Medicaid managed care organizations face increasing challenges in addressing health disparities as cultural and political shifts shape the national conversation on diversity, equity and inclusion.
In a recent panel, leaders from University of Pittsburgh Medical Center (UPMC) Health Plan discussed how to move health equity from a set of initiatives to an organizational identity, sharing insights from programs that have improved outcomes in areas like workforce development and maternal health care.
The presentation was led by Crystal Clark, chief medical officer for Community HealthChoices at UPMC Health Plan, and Janine Jelks-Seale, director of health equity for UPMC Health Plan.
“We spend a lot of time trying to focus on patient member experience and diversity, excellence and the development of leaders in our company,” Jelks-Seale said. “We have been trying to advance the diversity, equity and inclusion agenda for quite some time.”
The presentation highlighted the disparities that people of color and underserved populations face in the health care system. Clark highlighted one specific example: two young men, same age, same kidney impairment.
The only difference? One is Black, and one is white.
Doctors performed a test to determine kidney function to see if they were eligible to be placed on the transplant list. The white young man made it to the list, while the Black young man did not. This is because of a dated race correction used when measuring kidney function that would make it appear that the Black man had more function, deeming him not eligible for the waitlist.
It is these practices that Clark and Jelks-Seale said need to change.
“There was no individual trying to keep Black people off the transplant list,” Clark said. “This was a baked-in system of inequity that prevented people who truly qualified from not being put on the list.”
There are many other tests that still use these race corrections, Clark said. Cardiology, cardiac surgery, nephrology, obstetrics, urology, oncology and pulmonology all use them.
Clark and Jelks-Seale use their model at UPMC Health Plans as an example of possible steps Medicaid programs can take to increase healthy equity, starting with patient safety culture and what health equity really means.
“People’s overall health is not just due to their individual decisions but their interpersonal relationships, institutional relationships, community relationships and systemic relationships that all have an impact on the overall health of that person,” Clark said.
Clark and Jelks-Seale partner with community-based organizations to close those gaps in care and to rework the framing of health equity to abolish the old and start new. Their three areas of focus are workforce development, housing and maternal health.
Their efforts have utilized these three areas to partner with community organizations to better determine what their patients need. By shifting health equity from isolated programs to a defining organizational value, Medicaid companies can create lasting change.
As UPMC Health Plan leaders demonstrated, the key lies in clear messaging, innovative programs and a commitment to making health equity a central part of their mission, ensuring that progress is not only made but sustained.
“Partnerships with community-based organizations who prioritize health equity is another example of a measure that (Medicaid companies) could commit to so that we can show we are impacting all the levels and work that needs to be done to transition from piecemeal initiatives to more of a systemic overall approach to inequity,” Clark said.
While several Indiana Medicaid companies have hired leadership in health equity roles, there have not been significant steps to partner with community-based organizations to fill the gaps in the care Hoosiers need.
Indiana FSSA’s new waivers and PathWays for Aging program – Indianapolis Recorder
Contact Health & Environmental Reporter Hanna Rauworth at 317-762-7854 or follow her on Instagram at @hanna.rauworth.
