Racial and Ethnic Health Disparities In the Workplace:
Achieving Equity Among the Insured
Employer Presenter Name Here
Title
Company
In Partnership with:
National Business Group on Health and
U.S. Dept. of Health and Human Services, Office of Minority Health
This material was developed by the National Business Group on Health,
which should be cited accordingly. Copyright 2011 National Business Group
on Health.
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Presenter Company Profile
•
Presenter company profile
 What we do as an organization and who works for us
 Types of health and wellness benefits that we offer to
whom
 How we communicate our benefits
 How do we partner with the health plan or data
warehouse
 Which of our initiatives focus on racial and ethnic health
disparities
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Table of Contents
I.
Background on Racial and Ethnic Health
Disparities
II.
Why Employers Should Care
III.
Presenter Company Example
IV.
What Employers Can Do: Strategies
V.
Business Group Resources
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Background on Racial and
Ethnic Health Disparities
What are Health Disparities?
•
Health disparities can be broken down into two categories:
disparities in health status and disparities in health care.1
• Disparities in health status refers to the individual
differences in disease prevalence, habits, and risk
factors between various races and ethnicities.
• Disparities in health care refers to different people’s
access to health insurance, preventive services, and
medical care or lack thereof.
1 Addressing
racial and ethnic health disparities: Getting started and things to consider in the workplace.
Employer Guide. National Business Group on Health. September 2009.
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Racial and Ethnic Disparities in
Health Status
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African Americans make up almost half of the U.S. HIV/AIDS
population and African American women are over 20 times more
likely to die from HIV/AIDS than white women.1
American Indians and Alaska Natives are six times more likely to die
from tuberculosis and over five times more likely to die from
alcoholism than whites.2
Hispanic adults are twice as likely to be diagnosed with diabetes
than white adults.3
South Asians have up to four times the risk of death related to heart
disease compared with other ethnic groups.4
1 Office
of Minority Health. African American Profile. Available at:
http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=51. Accessed on February 26, 2011.
2 Indian Health Service. Facts on Indian health disparities. Available at:
http://info.ihs.gov/Files/DisparitiesFacts-Jan2006.pdf. Accessed on February 26, 2011.
3 Office of Minority Health. Hispanic/Latino profile. Available at:
http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=54. Accessed on February 26, 2011.
4 South Asian Heart Center at Camino Hospital. Why South Asians?: the problem. Available at:
http://www.southasianheartcenter.org/why-southasians/theproblem.html. Accessed on September 21, 2010.
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Racial and Ethnic Disparities in
Health Care
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•
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1
Racial and ethnic people have more medical errors with negative clinical
consequences.1
Even among insured populations, people of color are less likely to receive
preventive health services. African Americans especially are twice as likely
to utilize emergency room service than non-Hispanic whites.1
Racial and ethnic people undergo more tests in emergency rooms due to
poor communication, and those who need medical translators often do not
have access to them.2
Hispanics are less likely to receive or use medications, especially for
asthma, cardiovascular disease, HIV/AIDS, mental illness or pain.2
Racial and ethnic people make up 51% of the transplant waiting list.3
HealthReform.gov. Health disparities: a case for closing the gap. Available at:
http://www.healthreform.gov/reports/healthdisparities/. Accessed on September 30, 2010.
2 Flores G. Language barriers to health care in the United States. New Engl J Med. 2006;355:229-231.
3 PR Newswire. Minorities account for 51% of the transplant waiting list. Available at:
http://www.prnewswire.com/news-releases/minorities-account-for-51-of-the-us-transplant-waiting-list52784102.html. Accessed on September 30, 2010.
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U.S. Cost of Health Disparities
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1
The estimated cost of racial and ethnic health disparities in direct
medical costs in the U.S. was over $229 billion dollars from 20032006.1
Over 20% of these costs were excess costs due to health disparities
for African Americans, Asians, and Hispanics.1
In 2009, disparities among African Americans, Hispanics, and nonHispanic whites cost the health care system almost $24 billion
dollars. Over $5 billion dollars of these additional costs were
incurred by private insurers.2
National data indicate that over the 10-year period from 2009-2018,
the total cost of health disparities will be approximately $337 billion
dollars, with $117 billion incurred by private insurers.2
Company
LaVeist T, Gaskin D & Richard P. (2009). The economic burden of health inequalities in the United
States. Sept. 2009.
2 Waidmann T. Estimating the cost of racial and ethnic health disparities. The Urban Institute. Sept. 2009
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Why Employers Should Care
Why Employers Should Care:
Growing Workforce Diversity
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1
Racial and ethnic people now comprise roughly one-third of the
U.S. population, and are expected to represent a 54% majority by
2050.1
Yet widespread disparities in key health indicators continue to
exist for adults and dependents among cultural, ethnic and racial
minorities due to variations in cultural health norms and provider
delivery systems.
As multi-national companies become more diverse, racial and
ethnic people are expected to comprise over 41% of the
workforce population in 2015 (up from 34% in 2008).1
Patient Protection and Affordable Care Act of 2010: Advancing Health Equity for Racially and Ethnically
Diverse Populations. Joint Center for Political and Economic Studies. July 2010.
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Why Employers Should Care:
Disparities Among the Insured
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•
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1
Employers shoulder the lion’s share of health care costs to cover
their employees and families, yet not every enrollee is able to
receive the optimal level of health care.
Health disparities associated with race and ethnicity persist even
minorities have adequate health benefits coverage, equivalent
socioeconomic status and comparable comorbidities.
A “one size fits all” approach to health and wellness programs
does not work because minorities experience stark differences in
health conditions and outcomes as well as preventive, diagnostic
and treatment services provided.
Many surveyed employers reported being generally unaware of
racial and ethnic health disparities as a business issue.1 Company
Employer Survey on Racial and Ethnic Disparities: Final Results The National Business Group on Health.
July 30, 2008.
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Presenter Company
Case Study
Presenter Company Case Study
 How did you interpret the legal environment on using racial and
ethnic data? What did your counsel tell you?
 How did you nurture a dialogue with your health care vendors
(health plans, disability, EAP, wellness providers, etc.)?
 Did you collect and analyze health disparity data for your
workforce to identify gaps in program utilization and unequal
health status?
 How did you train culturally-competent staff to deliver tailored
services to diverse workforces?
 How did you communicate disparities-related activities in your
organization to employees?
 Did you form industry partnerships in the community?
1
Disparities (cultural, ethnic and racial). A-Z compendium page. National Business Group on Health. March
2011.
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What Employers Can Do:
Strategies
Part I: The Business Case

Secure senior management buy-in and on-going support for
closing health disparities gaps

Incorporate closing health disparities as part of your corporate
health care strategy and HR diversity/inclusion strategy

Close health disparities gaps through better plan design and
employee engagement

Support research on racial and ethnic health status, treatment
and outcomes differences


Highlight the value of cultural diversity

Use the Health Disparities Cost Impact Tool developed by the
National Business Group on Health and Urban Institute to
identify, evaluate and rank the most prevalent and costliest—yet
manageable—health conditions by ethnicity, age and job
category
Investigate your health disparities impact on productivity
measures
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Part II: Disparities Data Strategy and
Operations
 Create an action plan to collect and analyze racial and ethnic data using all of your available
resources: new employee intake forms, health appraisal or geocoding. Provide this plan to
your health partners for analysis.
 Ask health partners who touch employees to identify gaps in engagement and/or outcomes
and recommend highest-value solutions (health plans, data warehouse, EAP, wellness
advocates, disease management and PBM)
 Examine key employee factors, including race/ethnicity, primary language, gender, age, length
of service, location, disability, and job family (level 1); full-time status, income, education,
health literacy and other perceptions (level 2)
 Consider environmental factors where employees live with respect to multicultural lifestyle
demands, provider practice variations, community feedback and geographic well-being
 Integrate or cross-walk aggregated employment data with medical data for health promotion
 Review certification status of vendors for implementing disparities-directed initiatives (e.g.,
NCQA multicultural health care distinction)
 Modify HR policies to increase internal access to sensitive but aggregated
employee data (i.e., employment data with medical data for health promotion)
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Part II: Disparities Data Strategy and
Operations Continued
 In partnership with your health plan, data warehouse and other
vendors, collect utilization and outcomes data based on race
and ethnicity for:
 Disease risk profiles
 Emergency room utilization rates
 Disease management data
 Preventive care utilization
 Chronic care management and specialist referrals
 Wellness program rates
 Disability, worker’s compensation, absenteeism and other
productivity metrics
Part III: Plan Design Benefits

Hold health plan partners accountable for closing disparities gaps: develop a
strategic action plan using touch points in health/pharmacy benefits outreach,
wellness support and productivity programs

Investigate psychosocial and biological differences across ethnicities which
may increase susceptibility to certain health conditions (e.g., healthy-weight
Asians at risk for diabetes or hepatitis) or behaviors (e.g., African Americans
less likely to participate in health appraisals)

Build staff cultural competency using training tools incorporated into your
renewal contracts and performance guarantees for all health and wellness
vendors

For optimal results, manage program incentives—designed to galvanize total
employee engagement– that may inadvertently impact health differently
across ethnicities which are disproportionally more affected by health
conditions (obesity) or behavior (tobacco use)

Implement favorable benefits premiums and out-of-pocket pricing for
low-wage workers, if ethnicities highly constitute this income group
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Part IV: Employee Communications
 Design disparities-related communications on general disparities
information, how employees can help close health care gaps through
appropriate use of health services, and success stories of ethnic
workers enrolled in programs
 Affirm privacy protection statements non-punitive use of data
collection, as well as information about plan and community
partnerships
 Better understand and overcome cultural mistrust among ethnic
employees, where it exists, by partnering with community leaders
 Establish multicultural staff champions and employee resource groups
to support on-site health services
 Encourage health lifestyles for diverse spouses, domestic
partners, dependents and families
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Part V: The Legal Environment
 Work with corporate counsel to translate law into health
disparities policy
 Support aggregating employment data with medical and
productivity for health promotion
 Manage HR risks associated with using various methods of
collecting race/ethnicity data
 Confirm compliance with existing federal laws (e.g., HIPAA
privacy and security)
 Develop or revise your Notice of Privacy Practices and HIPAA
authorization forms, as necessary
 Review any applicable state laws
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The Legal Environment: Federal Laws
Federal Laws
None of these federal laws prohibits collection or integration of employees’
racial or ethnic data.
Most employers will already have documents, policies, and procedures to
comply with these federal laws.
Employers should review existing policies and plan documents to confirm
compliance with these laws.
Develop or revise Notices of Privacy Practices and HIPAA authorization
forms, if necessary.
Source: 2011 National Business Group on Health.
The Legal Environment: Federal Laws
Federal Laws
Title VII of the Civil Rights Act of 1964 (Title VII). Title VII prohibits
employment discrimination (including discrimination in health benefits) on
the basis of race, color, religion, sex, or national origin.
Health Insurance Portability and Accountability Act of 1996 (HIPAA).
HIPAA imposes a number of requirements on group health plans and
health care providers that are designed to protect “protected health
information”
Genetic Information Nondiscrimination Act of 2008 (GINA). GINA
prohibits group health plans, health insurers, and employers from
discriminating against individuals on the basis of their genetic information.
Employee Retirement Income Security Act of 1974 (ERISA). ERISA
includes a number of rules regarding the establishment and operation of
employee benefit plans, including most employer-sponsored group health
plans.
Source: 2011 National Business Group on Health.
The Legal Environment: State Laws
State Laws
A 2001 assessment of state laws pertaining to collection and reporting
of racial, ethnic, and primary language data resulted in the
conclusion that “state laws overwhelmingly do not prohibit the
collection of racial, ethnic and primary language data by health
insurers and managed care plans.”
Racial/ethnic data collected for plan purposes: Any state laws
restricting collection and integration of racial and ethnic data would
not apply to most self-insured group health plans because such
laws would be preempted under ERISA.
Source: 2011 National Business Group on Health.
Business Group Resources
Business Group Resources on Health
Disparities
The major Business Group resources can be found on our A-Z
Disparities Compendium page. Selected publications include:
• Addressing Racial and Ethnic Health Disparities:
Employer Initiatives (2009)
• Addressing Racial and Ethnic Health Disparities:
Getting Started and Things to Consider in the
Workplace (2009)
• Employer Communications on Health Disparities:
Resource Document (2009)
• Eliminating Racial and Ethnic Health Disparities: A
Business Case Update for Employers (2008)
• Employer Awards for Innovation in Reducing Health
Care Disparities
Source: 2011 National Business Group on Health
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About the National Business Group on
Health
About the National Business Group on Health
The National Business Group on Health is the only national non-profit
organization exclusively devoted to representing the perspective of large
employers and providing practical solutions to its members’ most important
health care problems. The Business Group has over 300 members, including
66 of the Fortune 100, that provide healthcare coverage for 60 million
employees, retirees and family members, including approximately 18 million
children.
About the Advisory Board on Reducing Racial and Ethnic Health
Disparities
Since September 2007, the Business Group has partnered with the Office of
Minority Health as part of the National Partnership for Action to End Health
Disparities. The board’s objective is to reduce health disparities by improving
employer awareness of causes and consequences and changing employers’
health care purchasing strategies in health insurance, wellness programs
and more. This advisory board is comprised of employers, government
Company
agencies, health plans, and academic institutions.
For more information, please contact the National Business Group on Health at
healthservices@businessgrouphealth.org or visit www.businessgrouphealth.org
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