Improving Healthcare for Low-Income Americans Through Better Managed Care

I handled healthcare policy for the late Congressman John Lewis, and today work for the Black Women’s Health Imperative. If you work in healthcare policy today, you know that health equity – or ensuring that disadvantaged populations get customized approaches to care and better medical outcomes – is a top priority.

Minimizing inequities

Health equity is an issue that should also resonate with lawmakers on Capitol Hill seeking to rein in healthcare expenditures. According to a recent study, if inequities remain unaddressed, healthcare spending for the average American could rise from $1,000 annually today to $3,000 by 2040, with historically underserved communities disproportionately affected.

I applaud the Biden administration for its leadership on equity issues. A January 20, 2021 Executive Order on Advancing Racial Equity and Support for Underserved Communities Through the Federal Government, stated that “Entrenched disparities in our laws and public policies, and in our private and public institutions, have often denied that equal opportunity to individuals and communities.”

One example of the Administration’s response to this Executive Order, is that in March of this year, the National Institutes of Health (NIH) announced it was “Creating New Research on Health Disparities, Minority Health, and Health Equity.” Included were actions to better track federal government funding for health equity issues, identifying gaps in scientific funding for these critical matters, recognizing roadblocks for health equity funding, and looking across NIH to find collaborative opportunities to drive scientific advances on these problems.

Healthcare and equity

The healthcare industry also has a role to play to confront health equity challenges. Drug companies, insurers, hospitals, doctors and others must also dedicate resources to implementing innovative methods to tackle health equity and close the health gap between rich and poor.

For example, the New England Journal of Medicine (NEJM) recently published findings from a study conducted by the private insurer Humana regarding a new tool that can help identify who is, and who is not, getting comprehensive, equitable health care. The tool identified individual health behaviors (like visits to a primary care physician, vaccinations, cancer screenings, and medication adherence), created a health equity score based on the number of behaviors patients were engaged in, and compared those scores across racial and ethnic subgroups. Given the amount of data we have on patient outcomes, perhaps new tools like this one will help address disparities in care and improve the medical treatment for people who often slip through the cracks.

In looking at the data, I was reminded that health disparities in Medicare are often driven by economic status, as dual-eligibles (i.e., those eligible for both Medicare and Medicaid) were often found to engage in fewer of the individual health behaviors. Yet, those beneficiaries on Medicare Advantage plans – private Medicare plans that offer comprehensive, integrated services – scored on the whole better than those with traditional Medicare plans. This may speak to the health equity advantages of a managed care approach to health care.

Groups like mine, which advocate on behalf of Black patients, partner with other organizations that focus on poverty issues to find ways to achieve wellness for our lower income communities with fragmented access to care. Expanding the coalition of stakeholders, and the tools we have, will help us fight to improve health equity and make progress.

Ultimately, getting better healthcare to disadvantaged populations and communities of color means, from a humanitarian standpoint, that people are healthier. From a policy perspective, preventive care reduces the burden on taxpayers by diminishing the need for long term and costly medical treatments. I look forward to tracking the progress of this new tool and seeing if it can help increase health equity in the U.S.