Safety net health plans are using health equity committees and councils to align internal and external stakeholder priorities and to drive progress on health equity goals across their plans. The goal of health equity committees and councils (referred to in this brief as health equity groups) varies widely across plans depending on the needs and opportunities of the organization and the communities they serve. This brief explores how safety net health plans are using these advisory groups to help them reach their health equity goals, including state and federal priorities. While findings are plan-specific, the factors and considerations addressed can also inform stakeholders at other health care organizations, including state Medicaid agencies.

To better understand how safety net health plans are using health equity groups to advance their health equity efforts, the Center for Health Care Strategies (CHCS) and the Association for Community Affiliated Plans (ACAP) surveyed health plans participating in the ACAP-CHCS Health Equity Learning Collaborative. This brief shares survey findings from 12 Medicaid safety net health plans that have implemented health equity committees and councils within their organizations. It highlights factors that increase the efficacy and impact of these health equity groups and offers considerations for working to strengthen and sustain these groups.

Methods

CHCS and ACAP conducted an online survey of 15 Medicaid plans participating in the Health Equity Learning Collaborative in August and September 2023. Of 15 plans that received the survey, representatives from 12 plans responded (an 80 percent response rate).

The survey sought to identify:

1. Implementation and experiences of health equity committees and councils;
2. Relationships between the health equity committees and councils and the individuals within the organization leading health equity work;
3. Accountability and decision-making processes used by health equity committees and councils; and
4. Position and governance of committees or councils within health plan organizational structure.

Findings

Of the 12 plans that responded to the survey, 11 indicated they have one or more health equity council and/or committee. With some variation, most plans used the term “council” to refer to an internal advisory body that provided strategic guidance, while “committees” were more often responsible for operations and implementation (see Exhibit A below).

Membership in health equity groups varied. Some plans have groups comprised of health plan staff only, while others reported a mix of internal staff and external stakeholders, such as plan members, providers, and community partner organizations. For example, one plan shared: “the Community Health Equity Committee intentionally convenes a group of diverse members representing several key stakeholders within health care including health plan staff, community partners, network providers, and enrollees in the health plan.”

Several plans shared the responsibilities and reporting structure of their health equity groups, shedding light on how they operate. For example, one plan’s committee charter states “the Committee is responsible for approving and prioritizing health equity initiatives and strategies brought forth by work groups, committees and councils defined within the Health Equity Governance Structure.” Another plan describes its health equity council as being “responsible for providing direction and overseeing [their] strategy, priorities, and opportunities to help advance [their] goals as an organization, improve the health and lives of [their] members, and reduce health inequities.”

Exhibit A provides additional details on the structure of these health equity groups and differences and similarities between what plans label as “councils” and “committees.”

Exhibit A: Health Equity Councils vs. Health Equity Committees

Health equity committees and councils provide a way for plans to partner with plan members and community members to reduce health inequities and develop community-informed solutions to programmatic challenges. Almost all plans surveyed shared a desire to incorporate more plan members and community members into their health equity groups. To recruit these individuals, surveyed plans use the following approaches:

• Promoting in quarterly member newsletters, paired with outreach from designated staff to engage with interested individuals;
• Tapping into existing networks such as member advisory councils and community partners (e.g., local health departments, school systems); and
• Partnering with an organization that has expertise in member and community engagement to help recruit and support members interested in participating.

Key Factors for Effective Health Equity Committees and Councils

Plans reported a variety of strategies for designing and implementing these groups. Below are four key factors that contribute to these groups having a meaningful impact on health plan efforts to advance health equity and in ways that are operationally sustainable.

1. Leadership Buy-in and Participation

Plans highlighted the importance of leadership buy-in and participation. One plan noted “having our leadership represented on the council to bring a voice and provide direction to the organization’s health equity strategic plan helps us advance our goals.” Senior leadership participation includes: (a) attending meetings and being active members of the committees or councils; (b) holding teams accountable for progress metrics; and (c) communicating the work to internal and external key partners and stakeholders (e.g., boards of directors and community-based partners).

2. Health Equity Focus Woven into Existing Structures

Many plans noted the value of integrating health equity work into existing organizational structures. However, one plan identified the challenge of “continually ensuring that all business areas recognize health equity is not just one person’s role [but rather] is the responsibility of all to integrate into daily responsibilities.” Several plans reported addressing this challenge by incorporating and pursuing health equity goals through various workstreams and across departments. One plan noted “the majority of our [health equity-related] work plan items impact multiple departments that work together to achieve our [shared] health equity strategic goals.” Many plans reported success with establishing cross-departmental health equity-focused projects, which makes it easier to operationalize health equity goals and ensure they are explicitly embedded in the work of all teams. Health equity groups can support this work by collecting and sharing information about cross-departmental projects, giving input and feedback where requested, and tracking actions that help the plan move forward on overall health equity strategic goals.

Exhibit B illustrates a plan’s reporting structure where it incorporates health equity activities into existing committees.

Exhibit B. Health Plan Organizational Chart

3. Clear Accountability Mechanisms and Decision-Making Processes

When asked about accountability mechanisms to support progress by the committees and councils, many respondents mentioned a common set of strategies, including:

• Annual work plans that detail the tasks and activities that the health equity group commits to pursuing;
• A well-defined governance structure and reporting criteria; and
• Regular written or verbal reports of updates on key activities and metrics to members, senior staff, and board members.

One plan shared that members of the health equity committee are “required to attend the meetings and meet with the Director of Health Equity between meetings to determine work plan items and measure progress. The Director of Health Equity subsequently presents progress on our health equity strategic plan at each committee meeting.” Exhibit C provides an example of a plan’s governance structure for their health equity activities.

Exhibit C. Health Equity Governance

Participant plans’ committee charters also outline decision-making processes and authority of the health equity groups. Exhibit D is an example of a decision-making process of a plan health equity committee.

Exhibit D. Decision-Making Process of a Health Equity Steering Committee

4. Communication Strategies

Survey respondents shared mechanisms that their health equity committees and councils developed to help break down silos and function effectively across teams, including robust internal communications channels. Sample communications strategies shared by participant plans included discussions of the group’s work in recurring cross-departmental and internal staff meetings and posting health equity-related updates on their organization’s intranet. A few plans mentioned strategies to inform external stakeholders and partners of their organizational health equity efforts, such as sharing updates through the plan’s website, provider portals, and town hall meetings.

Key Recommendations for Implementation

The survey results offer a variety of insights that can inform implementation for safety net health plans interested in establishing or strengthening health equity groups. Following are four takeaways:

1. Seek participation at all levels of the organization. Develop structures that facilitate input from plan staff who work directly with members, as well as those with a broader strategic purview and decision-making power. One way to do this is to have two types of committees with distinct functions. For example, one plan surveyed has a steering committee made up of senior leaders who have a broad view of the organization and strategic decision-making authority, as well as health equity workgroups comprising staff at all levels who have detailed operational knowledge and are engaged in daily efforts to advance health equity. Combining the efforts of multiple committees and workgroups can increase buy-in and effectiveness of health equity efforts.
2.  Incorporate plan members into health equity committees and councils. Safety net health plans surveyed currently incorporate plan members in advisory council structures, rather than operational workgroups, however they aim to increase member participants in health equity committees and councils overall. Plans looking for avenues for member involvement can start by defining a specific function for a member advisory council. For example, a Member Education Advisory Board can provide feedback on member-facing documents and policies. To expand participation, plans can also include external community stakeholders such as representatives from state or county health departments, the state’s department of social services, clinical family advisory committees, and affiliated providers, in their health equity advisory councils.
3.  Plan for ongoing strategic communications. Establish processes for how health equity work and results are communicated both inside and outside the organization. One plan noted that it uses monthly status updates that are simple, direct, and fit on a single slide to facilitate ongoing communications.
4. Build accountability by incorporating health equity work into existing structures and processes. It is easy for staff and leadership to view health equity work as extraneous when it is seen as something outside of their job descriptions or additional work on top of existing responsibilities. Integrating a health equity focus into all aspects of a plan’s efforts can help build internal health equity capacity and enhance results. One promising example comes from a plan that is including a health equity component in state-required health plan performance improvement projects. The plan will use existing data sources, stratified by different factors, to identify and address disparities greater than 10 percent.

Conclusion

Safety net health plans are using health equity groups to build sustained opportunities for improving health equity. Plans have found that leadership buy-in, cross-organizational collaboration, and incorporating the voices of members are important factors in this work. To support successful health equity efforts, plans can seek broader inclusion and participation from internal and external plan stakeholders, plan for ongoing internal and external communications about health equity efforts, and look for ways to build accountability into their existing processes and strategies.