the associated structural constraints, stereotyping, bias, and discrimination, happen along both racial and ethnic lines, all of which impact health outcomes. Yet, historically, race and ethnicity have not been a component of subgroup population health analyses, particularly for private, commercially insured populations, which represent the majority of insured individuals in the US.
Challenges To Race And Ethnicity Data Collection
Employers, health plans, and health care entities often cite challenges to collecting, tracking, and reporting race and ethnicity data in their well-being initiatives or health benefit programs. These challenges include the need to justify or provide evidence for a business case and positive return on investment to gain leadership support, concerns about bad publicity and inaccurate perceptions about the structure of their businesses, and misunderstood legal restrictions on health plans to collect race data. Additionally, some may cite administrative cost concerns, lack of a compelling rationale, or lack of evidence for practical strategies for reducing disparities. Others share sociopolitical concerns about rising immigration rates, inter-racial marriages, emerging variations in individual self-identification and the complex ways in which employees may identify themselves, for data collection, categorization, and measuring. We provide arguments in response to these noted challenges and concerns and suggest potential solutions.
Accept Administrative Complexity And Costs Of Collecting Race And Ethnic Data
Organizations that track employee health, address health inequities, and invest in their communities can expect to reap cost benefits and savings in the form of reduced health care costs, greater productivity, increased employee retention, enhanced morale, and reduced absenteeism. For some employers, the costs of collecting, measuring, and tracking race and ethnicity data to address racial equity may require organizational culture changes, data-sharing policy implementation, investments in improved technology or analytics platforms, and possible infrastructure changes. It is important to accept these upfront costs and administrative complexities involved with implementing of these changes because they may be financially beneficial in the long run. Health disparities are costly to society, and organizations acknowledge the importance of employee health to their bottom line.
Build An Internal Culture Of Health
Organizations can begin to address findings about employee race and ethnicity data by changing internal culture. Adopting an organizational culture of health focused on equity creates an opportunity to confront and address unmet employee needs. Elements of a culture of health include prioritizing employee well-being by ensuring adequate resources, for culturally sensitive health benefits programs. For example, these initiatives could include launching culturally and linguistically appropriate health and wellness programs at the worksite with trained staff or dissemination of culturally and linguistically appropriate health education materials that raise awareness about health issues that disproportionately affect racial and ethnic minorities.
In addition to health programs, promoting open communication builds employees’ trust and enthusiasm in their participation. Employers who make it easier for their employees’ voices to be heard and make a fair and concerted effort to understand their issues demonstrate that they value and care about the well-being of their employees. One way to confront any unmet needs or sensitive issues that may arise in the analysis and measurement of race data is to develop strategic diverse teams to help guide and formulate plans to address the issues and inform optimal approaches. Engaging employees and experts from racial and ethnic minority groups when reviewing identified issues or population-specific findings is a vital step in developing collaborative solutions. Diverse teams not only drive better decision making, but they also reflect a supportive workplace culture that values diverse perspectives, invests in transparent, open communication, and can lead to better business outcomes.
Center Race And Ethnicity Data In Analysis
Health care costs for large employers were projected to rise by a median of 6 percent in 2020, and an estimated 40 percent of employers planned to use cost-management tactics to reduce the projected plan cost increases. Even though overall spending and health care services use dropped in ambulatory care settings during the pandemic, there is uncertainty around projected costs in 2021 for treating patients with COVID-19, fulfilling delayed health care appointments and flattening the post-COVID-19 curves of mental illness, chronic diseases, health disparities, and infection rates. Therefore, organizations should be incentivized to offer health care plans that deliver the best value and provide equitable access to care for their diverse workforce. However, at present, health care and wellness analytics are largely related to identifying high-risk groups, reducing costs, or understanding disease progression, not closing racial and ethnic equity gaps. Age segmentation of the data is commonly used to better understand subpopulation concerns, but notably, race and ethnicity categorizations are rarely used.
In addition, there is robust evidence for racial disparities in health care and health outcomes that persists even when socioeconomic factors are controlled. This means that it is not enough to track, measure, and control for socioeconomic factors or geography alone in these data analysis. Studies show that early life or childhood psychosocial and economic adversity impacts health; however, this adversity is amplified in racial and ethnic minority populations and is an important contributor to racial disparities in adult health. These findings further support the need to focus attention on equitable family benefits. Since most employers cover eligible dependent adults and their children, addressing racial equity and health disparities through collection of health data and equitable selection of benefits is also investing in the health of the future population.
Strategies For Reducing Health Disparities Within The Workforce
The Centers for Disease Control and Prevention has published evidence-based strategies that employers and health plans can adopt to address racial equity and health disparities. Implementing culturally sensitive programs are not only beneficial for building an internal culture of health in the workplace but also can directly address shortcomings within health care services that result in compromised care for racial and ethnic minority populations. Companies can use race and ethnicity data to provide tailored preventive care (for example, flu shots, stress reduction workshops), early detection and screening programs, and behavioral interventions such as nutrition classes and smoking cessation.
Equity-oriented health benefits should address health needs outside of the physical workspace. For example, identifying race- or ethnicity-related differences in health care use patterns among employees, such as emergency department use for low-acuity care, can highlight opportunities to improve access to other lower-cost ambulatory care settings to address use concerns. Meeting with focus groups of racial and ethnic minority populations to identify unmet needs would ensure these interventions in and out of the workplace address racial and ethnic health disparities.
Employers can also assess the cultural competence of a health plan by reviewing their Health Plan Employers Data and Information Set (HEDIS) scores and the Consumer Assessment of Health Plan Survey (CAHPS). The HEDIS score provides an assessment of the quality of health plans and includes measures of culturally competent and translation services. The CAHPS also includes indicators to judge consumer satisfaction and experience with the health care system. Both surveys can provide a basis for comparison for plans that serve a sizeable diverse racial and ethnic minority population and used to guide selection of health plans that strive to address health equity. The Henry J. Kaiser Family Foundation 2020 Employer Health Benefits Survey also provides analysis of employers and health plans’ quality of services in their provider networks.
Finally, collaborating with other community organizations and health care providers to address social determinants and coordinate patient and family-centered care options for employees may also contribute to the delivery of more equitable care. This collaboration could include working in coalitions that may include the local public health department, social services, commerce and community stakeholders to leverage resources, and to share, measure, and track data collectively. This makes for a more compelling business case as it has been shown that companies could maximize their health benefits and productivity by integrating employee, community, environmental, and consumer health efforts into a single impactful strategy.
The Time Is Now
It is time to ensure equitable access to culturally sensitive health benefits and recognize that improved health and well-being is associated with enhanced business performance. The historical approach to claims-based analyses has treated commercially insured populations as homogeneous. A more systematic approach to analysis, including identifying and tracking race and ethnicity, can help to identify unmet needs and barriers to health and work engagement, and define cultural mismatches contributing to health disparities among groups with the same coverage options. The time has arrived to comprehensively incorporate race and ethnicity data into workforce health and well-being analytics. Failure to do so reflects complacency. If we are collectively committed to addressing the issue of racial health inequities, inclusion or race and ethnicity data is a critical—and necessary—next step.
Authors’ Note
Bruce Sherman is a medical adviser with the National Alliance for Healthcare Purchaser Coalitions, a coalition of large employers and payers that spend billions annually on health care and are seeking to leverage and accelerate needed change to promote racial equity in health care and among their member coalitions. Irene Dankwa-Mullan, Hema Karunakaram, Leah Kamin, Tiffani Bright, and Kyu Rhee work for IBM and IBM Watson Health, a large employer company that purchases health care plans for their employees.
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