Reducing workforce health and well-being inequities is good for business

Health inequities are costly. In fact, a recent analysis from the Deloitte Center for Health Solutions indicated that the incremental expense of health inequities in the US amounts to $320 billion annually. If unaddressed, projections indicate the expense may exceed $1 trillion annually by 2040.

Conversely, effectively addressing health inequities could add as much as $2.8 trillion to the US economy by 2040, according to a recent actuarial analysis.

Addressing workforce health inequities can achieve these economic gains by improving employee health and well-being.

The business case for employers to support health equity is straightforward: Employees who are healthy and have higher levels of well-being are more engaged with their employers.

According to Gallup researchers, greater employee engagement levels are associated with multiple measures of business success, including reduced absenteeism and turnover, enhanced productivity, greater customer satisfaction, and improved profitability.

Considering all stakeholder groups

A helpful way to think about the drivers of health inequities is by appreciating how each stakeholder group influences the use of health care and well-being benefits.

In general, stakeholder groups typically include employees, employers, health systems, well-being vendors and health plans.

Representative considerations affecting health and well-being benefits use are summarized below:

◆ Employees: health literacy, health benefits literacy, benefits affordability and access, medical mistrust.

◆ Employers: equitable benefits design, access to care, relevance and access of well-being program offerings, health care navigation support.

◆ Health systems: inequities in health care delivery (including implicit bias, cultural humility limitations).

◆ Well-being vendors: inequities in program offerings as evidenced by reduced participation rates among employee subpopulations, access limitations due to employee time demands, inconvenient location, lack of employee input into program offerings.

◆ Health plans: network access limitations, lack of accountability for observed inequities in health care utilization and health outcomes.

Incorporating workforce health equity considerations into health benefit design may be best achieved by using a systematic, or systems-based, approach.

Analyzing care utilization patterns

In a recent peer-reviewed article, we describe how employers can identify racial, ethnic or wage-based differences in health care and well-being utilization patterns in claims and well-being program data.

How can employers begin to address workforce health inequities?

Perhaps the most sensible starting point is to analyze available claims and well-being program data, comparing utilization rates on the basis of race/ethnicity and wage levels. Each of those sociodemographic factors has been associated with differences in employee use of benefits offerings.

Once differences in use have been identified, employers can then focus on identifying the root causes or drivers of the observed findings.

Addressing the root causes is important because the process of doing so can lead to sustained improvement.

By comparison, providing what may seem to be a simple fix, such as a financial incentive to drive employee behavior change, may not be successful if employees feel like they don't matter to the organization.

In that setting, employees are likely to be disengaged and not participate, even if an incentive is at stake.

Promoting dialog

From our perspective, the best way to understand factors underlying workforce health inequities starts with learning from employees.

It's important to understand the reasons why they're not using preventive care services or participating in workplace well-being programs.

Encouraging employee input — perhaps through focus groups or employee resource group involvement — accomplishes two objectives.

First, employers can learn what employees are really thinking, rather than making assumptions about employee health benefits utilization patterns.

Second, and perhaps more importantly, engaging employees may be seen as an important step in empowering them and allowing them to feel heard and foster greater engagement with the organization.

When eliciting employee perspectives, employers should strive not to make assumptions about employees' health and well-being concerns.

Employers — or perhaps better, an independent third party or employee representative — can use open-ended questions to explore and prioritize unmet employee needs that are limiting access to existing benefit offerings.

A systematic approach to exploration that includes the roles of the different stakeholder groups listed above is likely to elicit substantial employee feedback and suggestions for changes to reduce observed workforce health inequities.

Employers should be unafraid to explore these issues with employees.

While it may be difficult for some to hear criticism of employer-provided benefits, the responses can provide a basis for valued enhancements to employee benefits offerings.

These, in turn, can foster greater employee engagement and lead to broader, collaborative discussions with employees about other health and well-being topics.

Creating report cards

Importantly, ongoing reporting from health plans and well-being vendors can be used to evaluate the impact of any changes in benefits offerings to improve health inequities.

Selected aggregate reports can also be shared with employees to demonstrate the employer's commitment to workforce health equity.

In the future, both health plans and well-being vendors may be willing to share accountability for health equity performance measures to ensure that all employees — and their families — have equitable use of available health benefits offerings.

While some employers may worry about the current negative focus on workplace diversity, equity, and inclusion efforts, workforce health equity is different.

From our vantage point, workforce health equity is not an issue of meritocracy in competition for employment or career advancement.

Everyone — including employees and their family members — should be able to receive affordable and accessible, high-quality care for their health concerns.

And given that workforce health equity can enhance organizational outcomes, incorporating it as a component in strategic benefits planning simply makes good business sense as well.

Bruce Sherman, MD, FCCP, FACOEM, is a faculty member at the Case Western Reserve University medical school, medical director of the North Carolina Business Coalition on Health and a consultant at the National Pharmaceutical Council. Brian Sils is a consultant at the council, and Kimberly Westrich is the council's chief strategy officer.