Public Policy and Research Page
EMPLOYERS, HEALTH PROVIDERS MEET TO ASSESS AND ADDRESS THEIR HEALTH DISPARITIES SCORECARD
Businesses need to address disparities in healthcare, not just as a social issue, but as an economic issue, Patrick Geraghty, senior vice president, service, Horizon Blue Cross Blue Shield of New Jersey, told participants at the American Conference on Diversity's Healthcare Diversity Scorecard program, funded by Harrah's Entertainment. Geraghty, who also is immediate past chairman of the American Conference on Diversity, emphasized that differences in healthcare provisioning and outcomes impact employees' health as well as employers' direct and indirect costs, including productivity.
Some 100 representatives from 68 companies and organizations participated in the program, sponsored by the American Conference on Diversity, one of New Jersey's leading human relations organizations. The Impact of Racial and Ethnic Health Disparities on New Jersey Business is one of many initiatives the organization has undertaken to address racial and ethnic health disparities, an issue that is gaining wide attention because of its social and economic impacts, especially as a third of the three million people employed in New Jersey are members of under-represented groups. The organization also has been leading cultural competency training to help systems provide consistent care to all patients, whatever their ethnic background or country of origin, and to meet their social, cultural and linguistic needs. In 2005, New Jersey became the first state to require cultural competency training as a part of physician licensure.
"Research studies have confirmed that racial and ethnic minorities experience a lower quality of health service and are less likely to receive even routine medical procedures than are White Americans," stated Diane Schwartz, American Conference on Diversity president and CEO. "Such a disparity in healthcare can impact businesses' bottom line in many ways."
For example, she reported: - The Full Costs of employee absence are more than four times total medical payments; - Absence-related costs alone amount to 76 percent of net income when considering lost productivity from absence and wage replacement benefits; - Though incidental absence may be difficult to manage as it occurs, employers that identify it as a problem can shift resources to prevention, wellness and disease management to curb the incidence of incidental absence; and - Investment in reducing absence that produces a return on investment (ROI) of 2:1 in wage replacement cost savings alone represents an ROI of 16:1 when the Full Cost implications of reducing absence are considered.
Health disparities are defined by the National Institutes of Health (NIH) as "differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States." Even though employees may receive the same health benefits, their care and outcomes often differ. The "scorecard" concept is being used by the American Conference on Diversity to translate the mission of improved health care for all employees into measurable goals.
As examples of healthcare disparities: - African American mortality rates for heart disease are 50 percent higher than for whites; - African Americans are two times more likely to have diabetes than whites; - Latinos and African American with health insurance are less likely than whites to undergo cardiac catheterization, angioplasty, and bypass surgery, even though they have the same health insurance coverage and disease severity; - All women of racial and ethnic minority groups over the age of 40 are less likely than white women the same age to get a mammography.
These disparities are due in part to and can be exacerbated by unconscious bias and stereotyping, socio-economic issues, education (especially on health issues), income, unemployment, discrimination, lifestyle and behavior, genetic risks, environmental exposure, and accessibility to and quality of health care.
"Disparities in healthcare are unfair, unjust and preventable," stated Diane Brown, PhD, executive director of the Institute for the Elimination of Health Disparities at the University of Medicine and Dentistry of New Jersey (UMDNJ), emphasizing this is not an issue that needs to be addressed only by large corporations. "Every company can review what occurs when an employee of color seeks health care to make sure they're receiving the same care as the Caucasian employees." Employers can help make sure employees of color don't have difficulties getting referrals, have convenient access to quality care, can fill out needed paperwork, and can read and understand pharmaceutical and physician instructions. Further, employers can provide or monitor patient follow-up, to make sure employees are taking prescribed medications or following doctor's orders regarding diet or exercise.
Fred Jacobs, MD, JD, commissioner of the New Jersey Department of Health & Senior Services, stated that addressing minority and multicultural health issues is "a top priority" for him and is "the cornerstone of the department's mission." "When a company invests in a healthier and safer workplace and workforce by addressing diversity issues it sends a message to employees that you value their health and safety," Dr. Jacobs said. "Ultimately this sensitivity leads to a reduction in healthcare costs and lost days, thereby increasing productivity."
According to a study by the Institutes of Medicine, those of racial or ethnic minorities generally receive a lower quality of healthcare than their white counterparts even when their income is the same because of where they live and a lack of convenient access to health services and lack of health education, Dr. Jacobs pointed out. And because they are less likely to receive early diagnosis and treatment, their outcomes are worse. "Ongoing and comprehensive medical attention to such chronic medical conditions as heart disease, hypertension, asthma, diabetes and obesity can help cut the high costs associated with crisis management and trips to emergency rooms."
The speakers urged all businesses to develop specific programs to meet the health care needs of their particular employee populations in their respective "spheres of influence": their employees, the communities in which the employees live and from which companies recruit, and the larger community, the state. These programs, including those for specific employee populations, can include providing healthy foods in their employee cafeterias, exercise rooms, bilingual healthcare programs and health education brochures, and on-site health centers that provide wellness and preventive healthcare programs and medical tests.
"Businesses cannot afford to do nothing about health disparities," Geraghty said. "If each business reaches to and beyond its sphere of influence, that will do a lot to combat this costly social injustice."
Harrah's Entertainment, the state's third largest employer, with over 15,000 employees in Atlantic City, not only embraces diversity, with over 65 percent of its employees people of color, but provides a workplace that supports diversity. Patricia Johnson, manager, EEO Diversity, pointed out the company's health and wellness program emphasizes preventive care and early intervention, including education on proper nutrition, and offers a professionally-staffed fitness center and on-site health services and screening.
"Our goal is to provide a quality health system that addresses employee behaviors and provides them with activities that promote good health, while balancing the provision of these services against cost," Johnson said. With three large facilities in New Jersey, each with an on-site medical clinic, Merrill Lynch prides itself on providing inclusive wellness programs that focus on prevention and health education, including programs that meet the needs of specific populations. According to Jeanette Fuente, vice president, corporate wellness, these programs keep employees healthier and more productive; reduce health care costs by reducing illness through prevention; contribute to employee morale; and save employees time from having to go off-site for services.
With some 900,000 people in Verizon's health care community, Audrietta Izlar, benefits manager, corporate benefits, said the company must focus on health care costs, but also is committed to eliminating ethnic and racial health disparities. She cited key Institute of Medicine recommendations employers can use to eliminate disparities: increased awareness of racial and ethnic disparities in healthcare; collect and report data and health care access and utilization by patients' race, ethnicity, socio-economic status and primary language; and implementing patient education programs to increase patients' knowledge of how to best access care and participate in treatment decisions.
As a technology-based company, Verizon uses on-line programs, including one offered by WebMD, to help employees make wise, individual health care decisions, to provide education, and to keep employees' personal health records in a single location.
Measuring results naturally is important to companies in terms of ROI. "If you don't measure it, you can't manage it," emphasized K. Andrew Crighton, MD, chief medical officer, Prudential Financial. Brent Pawlecki, MD, corporate medical director at PitneyBowes, with 1,200 employees in New Jersey, concurred that results need to be measured and added that benchmarking what other companies are doing to address health disparities in the workplace can be valuable. PitneyBowes, for example, espouses a "Culture of Health" that "spends a lot" on providing and eliminating barriers to getting good care services for all its employees, but also measures results to ensure the company and its employees are getting "good value" for the dollars invested. One of the company's key strategies is to actively involve employees in making their own health care decisions through a combination of education and partial financial responsibility.
DiversityInc measures the success of companies in all areas of diversity. Most important to addressing diversity is leadership from the very top, stated Barbara Frankel, DiversityInc senior vice president and executive editor. Noting that its Top 50 companies for diversity outperform their competitors in shareholder return, Frankel suggested, "If a CEO 'doesn't get' the importance of diversity, you have to make a business case for it. They can see what their competitors are doing; CEOs do listen to each other."
"The health disparities and cultural competency movements have reached the 'tipping point'," concluded Robert C. Like, MD, professor and director, Center for Healthy Families and Cultural Diversity, Department of Family Medicine, UMDNJ-Robert Wood Johnson Medical School. Cultural competency, the ability of systems to provide consistent care to all patients, whatever their backgrounds and to meet their social, cultural and linguistic needs, has become a key component to addressing healthcare disparities. In 2005, New Jersey became the first state to require cultural competency training as a part of physician licensure. The American Conference on Diversity has spearheaded cultural competency training in the state.
"The business sector has an important role to play in helping to eliminate disparities in access to care, service utilization, quality, safety and health outcomes. New Jersey can become a national leader in these efforts by developing successful public/private sector partnerships and addressing important related health, health care financing and social policy issues."
The American Conference on Diversity will be spearheading subsequent meetings to focus on healthcare disparities and their impacts on the workplace. Program moderator Katherine Kish, president of Market Entry, Inc., and co-executive director of Einstein's Alley, an economic development initiative in central New Jersey, received encouragement from the attendees to hold regional healthcare diversity summits in the near future.
For further information on the topic and these programs,
contact Diane Schwartz at 732-745-9330; diane@americanconferenceondiversity.org.