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Employer-Provided Healthcare: One Size Does Not Fit All

Offering all participants in a healthcare program equal access and opportunity to receive quality care and medical purchasing efficiency should be the goal of any organization. Experts say eliminating structural and language barriers, and respecting the cultural context of each individual employee or their family members, are the keys to success.

Thursday, August 30, 2012
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In the world of consumer decision-making, it's very common for buying patterns to be guided by ethnic and gender preferences and differences.

There is little doubt the same is true of healthcare, but in this case, that diversity can prove costly both for employers, via rising healthcare bills, and employees, who may not receive the best possible health outcomes.

Some call it "culturally competent healthcare." To others, it is described as "targeted" health.

Whatever it's called, the emerging trend is best defined as an approach that offers all participants in the healthcare process equal access and opportunity to receive quality care and medical purchasing efficiency. How? By eliminating structural/language barriers and respecting the cultural context of each individual employee or their family members.

While a quick search will find that the concept has existed for more than a decade, employers faced with rising healthcare-benefit costs across the country are turning to this strategy. In fact, eight such employers -- Aetna, American Express, Franciscan Missionaries of Our Lady Health System, H.J. Heinz, Verizon, Pitney Bowes (in partnership with UnitedHealthcare), Cigna and Wyndham Worldwide -- recently were recognized by the U.S. Department of Health and Human Services, the White House Business Council and the National Business Group on Health for their efforts in reducing healthcare disparities in the workplace.

Stamford, Conn.-based Pitney Bowes, for example, worked with UnitedHealthcare to improve the health status of the former's employees and engage the company's Spanish-preference employees. UHC brought in a dedicated team of Hispanic professionals -- Latino Health Solutions -- to improve the health and well-being of its Hispanic/Latino members.

Mary Bradley, director of healthcare planning at Pitney Bowes, explains that as the company began to develop an ethnically diverse workforce, it needed to do more to help specific employee populations get the most out of their healthcare benefits. In one case, the company acquired some new facilities where employees had a basic understanding of English, which was not enough to use their benefits appropriately.

"That was a defining moment for us, knowing we had to do something different," she says. "We started with a basic focus group that spoke both English and Spanish, and went from there."

For one, it was difficult for those employees to find Spanish-speaking providers. In many cases, their children were translating the benefits information. Also, an unexpected finding was "informal" local leadership felt pressured to provide translation for co-workers.

"People were always clustering around them, constantly asking them questions, and they were distracted from doing their own benefits decision-making," she says.

Of course, using informal trainers was not a good solution. Enter the partnership with UHC and its Latino Health Solutions group.

"LHS had initially focused on smaller markets," says Bradley, adding that Pitney Bowes, which is a $5.3 billion company with 29,000 employees worldwide, recently launched an Asian-American effort as well. "We were the first employer to integrate their services into a national self-insured program."

As far as bottom line value goes, Pitney Bowes is certain that the strategy is a win-win for both employees and the company.

"We know this is important work, because employee health is a huge driver of quality of life [for employees] and productivity [for Pitney Bowes]," says Johnna Torsone, the company's executive vice president and chief human resources officer. "It is equally important for leaders to share best practices so that more companies and people can benefit from these efforts and learnings."

Aetna, another company honored for its efforts, offers, among other tools and features, a dashboard that helps identify health conditions that are more common among ethnic and racial minority populations. This information is used to create targeted programs to improve health outcomes.

In the past 11 years, Aetna initiatives include Breast Health Ethnic Disparities Initiative, Beginning Right Maternity Program, African-American Hypertension Study, and ER Utilization in Minority Asthmatic Populations. Also, a key component of the effort has been the company-supported and employee-managed employee resource groups. ERGs have helped reduce barriers to collecting racial and ethnic data on a voluntary basis to help create more culturally focused disease management and wellness programs.  

 "We must continue to develop targeted programs that address differences in healthcare among people of different races and ethnic backgrounds," says Aetna's Dr. Wayne Rawlins, national medical director.

Another insurer, Philadelphia-based Cigna, launched its Health Disparities Council in 2008. It comprises more than 200 employee volunteers from across the company's departments who facilitate the exchange of ideas, share knowledge, and identify internal and external opportunities to address healthcare disparities in culturally sensitive and medically appropriate ways.  

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Also, a key part of Cigna's work has been improving the cultural competency and linguistic sensitivity of its staff. More than 20,000 employees have completed cultural competency training and all bilingual employees are tested for proficiency. The company has also adapted into Spanish and traditional Chinese its "Words We Use" guide for simpler communications.  

"It gets back to the concept of 'know me as an individual,' which is fundamental to our strategy," says David Cordani, Cigna's president and chief executive officer. "If we're going to be successful at helping people improve their health, we have to reach them at an appropriate time with meaningful messages that relate to their unique status."  

While the eight companies cited are leading the way, there is still much work to be done within the HR and employers. For example, a study by the Joint Center for Political and Economic Studies calculated the direct and indirect costs of racial and ethnic disparities in healthcare in the United States for the period 2003 through 2006 was $229.6 billion.

Also, a 2008 survey by the Harvard School of Public Health of 609 large public and private employers and 252 health plans showed that nearly all health plans (90 percent) and most employers (58 percent, with the percentage increasing with size of employer) cite healthcare disparities. However, only three percent of employer respondents analyzed differences in health plan performance by race and ethnicity or chose plans that addressed racial and ethnic disparities.

Jim Winkler, the chief innovation officer for health and benefits consulting at Aon Consulting, in Norwalk, Conn., says he sees this growing trend as a part of a broader strategy that requires employers to finally stop thinking that everyone is the same.

"It is about being culturally aware, age and gender aware, and understanding the different mindsets these groups have," he says. "This is finally getting more traction. Employers for a long time were all using fancy words to say 'we print [our] manuals in English and Spanish'."

Winkler adds all of the companies honored go well beyond just communicating differently or changing a phone prompt to both English and Spanish.

"It's clear that in different cultural settings people think and act differently in how they view health and using the healthcare system," he says. "This is much more frequently discussed as a topic."

The fact that this is only the second annual Healthcare Disparities award alone speaks volumes about how new it all is in terms of real action, Winkler notes.

"Today, there is movement away from recognizing just language differences to recognizing cultural differences," he says. "The makeup in the U.S. is changing and employers are focusing on the workforce globally. We know from years of banging our heads against the wall that traditional disease management programs don't work. Today we all think and act differently."

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