Health Check, Fall 2023

Symposium Brings Together Stakeholders to Discuss Strategies to Advance Health Equity

At its inaugural Health Equity Symposium, the Academy brought together actuaries, health plan experts, and other thought leaders to collaborate on how to improve health equity by incorporating more equity-enhancing elements into health benefit designs.

The Nov. 15 hybrid event was a culmination of four virtual workshops held with thought leaders earlier in the year by the Academy’s Health Equity Committee. View the event recording on the Academy YouTube page.

The workshops and subsequent issue briefs—available on the Health Equity Committee webpage—explored the challenges to incorporating equity-enhancing benefit design features and how to address those challenges. The committee also released a summary issue brief reflecting the key points from this summer’s discussion groups, which were the building blocks of the symposium.

James (left) makes a point in a symposium panel

Although the workshops and issue briefs focused primarily on benefits in the employer-sponsored insurance market, the symposium also explored related issues in other markets and how lessons could be shared among the different markets. The workshops and symposium also highlighted the importance of actuaries in the benefit design decision-making process and how actuaries can be part of long-term solutions.

“Addressing equity is not just the right thing to do, not simply a moral imperative—it is an economic and business imperative,” Annette James, chairperson of the Health Equity Committee, told those attending the event in person and viewing virtually.

She stated that actuaries must contribute to such discussions given that health disparities cost $135 billion each year in excess medical costs and lost productivity, according to a 2018 Kellogg Foundation report. “We can’t sit on the sidelines; we have to get in the game,” James said.

Speakers Highlight Key Issues

Several speakers highlighted the need to build trust between communities of color, other minority groups, and those in the health and insurance industries. They said communication and education are keys to making sure that employees and plan participants understand and use their health benefits effectively.

Keynote speaker Dr. Lisa Fitzpatrick

Lisa Fitzpatrick, founder and CEO of Grapevine Health—and known as “Dr. Lisa On The Street” for her YouTube series of the same name—said rumors and inuendo in some communities take the place of facts, compromising care in the process.

“Health literacy is the driver of everything,” Fitzpatrick said, noting a lack of knowledge is often behind why people won’t go to appointments or even take their medicine. Misconceptions due to lack of literacy, she said, can be “hard to hear.”

Dr. LaShawn McIver, chief equity officer at AHIP, said there needs to be a commitment from stakeholders in both the public and private sectors to make health equity sustainable and ensure that systemic change happens.

“By doing this work, we are not just helping our friends and our neighbors, but ultimately our family and ourselves,” she said. “The more we talk about it, the more it is in our general consciousness.”

Panels during the symposium focused on such topics as successes and challenges; costs and cost-effectiveness; communicating and educating plan participants; and improved implementation.

During a discussion looking at employers’ efforts to improve health equity, panelists discussed the unique challenges they face with their particular workforces. For some, it meant educating young employees about health benefits because this was their first time receiving them. Others have workers from diverse backgrounds that had different concerns to be addressed.

(L–R) Panelists Dr. Christa-Marie Singleton and Dr. Wayne Rawlins, with attendee Craig Lisk

To meet their needs, using data is essential. Dr. Christa-Marie Singleton, chief medical officer for the U.S. Office of Personnel Management, said using residential data can help identify shortcomings. “We found one ZIP code where we had a clump of employees that had a number of providers there, but worse outcomes,” she said. “Now there is something going on there.”

On cost effectiveness, several representatives said employers and providers need to weigh improved health outcomes from new benefits instead of focusing on initial plan cost. “As actuaries, we have a responsibility to help our stakeholders see beyond that,” said C.J. Wolfe, vice president at Aon.

The key, he said, is taking a long-term view on the issue. “It is absolutely essential for employers to understand when their employees … are at risk and for what.”

But there also has to be a greater effort to explain to plan participants in simple terms how to use their benefits, and to minimize additional user costs. That means having people or navigation tools available that can answer their questions and direct them to the right contacts for care.

“Let’s reach back to our members and co-create with them to understand what kind of detailed information they need as it relates to expected cost and push that out to the member,” said Teresa Money, executive director of care delivery implementation for Blue Cross Blue Shield Association. “Oftentimes this information gets buried.”

To make real gains in health equity, however, there is a need to overcome challenges to implementing equity-enhancing design features. That comes back to having the best data possible so health challenges can be identified and addressed, participants said.

Lina Rashid, senior policy advisor for CMS Center for Consumer Information and Insurance Oversight, said there is a need to build partnerships to share data that address specific racial and ethnic communities.

“All of us have different roles to play,” she said. “We need to leverage that to build data.”

McIver lauded the work of the Academy and actuaries for advancing the dialogue on health equity since taking up the issue several years ago.

“I want to congratulate you because the conversation that we had here today is how we will transform the future of health care,” she said. “So, thank you for gathering and putting people in a room who may not typically be in a room” together.

Health Practice Council Outlines ’24 Priorities

The Health Practice Council is currently focused on a broad range of health policy issues including:

Health Equity—Actuaries are actively exploring numerous potential contributors to disparities, and ways to address them.

Public Health Challenges—Actuaries continue to provide insight on public health challenges including behavioral health issues and can provide input on integration of behavioral health with overall health; mental health parity in insurance coverage; network adequacy and access; and the economic and impact to the healthcare system.

Insurance Coverage and Benefit Design—Actuaries have specific expertise related to health insurance markets and the Affordable Care Act (ACA), including proposals to reduce uninsurance and underinsurance rates and increase the availability of affordable coverage.

Health Care Costs and Quality—Innovations to health care payment and delivery systems aim to improve health care affordability and health care outcomes.

Medicare Sustainability—Medicare faces near- and long-term financial challenges, and actuaries can help understand the implications of potential Medicare changes on trust fund solvency, program spending, beneficiaries, providers, and taxpayers.

Long-Term Services and Supports—Actuaries play a crucial role in the financing and design of long-term care (LTC) systems—from private LTC insurance to public programs that provide LTC benefits and services. Actuaries can provide insights on the implications of potential financing approaches on access and affordability and how such approaches would align with programs including Medicaid.

Financial Reporting and Solvency—Actuaries provide input to the NAIC and other organizations regarding accounting and auditing issues for health insurance and support regulatory bodies with developing and maintaining capital requirements intended to ensure the solvency of insurers and others responsible for funding and delivery of health benefits.

Professionalism—In support of the Academy’s mission to objectively serve the public, the HPC provides continuing education to actuaries through webcasts, practice notes, and other venues that offer examples of current and emerging approaches to selected actuarial tasks.

Health Public Policy News in Brief

• Senior Health Fellow Cori Uccello and Health Equity Committee (HEC) members Ugo Okpewho and Sara Teppema gave an overview of the HEC’s work on equity considerations related to provider contracting and network development to AHIP’s Health Equity Workgroup.
• Uccello and HEC member Rebecca Sheppard also gave a well-received overview of the committee’s work on equity considerations related to health plan pricing to AHIP’s Health Equity Workgroup.
• Uccello gave an overview of the HEC’s work on equity considerations related to benefit design to the Center on Budget and Policy Priorities’ Marketplace Affordability Project.
• The Long-Term Care Reform Committee submitted comments to Washington state’s Office of the State Actuary on key issues related to LTC financing and risk management, providing information on considerations necessary to achieve and maintain long-term services and supports trust solvency for the WA Cares Fund Program.
• The Medicare Committee submitted a comment letter to the Centers for Medicare & Medicaid Services (CMS) on the draft part one guidance for the Maximum Monthly Cap on Cost-Sharing Payments Program.
• The Individual and Small Group Markets Committee, Risk Sharing Subcommittee, and Active Benefits Committee submitted a comment letter to federal agencies on a notice of proposed rulemaking on short-term limited duration insurance, fixed indemnity coverage, level-funded coverage, and critical illness and specified disease coverage.