Three strategic guideposts for health plans in the fast-paced digital age: Part 2 - Health equity

Building on the first blog in this series about data democratization, this blog delves into one of the most significant factors affecting the overall health of populations around the world: health equity. 

Just as data accessibility, technology and equitable information distribution have disrupted traditional ways of operating and the ability to gain insights in healthcare, so too can they revolutionize health equity.    

Here, we explore the factors shaping health equity as well as how new technology and data analytics and BPaaS advancements can pave the way for a more equitable system of healthcare — one where access to coverage, quality care and resources are available to every individual, regardless of their social or economic circumstances.

Health equity

The Centers for Disease Control (CDC) defines health equity as “the state in which everyone has a fair and just opportunity to attain their highest level of health.” It is an emerging quality standard for all healthcare stakeholders in the U.S. 

Health equity recognizes that some populations face systemic barriers leading to disparities in access to care, health outcomes and overall well-being. These disparities have ramifications far beyond individual health. According to a 2018 study funded by the National Institutes of Health (NIH), health disparities produce an economic burden of $451 billion in the U.S. And as the CDC’s definition of health disparities reminds us, those disparities are preventable.  
In short, addressing health disparities is the quickest route to achieving health equity. 

Vulnerable populations

Several demographic categories are more vulnerable to health disparities than others. The NIH lists racial and ethnic minority groups; people with lower socioeconomic status; underserved rural communities; sexual and gender minority groups as the main populations experiencing health disparities.

Today, 42% of the U.S. population are people of color, including Hispanic, Black, Asian, American Indian/Alaska native, Hawaiian native/other Pacific Islander, and Multiple Race groups per KFF’s distillation of data from the U.S. Census Bureau’s American Community Survey. 

Overall, social determinants of health are a primary factor contributing to disparities in health and health outcomes. 

Many stakeholders, including governments, are working hard to address health disparities, leveraging innovations in digital-to-human interfaces, intelligent technology and next-gen data analysis tools to open up healthcare access and resources. 

The important role of health plans

Because of their prominent role in healthcare services delivery, health plans are in a unique position to address disparities and improve health equity. 

Recognizing this, on April 5, 2023, the Centers for Medicare and Medicaid Services (CMS) released a final rule creating a 2027 Star Rating reward using a Health Equity Index (HEI) score for measure years 2024 and 2025. Intended to incentivize Parts C and D plans to improve care for members with social risk factors such as disability, low-income, etc., CMS will use existing measures to compare outcomes between “at risk” populations and populations without those risks.  

By calling for culturally responsive care, CMS is projecting Medicare healthcare spending will be reduced by $230 billion over four years, amplified by an additional $1 trillion reduction in indirect costs associated with the excess disease and mortality produced by disparities.  

Health equity and enrollment 

Enrollment is a logical starting point for health plans to address health equity. Simplifying enrollment processes, reducing administrative burdens and eliminating barriers to enrollment can improve coverage and access to care. Plans offering streamlined applications, minimizing documentation requirements and aiding through online platforms, call centers or in-person enrollment assistance programs, can broaden accessibility for individuals and families and foster an important first step on the healthcare journey. 

As plans make enrollment more accessible and user-friendly, they can accelerate annual processing, create a better end-to-end onboarding experience and support more individuals in navigating the process to obtain health insurance coverage. 

The digital divide is a primary barrier

The digital divide impacts the enrollment process and ultimately healthcare coverage. Studies have shown that lack of internet access, computer literacy and devices affect around one-third of U.S. workers, and is overrepresented by Blacks, Hispanics, and adults aged 65 and older (a rapidly increasing percentage of the U.S. population). As much as 30% or more of these groups do not use or have access to the Internet and/or do not own a smartphone. Digital access has been identified as a “super determinant of health.”

Health plans can help bridge the digital divide and meet individuals with digital disparities where they are. One key way to do this is with an efficient paper-to-digital interface fueled by intelligent document processing capabilities such as automated document recognition (ADR), optical character recognition (OCR), natural language processing (NLP), natural language understanding (NLU), advanced data extraction and robotic process automation (RPA). 

Technology advances like these can ensure processing efficiency as well as accuracy of paper and telephone communications without intensive manual requirements.

New technology solutions are helping

Real-world examples are the best way to show how technology advancements are making progress toward health equity. This case study details how health plan applicants, issuers and members benefit from enrollment technology innovations and how those advancements help address the digital divide.

In another example, the graphic below shows how advanced data extraction technology from Conduent helped a health plan expand and accelerate their Medicare Advantage annual enrollment, reducing manual requirements more than 40% and processing 2 million images into digitized data with 99% accuracy. 

As Jeff Hickerson noted in the first blog, business process as-a service (BPaaS) can be a catalyst helping plans quickly advance their operations. Combining business process, technology and people, BPaaS delivery drives efficiency and actionable insights. 

Those advancements help health information, coverage and data become more accessible to a wider audience, paving the way for health equity. 

Part three of this series will look at payment integrity in healthcare.

About Conduent Healthcare Payer Solutions

As a partner to the entire healthcare ecosystem, Conduent helps increase access to care, optimize the cost of care, and improve health outcomes. We work with 17 of the 20 largest health plans serving over 25 million members — driven by our HSP Payer Suite technology supporting core administration, member engagement and automated document solutions. Learn more here.

Conduent’s BPaaS Solution for Health Plan Administration, empowers health plans across every aspect of their operations — from enrollment and claims processing to member and provider services, payment integrity, care coordination and more.