Not-for-profit Safety Net Health Plans play a crucial role in managing health care for historically marginalized populations, offering a unique opportunity to advance health equity within the communities that these plans serve. While many Safety Net Health Plans already prioritize health equity, developing a strategic plan can significantly enhance the coordination and effectiveness of their efforts, transforming ad hoc, disconnected initiatives into comprehensive, impactful plan-wide approaches to address health equity.
To help Safety Net Health Plans develop a strategic plan for health equity that aligns organizational goals, the Health Equity Learning Collaborative was launched in 2022 by the Association for Community Affiliated Plans (ACAP) in partnership with the Center for Health Care Strategies (CHCS). Over the past two years, a group of 15 Safety Net Health Plans worked together to bolster member, community, and provider engagement, while addressing data governance, internal change management, and strategic planning to promote health equity. Among numerous successes, participating plans were able to integrate health equity strategic plans and standardize practices for collecting race, ethnicity, and language data across their organizations.
Following are key lessons for success that emerged across plans participating in the learning collaborative, including firsthand perspectives from plan representatives. Insights from these Safety Net Health Plans can inform other health plans serving Medicaid members across the nation, including work to meet health-equity related regulatory requirements and achieve health equity accreditation.
Lessons for Sustaining Progress in Addressing Health Equity for Medicaid Members
Across all plans, five specific actions helped plans make and sustain progress in advancing their health equity goals:
1. Use plan strengths, in alignment with organizational values and regulatory requirements, to move forward.
Plans faced several challenges when deciding how to move forward on addressing health disparities and inequities, such as interpreting large sets of incomplete data, and prioritizing actions to undertake in the short-, medium-, and long-term. Plans in the learning collaborative found that adopting formal processes for generating strategic plans and prioritizing actions that align with their mission, vision, and state requirements enabled them to move forward despite challenges. For example, one plan participant prioritized interventions to strengthen member engagement on their community advisory board (CAB) based on their vision to enhance member input into plan priorities, as well as a state requirement to have a CAB that is empowered to make a difference in organizational policy. This priority focus encouraged the plan to pursue deeper engagement of their CAB members, including by providing interpreter services at CAB meetings and tracking engagement through participation, statements, requests, and feedback in meeting minutes.
2. Collaborate across departments and workgroups.
Plans in the collaborative moved health equity planning out of often “siloed” efforts. They designed health equity efforts collaboratively across departments using workgroups and committees made up of staff from operational areas, such as information technology and human resources, as well as clinical and member-facing areas, including case management and customer service. This approach helped plans integrate and make progress on health equity work across their organizations.
“We started the learning collaborative with an internal health equity workgroup that had representation from each department, as well as an external Health Equity Council of various stakeholders. However, the structure of our internal workgroup changed to promote more engagement with staff. Rather than one large internal workgroup, we decided it would be more valuable for staff to participate in the smaller workgroups associated with health equity-related projects.”
Tamikka Woods, Partners Health Management
The plans used strategic planning as a vehicle for coordinating the many actions already in place that support advancing health equity. For example, several plans generated inventories of organization-wide efforts to address health equity, identifying existing strengths, opportunities for improvement, and new ways to collaborate. This helped the health plans to build organizational awareness and bolster buy-in for health equity work.
“That intentional, driven teamwork has given us the foundation to build our commitment to the program…We had opportunities, and we were affecting some elements of health equity… This learning collaborative compelled us to communicate, collaborate, and organize our information, so that we could compose and implement a formal health equity plan.”
Kim Worrall, South Country Health Alliance
3. Generate internal buy-in with tailored messaging.
Plans in the learning collaborative shared that effective messaging to reach various internal stakeholder groups was critical for supporting their health equity strategic plans. One plan participant found that senior leaders wanted to see cost and utilization data connected to health disparities before supporting actions to address disparities. Another plan shared that staff across the organization needed to build knowledge around health equity concepts, such as systemic racism and implicit bias, to understand how the plan can achieve its goals by focusing on health disparities.
“When you mention looking at projects with a health equity lens, you may receive questions on the value of stratifying by demographic characteristics. More education is needed on the importance of health equity and identifying health disparities.”
Leah Williams, Partners Health Management
4. Build internal culture for advancing health equity.
Health plans in the learning collaborative highlighted the importance of engaging in work within their organization, creating goals and strategies to improve internal culture, and embedding an equity lens into organizational goals. For example, participating plans incorporated new or enhanced staff trainings on diversity, equity, and inclusion, and examined opportunities to increase the diversity of vendor relationships in their communities, such as identifying opportunities to support local woman- or Black-owned businesses to align with their goals.
“We held our first Health Equity Summit…we had a fireside chat with a provider…she said, ‘health equity moves at the speed of trust and the real question is not why people don’t trust us, but why are we not trustworthy?’ So, when we think about data and collecting data, it’s a matter of trust. [We are asking ourselves] how are we trustworthy in obtaining information and why would they give it to us?”
Barbara Holloman, Community Health Network of Connecticut
5. Partner — internally and externally — and share to expand the reach of your team.
Plans in the learning collaborative built relationships with each other by sharing information and resources, and enhanced member, community, and provider partnerships to support their health equity work. For example, plan partnerships with community-based food banks have led to expanded opportunities to address members’ food insecurity. These relationships have also provided spaces for learning, camaraderie, and inspiration in the difficult work of shaping systems change.
“It was so helpful to be able to reach out to [the other plans] and hear what works best for them and be able to apply it to what we’re doing and vice versa … We found out we’re not out here alone. Everyone is going through the same thing and putting together a lot to achieve health equity for all.”
Barbara Holloman, Community Health Network of Connecticut
Conclusion
Through participation in the learning collaborative, plans embarked on structured approaches to health equity strategic planning, in community with peers. Helpful strategies for enhancing plan readiness and commitment to health equity strategic planning included taking time to understand the health equity-related activities already underway within their organizations, using strengths in pursuing opportunities for improvement, and investing in partnerships and strategic communications to operationalize shared goals.
As resources and contexts for health equity work change throughout the country, these lessons can help plans and other Medicaid stakeholders as they continue to build and sustain health equity work.
