The last two years have seen enormous challenges for Michiganders. However, the health crisis facing underserved members of our community reached a critical point well before the pandemic. Black Michiganders are more likely to have hypertension or diabetes than whites, and have a lower overall life expectancy. These disparities were exacerbated by the COVID-19 pandemic, where, similar to other states, people of color have been more likely to be infected by or die from COVID-19.
These disparities have nothing to do with race, but rather racism, and the unjust policies and structures that prevent many people from achieving optimal health. Factors like unequal access to quality education, housing and high paying jobs contribute to the health inequities that plague Michigan and the entire country.
The Affordable Care Act’s Medicaid expansion was a great step forward in mitigating health inequities. Michigan expanded Medicaid coverage in 2014 for households with incomes up to 133% of the federal poverty level. That expansion increased total Medicaid/CHIP enrollment in Michigan by 43% and generally resulted in improved physical, mental and financial well-being for Medicaid beneficiaries. Michigan’s Medicaid program has been a leader in addressing social determinants of health through commitments to evidence-based services like community health workers.
We’ve made great progress but much more is needed. A commitment by all in health care — such as health plans, plan sponsors, government, providers and hospitals—is critical to creating an equitable health care system that works for everyone.
Data can drive equity
The Whitmer administration has been a leader in advancing health equity throughout the pandemic. Its work enabled Michigan to be one of the first states to identify and release data on racial and ethnic disparities in COVID-19 cases and deaths, and many other states followed. National data has identified stark disparities, with Black Americans 1.7 times more likely than whites to die of COVID-19. In Michigan, identification of these disparities led to swift action. Governor Whitmer declared racism a public health crisis and followed up by launching the Michigan Coronavirus Task Force on Racial Disparities that has continued to inform the administration’s pandemic policies and actions.
The Biden administration’s COVID-19 Health Equity Task Force has highlighted the importance of collection and prompt reporting of disparity data. Without such information, the ability to understand and address health outcomes across diverse communities is limited. Health equity is one of the five pillars of the quintuple aim, a national framework for how we should improve health care quality. Any health care leader who is serious about quality must include equity as part of that commitment. The collection, sharing and reporting of disparity data is an imperative as we work to assess and improve the quality of the health care services we provide.
Enforcing an equity standard
Aetna Better Health of Michigan is fully committed to quality and equity and is proud to work with the National Committee for Quality Assurance (NCQA) to develop the Health Equity Accreditation Plus program. The initiative sets a robust health equity standard to identify gaps in care and health outcomes and identify ways to close them. We were selected as one of nine health organizations to pilot the program. We’ll collect and analyze both community and individual data to promote thoughtful partnerships, support community referrals, measure impact and close gaps in care.
Equitable health care is local, and it must reflect the many unique challenges facing each community. Partnering with trusted local voices empowers us to provide the right care to our members and improve trust in the health care system. Each day, our team works to expand our network of community partners to better meet members where they are. A few of these excellent local agents of change include Neighborhood Service Organization, Matrix Human Services, Focus: HOPE, Housing Resources Incorporated and Great Start Collaborative.
Collaborating with community partners to improve health equity is essential for all health care leaders. Community organizations are critical to helping overcome barriers to fulfilling basic needs like housing and food, and build trust and engagement with the health care system.
Too many people have died from COVID-19 in Michigan and across the country, and we must continue to act with urgency to address the inequities that the pandemic has laid bare. The entire health care ecosystem must come together to improve the health of our communities, and the work must be firmly rooted in data and local partnerships. The color of someone’s skin or the zip code in which they live should not determine whether they will die during a pandemic or from any health condition. The pandemic will eventually end, but the importance of a data-informed, community driven, equitable health care ecosystem is a lesson we must not forget.
Joneigh S. Khaldun is vice president and chief health equity office for CVS Health. Beverly Allen, Chief Executive Officer, Aetna Better Health of Michigan
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