Employer Presenter Name Here Title Company In Partnership with: National Business Group on Health and U.S. Dept. of Health and Human Services, Office of Minority Health Racial and Ethnic Health Disparities In the Workplace: Achieving Equity Among the Insured Company logo pasted into lower right on all slides This material was developed by the National Business Group on Health, which should be cited accordingly. Copyright 2011 National Business Group on Health.

Presenter Company Profile Presenter company profile  What we do as an organization and who works for us  Types of health and wellness benefits that we offer to whom  How we communicate our benefits  How do we partner with the health plan or data warehouse  Which of our initiatives focus on racial and ethnic health disparities Company logo pasted into lower right on all slides

Table of Contents I. Background on Racial and Ethnic Health Disparities II. Why Employers Should Care III. Presenter Company Example IV. What Employers Can Do: Strategies V. Business Group Resources Company logo pasted into lower right on all slides

Background on Racial and Ethnic Health Disparities

What are Health Disparities? Health disparities can be broken down into two categories: disparities in health status and disparities in health care. 1 Disparities in health status refers to the individual differences in disease prevalence, habits, and risk factors between various races and ethnicities. Disparities in health care refers to different people’s access to health insurance, preventive services, and medical care or lack thereof. Company logo pasted into lower right on all slides 1 Addressing racial and ethnic health disparities: Getting started and things to consider in the workplace. Employer Guide. National Business Group on Health. September 2009.

Racial and Ethnic Disparities in Health Status African Americans make up almost half of the U.S. HIV/AIDS population and African American women are over 20 times more likely to die from HIV/AIDS than white women. 1 American Indians and Alaska Natives are six times more likely to die from tuberculosis and over five times more likely to die from alcoholism than whites. 2 Hispanic adults are twice as likely to be diagnosed with diabetes than white adults. 3 South Asians have up to four times the risk of death related to heart disease compared with other ethnic groups. 4 Company logo pasted into lower right on all slides 1 Office of Minority Health. African American Profile. Available at: Accessed on February 26, Indian Health Service. Facts on Indian health disparities. Available at: Accessed on February 26, Accessed on February 26 3 Office of Minority Health. Hispanic/Latino profile. Available at: Accessed on February 26, South Asian Heart Center at Camino Hospital. Why South Asians?: the problem. Available at: Accessed on September 21, Accessed on September 21

Racial and Ethnic Disparities in Health Care Racial and ethnic people have more medical errors with negative clinical consequences. 1 Even among insured populations, people of color are less likely to receive preventive health services. African Americans especially are twice as likely to utilize emergency room service than non-Hispanic whites. 1 Racial and ethnic people undergo more tests in emergency rooms due to poor communication, and those who need medical translators often do not have access to them. 2 Hispanics are less likely to receive or use medications, especially for asthma, cardiovascular disease, HIV/AIDS, mental illness or pain. 2 Racial and ethnic people make up 51% of the transplant waiting list. 3 Company logo pasted into lower right on all slides 1 HealthReform.gov. Health disparities: a case for closing the gap. Available at: Accessed on September 30, Flores G. Language barriers to health care in the United States. New Engl J Med. 2006;355: PR Newswire. Minorities account for 51% of the transplant waiting list. Available at: html. Accessed on September 30, html. Accessed on September 30

U.S. Cost of Health Disparities The estimated cost of racial and ethnic health disparities in direct medical costs in the U.S. was over $229 billion dollars from Over 20% of these costs were excess costs due to health disparities for African Americans, Asians, and Hispanics. 1 In 2009, disparities among African Americans, Hispanics, and non- Hispanic whites cost the health care system almost $24 billion dollars. Over $5 billion dollars of these additional costs were incurred by private insurers. 2 National data indicate that over the 10-year period from , the total cost of health disparities will be approximately $337 billion dollars, with $117 billion incurred by private insurers. 2 Company logo pasted into lower right on all slides 1 LaVeist T, Gaskin D & Richard P. (2009). The economic burden of health inequalities in the United States. Sept Waidmann T. Estimating the cost of racial and ethnic health disparities. The Urban Institute. Sept. 2009

Why Employers Should Care

Why Employers Should Care: Growing Workforce Diversity Company logo pasted into lower right on all slides 1 Patient Protection and Affordable Care Act of 2010: Advancing Health Equity for Racially and Ethnically Diverse Populations. Joint Center for Political and Economic Studies. July Racial and ethnic people now comprise roughly one-third of the U.S. population, and are expected to represent a 54% majority by Yet widespread disparities in key health indicators continue to exist for adults and dependents among cultural, ethnic and racial minorities due to variations in cultural health norms and provider delivery systems. As multi-national companies become more diverse, racial and ethnic people are expected to comprise over 41% of the workforce population in 2015 (up from 34% in 2008). 1

Why Employers Should Care: Disparities Among the Insured Company logo pasted into lower right on all slides Employers shoulder the lion’s share of health care costs to cover their employees and families, yet not every enrollee is able to receive the optimal level of health care. Health disparities associated with race and ethnicity persist even minorities have adequate health benefits coverage, equivalent socioeconomic status and comparable comorbidities. A “one size fits all” approach to health and wellness programs does not work because minorities experience stark differences in health conditions and outcomes as well as preventive, diagnostic and treatment services provided. Many surveyed employers reported being generally unaware of racial and ethnic health disparities as a business issue. 1 1 Employer Survey on Racial and Ethnic Disparities: Final Results The National Business Group on Health. July 30, 2008.

Presenter Company Case Study

 How did you interpret the legal environment on using racial and ethnic data? What did your counsel tell you?  How did you nurture a dialogue with your health care vendors (health plans, disability, EAP, wellness providers, etc.)?  Did you collect and analyze health disparity data for your workforce to identify gaps in program utilization and unequal health status?  How did you train culturally-competent staff to deliver tailored services to diverse workforces?  How did you communicate disparities-related activities in your organization to employees?  Did you form industry partnerships in the community? Company logo pasted into lower right on all slides 1 Disparities (cultural, ethnic and racial). A-Z compendium page. National Business Group on Health. March 2011.

What Employers Can Do: Strategies

Part I: The Business Case  Secure senior management buy-in and on-going support for closing health disparities gaps  Incorporate closing health disparities as part of your corporate health care strategy and HR diversity/inclusion strategy  Close health disparities gaps through better plan design and employee engagement  Support research on racial and ethnic health status, treatment and outcomes differences  Highlight the value of cultural diversity  Use the Health Disparities Cost Impact Tool developed by the National Business Group on Health and Urban Institute to identify, evaluate and rank the most prevalent and costliest—yet manageable—health conditions by ethnicity, age and job category  Investigate your health disparities impact on productivity measures Company logo pasted into lower right on all slides

Part II: Disparities Data Strategy and Operations  Create an action plan to collect and analyze racial and ethnic data using all of your available resources: new employee intake forms, health appraisal or geocoding. Provide this plan to your health partners for analysis.  Ask health partners who touch employees to identify gaps in engagement and/or outcomes and recommend highest-value solutions (health plans, data warehouse, EAP, wellness advocates, disease management and PBM)  Examine key employee factors, including race/ethnicity, primary language, gender, age, length of service, location, disability, and job family (level 1); full-time status, income, education, health literacy and other perceptions (level 2)  Consider environmental factors where employees live with respect to multicultural lifestyle demands, provider practice variations, community feedback and geographic well-being  Integrate or cross-walk aggregated employment data with medical data for health promotion  Review certification status of vendors for implementing disparities-directed initiatives (e.g., NCQA multicultural health care distinction)  Modify HR policies to increase internal access to sensitive but aggregated employee data (i.e., employment data with medical data for health promotion) Company logo pasted into lower right on all slides

Part II: Disparities Data Strategy and Operations Continued  In partnership with your health plan, data warehouse and other vendors, collect utilization and outcomes data based on race and ethnicity for:  Disease risk profiles  Emergency room utilization rates  Disease management data  Preventive care utilization  Chronic care management and specialist referrals  Wellness program rates  Disability, worker’s compensation, absenteeism and other productivity metrics

Part III: Plan Design Benefits  Hold health plan partners accountable for closing disparities gaps: develop a strategic action plan using touch points in health/pharmacy benefits outreach, wellness support and productivity programs  Investigate psychosocial and biological differences across ethnicities which may increase susceptibility to certain health conditions (e.g., healthy-weight Asians at risk for diabetes or hepatitis) or behaviors (e.g., African Americans less likely to participate in health appraisals)  Build staff cultural competency using training tools incorporated into your renewal contracts and performance guarantees for all health and wellness vendors  For optimal results, manage program incentives—designed to galvanize total employee engagement– that may inadvertently impact health differently across ethnicities which are disproportionally more affected by health conditions (obesity) or behavior (tobacco use)  Implement favorable benefits premiums and out-of-pocket pricing for low-wage workers, if ethnicities highly constitute this income group Company logo pasted into lower right on all slides

Part IV: Employee Communications  Design disparities-related communications on general disparities information, how employees can help close health care gaps through appropriate use of health services, and success stories of ethnic workers enrolled in programs  Affirm privacy protection statements non-punitive use of data collection, as well as information about plan and community partnerships  Better understand and overcome cultural mistrust among ethnic employees, where it exists, by partnering with community leaders  Establish multicultural staff champions and employee resource groups to support on-site health services  Encourage health lifestyles for diverse spouses, domestic partners, dependents and families Company logo pasted into lower right on all slides

Part V: The Legal Environment  Work with corporate counsel to translate law into health disparities policy  Support aggregating employment data with medical and productivity for health promotion  Manage HR risks associated with using various methods of collecting race/ethnicity data  Confirm compliance with existing federal laws (e.g., HIPAA privacy and security)  Develop or revise your Notice of Privacy Practices and HIPAA authorization forms, as necessary  Review any applicable state laws Company logo pasted into lower right on all slides

The Legal Environment: Federal Laws Federal Laws None of these federal laws prohibits collection or integration of employees’ racial or ethnic data. Most employers will already have documents, policies, and procedures to comply with these federal laws. Employers should review existing policies and plan documents to confirm compliance with these laws. Develop or revise Notices of Privacy Practices and HIPAA authorization forms, if necessary. Source: 2011 National Business Group on Health.

The Legal Environment: Federal Laws Federal Laws Title VII of the Civil Rights Act of 1964 (Title VII). Title VII prohibits employment discrimination (including discrimination in health benefits) on the basis of race, color, religion, sex, or national origin. Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA imposes a number of requirements on group health plans and health care providers that are designed to protect “protected health information” Genetic Information Nondiscrimination Act of 2008 (GINA). GINA prohibits group health plans, health insurers, and employers from discriminating against individuals on the basis of their genetic information. Employee Retirement Income Security Act of 1974 (ERISA). ERISA includes a number of rules regarding the establishment and operation of employee benefit plans, including most employer-sponsored group health plans. Source: 2011 National Business Group on Health.

The Legal Environment: State Laws State Laws A 2001 assessment of state laws pertaining to collection and reporting of racial, ethnic, and primary language data resulted in the conclusion that “state laws overwhelmingly do not prohibit the collection of racial, ethnic and primary language data by health insurers and managed care plans.” Racial/ethnic data collected for plan purposes: Any state laws restricting collection and integration of racial and ethnic data would not apply to most self-insured group health plans because such laws would be preempted under ERISA. Source: 2011 National Business Group on Health.

Business Group Resources

Business Group Resources on Health Disparities Addressing Racial and Ethnic Health Disparities: Employer Initiatives (2009) Addressing Racial and Ethnic Health Disparities: Employer Initiatives (2009) Addressing Racial and Ethnic Health Disparities: Getting Started and Things to Consider in the Workplace (2009) Addressing Racial and Ethnic Health Disparities: Getting Started and Things to Consider in the Workplace (2009) Employer Communications on Health Disparities: Resource Document (2009) Employer Communications on Health Disparities: Resource Document (2009) Eliminating Racial and Ethnic Health Disparities: A Business Case Update for Employers (2008) Eliminating Racial and Ethnic Health Disparities: A Business Case Update for Employers (2008) Employer Awards for Innovation in Reducing Health Care Disparities Employer Awards for Innovation in Reducing Health Care Disparities Company logo pasted into lower right on all slides Source: 2011 National Business Group on Health The major Business Group resources can be found on our A-Z Disparities Compendium page. Selected publications include:A-Z Disparities Compendium page

About the National Business Group on Health The National Business Group on Health is the only national non-profit organization exclusively devoted to representing the perspective of large employers and providing practical solutions to its members’ most important health care problems. The Business Group has over 300 members, including 66 of the Fortune 100, that provide healthcare coverage for 60 million employees, retirees and family members, including approximately 18 million children. Company logo pasted into lower right on all slides For more information, please contact the National Business Group on Health at or visit About the National Business Group on Health About the Advisory Board on Reducing Racial and Ethnic Health Disparities Since September 2007, the Business Group has partnered with the Office of Minority Health as part of the National Partnership for Action to End Health Disparities. The board’s objective is to reduce health disparities by improving employer awareness of causes and consequences and changing employers’ health care purchasing strategies in health insurance, wellness programs and more. This advisory board is comprised of employers, government agencies, health plans, and academic institutions.