How to Bake Health Equity into Health Reform
The Front Lines of Health Reform, Edition I
You could almost forget that the goal of health reform is better health for American residents. The conversations around implementation of the Affordable Care Act (ACA) are, by necessity, highly technical and complicated. We talk about essential benefits packages and health insurance exchanges, which would seem to paint the ACA as an opportunity to transform health insurance, not health care and ultimately, health.
The ACA is about more than just health insurance. By changing the way health care is delivered and paid for, the ACA acts as a lever by which the Connecticut Health Foundation (CT Health) and our partners can achieve our mission to improve the health of Connecticut residents.
In increasing access to health care, the ACA promises to bring in those who have historically been left out. With our focus on health equity for people of color, the Connecticut Health Foundation (CT Health) has a heightened consciousness around the needs of those communities. Improving the health of these Connecticut residents will take more than making health insurance affordable.
How can the ACA address Health Equity in Connecticut?
First of all, the good news is that, with 62 references to health disparities, the language of the ACA has embedded within it the ingredients for advancing health equity for people of color. An opportunity this size for advancing health equity is unprecedented, and we want to see Connecticut make the most of it. To do this, we can take the following steps:
- Start with good, solid definitions of desired health outcomes. When we talk about, for example, “good oral health,” what does that actually look like? The World Health Organization defines it as it as enabling “a person to speak, eat and socialize without active disease, discomfort or embarrassment.” Reaching agreement around these outcomes will give us a clear direction to work toward.
- Make it user-friendly. If the access points of health reform – such as the Exchange, where people can buy insurance plans, or the doctor’s office itself – are culturally insensitive or too hard to navigate, underserved populations will decline to engage and remain underserved. Information needs to be provided in multiple languages and appeal to the spectrum of literacy.
- Demonstrate the value of buying health insurance. If consumers can’t understand what they are being asked to pay for, or if they don’t trust the health plan will be there for them when they need it, they’ll say “thanks, but no thanks.” The success of health reform depends on people signing up, so that when they need care, they can afford it.
- Strike the balance between quality and affordability. It’s possible to design health insurance plans that cover any kind of care imaginable. The risk, however, is that such a plan would price itself out of affordability. On the flip side, the cost of a cheaper plan is that it won’t offer enough coverage to make itself worth the expense.
- Encourage the adoption of better care models. Seeing your doctor in an exam room for ten minutes is not necessarily the best way to receive care. A study conducted by the Commonwealth Fund found that when patients of color had health insurance and received team-based care in a person-centered medical home environment, they were more likely to have improved health care outcomes.
- Pay for value, not services. Changing the way health care is paid for incentivizes providers to shift the emphasis from delivering as many services as possible to achieving the optimal health of an individual. When providers are reimbursed for making their patients well, wellness becomes important.
CT Health is focusing on these steps to make sure the ACA is meaningful for all Connecticut residents. What steps are you and your organizations taking to ensure health reform is implemented in an inclusive way? What are the pitfalls we need to avoid along the way? We’d like to hear from you.