Equity Should Be a Core Corporate Competency. Here’s Where to Start.

Equity. Although the word is pervasive in the media, goals around equity can feel abstract and unattainable. That doesn’t mean companies should approach equity in incremental steps. On the contrary, companies need to go all in, guided by a clarity of purpose and technical expertise.

Everyone, no matter their industry, understands the importance of evaluating the business case underpinning programs, policies and investments. In health care, the patient’s well-being is our business. Data show differences in health outcomes in rural and urban areas, among veteran populations, among men and women, in the LGBTQ+ community and in communities of color. In short, health disparities impact every American in some way, either directly or indirectly. Indifference to the persistence of preventable disparities in health outcomes cuts against the mission of every health care entity. Put another way, there is no rational business case for inaction when it comes to health equity. This should not be a provocative position.

This is why health care organizations must reframe health equity as a core organizational competency. Promoting health equity can’t be the responsibility of a few people working in isolation in one small department. A consistent orientation towards equity should be the norm in decision-making processes across the organization.

A Disciplined Approach to Equity

Once we reframe the discussion about equity as a core competency, the work required to achieve it becomes more clear, routine and approachable. Standards for competency can be established. Progress can be tracked. Improvements can be measured.

To follow through on the business case analogy, rigorous cost/benefit analysis is key. In health care, this analysis requires the consistent practice of inquiry and investigation that is methodologically disciplined and rooted in the understanding that variations in clinical outcomes along sociodemographic lines can and must be eliminated. The costs of pursuing new strategies for closing gaps in health outcomes must be measured against the potential return on investment on the distant horizon; for example, addressing equity can ultimately drive revenue via changes to Medicare STARS ratings or risk adjustment.

In virtually every organization, the work of discovering, developing and honing their competencies in equity has only just begun. If these efforts are to succeed in the long run, they must be fueled by three universal commitments:

1) Commit to a systemic examination of equity across all departments and operational domains

My colleague Pam Diggs recently wrote about how Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has woven equity into the structural fabric of our organization . This critical step has helped every division recognize the role they play in the company’s work to reduce disparities and make health care work better for all. It’s not just a handful of individuals or a single team driving this work. We are committed to leading this transformation from the top down and inside out.?

Work within and across departments must be guided by clearly established equity goals and achievable benchmarks. Of course, when a company looks at its work through the equity lens, it won’t make sense for every division to adhere to the same analytical procedures. For example, Blue Cross NC’s communications efforts touch on member health largely in indirect ways. Nevertheless, the teams that lead these efforts have formally identified how non-inclusive communications practices can undermine the member experience. Anytime this happens, health care becomes less accessible and less effective, especially for members in historically marginalized communities. Non-clinical teams that engage with our members have taken concrete steps to address these challenges head on. This includes creating an enterprise-wide style guide outlining how to make written and visual content more inclusive; requiring every member of the marketing team to take training to help them build marketing strategies that reach every community; and investing in educational programs and recruitment tools designed to increase the diversity of insurance sales force . These and other efforts are about much more than attracting and retaining members; they’re also designed to help all our members find and utilize the health care resources available to them. They are just as critical to Blue Cross NC’s equity efforts as our Health Care Services division’s commitment to building out equity-based performance measures in our own work and in the work undertaken by the vendors with whom we collaborate.

In short, eliminating disparities in health outcomes isn’t just the responsibility of a few people. Every unit must develop its own competencies in this area to drive a culture in which equity-based goals are an expectation.

2) Commit to consistent analytic approaches

Any typical business case must outline the criteria for measuring progress and evaluating success. Health disparities are notoriously difficult to quantify with precision, which makes it even more critical for health care entities to engrain a methodology for establishing baseline measurements and charting incremental progress.

Formalizing standards for data governance and use should be integral to this commitment. This is a significant challenge, given how there is no agreed-upon standard for gathering data on the primary variables our industry uses to evaluate health disparities. Establishing these standards should remain a key priority for the industry as a whole. In the meantime, health care entities, local governments and community partners will need to work carefully together to iron out protocols that maintain both the integrity of the data and privacy of the patient.

Health Affairs recently published a rubric consisting of four health equity performance measures that could be a useful starting point for those organizations just beginning to brainstorm how they can best assess progress toward the ultimate goal of closing the gaps in health outcomes.

Within organizations, formalizing agreed-upon analytic approaches and engaging in consistent dialogue around their strengths and weaknesses is critical to driving a high-quality approach to understanding both baseline inequities and the impact that initiatives have on their resolution.

3) Commit to engaging with impacted populations

Data insights need to be pressure tested. A rigorous evaluation process that measures impact and calculates cost/benefit should be completed before any equity measures are scaled up. This can’t happen without thoughtful, sustained engagement with the communities whose health has been adversely impacted by hundreds of years of systematic discrimination, exclusion and disenfranchisement.

Blue Cross NC’s expanded commitment to helping communities address drivers of health need exemplifies the various ways community engagement is indispensable to the processes of identifying, testing and evaluating interventions that will reduce disparities in health outcomes. We recognize that helping our members get better access to non-clinical resources that promote well-being (e.g., food, healthy housing, companionship, education and transportation) is vital to our efforts to promote health equity. But we can’t do this work without collaborating with community organizations and convening with local leaders to pinpoint local areas of need and opportunity.

In addition to the philanthropic efforts led by our Community and Diversity Engagement team and the Blue Cross and Blue Shield of North Carolina Foundation , we established our Drivers of Health Strategy team as an incubator to design, implement and test model interventions for their viability as programs to scale up across our enterprise. Importantly, the team includes the quality of engagement with participants as a metric for evaluation. The team measures the health impacts of each model and also gathers data on which methods of communication are most effective, how participants respond to the programs and how their experiences shape their perception of Blue Cross NC.?

In our efforts to decrease the disparities in severe maternal morbidity in North Carolina, we began using focus groups to engage Black birthing people across the state and to shape strategy around their lived experiences. The efforts have been overseen by a group of Black birthing people within the organization, who assess and advise the work.

Whenever a company invests the time and energy lifting a program or initiative off the ground, changing course can be a challenge. Acknowledging a program’s failure and devising new strategies demands even more investments of time and energy, but it’s essential to any business case. That’s why a willingness to abandon programs or approaches that increase inequity is an all-important competency in our industry.

Transformation Begins with Commitment

Each of the elements listed above starts with a single word: commit. Commitment is the most important driving force in any transformational effort. Commitment is what leads an organization to building competency and engraining behavior across all teams. Commitment must be followed by truly engaged listening – to communities, to data, to employees. Guided by the ideal of an equitable future in mind, our action becomes an embodiment of our best selves – intelligent, insightful and committed to equity in all our work.

This future is possible for all organizations.