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Greater Washington Partnership Blueprint Report

PILLAR 06
Health Equity Accessible and Effective Health Care Ecosystems

Black and Hispanic communities are disproportionately affected by systemic healthcare inequities and experience poorer health outcomes than white populations as a result 291

Underrepresented communities across the Capital Region experience systemic barriers to living healthy lives, including racism and discrimination in care delivery and deep inequities in social determinants of health.DD Structural flaws in the healthcare system limit access to sufficient health coverage, affordable and equitable healthcare, quality food and nutrition education, and community resources.

As a result, our region faces enormous and longstanding disparities in health-related outcomes between underserved populations and white populations, including variations in life expectancy, birth rates, morbidity, and more. There are substantial societal costs of these disparities: in 2021, a Kaiser Family Foundation report calculated that health disparities cost the US $93B in excess medical costs and $42B in lost productivity per year.3

What
is Health Equity?
The Partnership defines health equity as the fair and just opportunity for everyone in our region to fulfill their human potential in all aspects of health and well-being. Health equity means that every community member can achieve an overall state of well-being encompassing clinical, mental, social, emotional, physical, and spiritual health
271

Health equity has become a central focus across the U.S. due to COVID-19’s disproportionate impact on Black and Hispanic communities, coupled with a national social justice reckoning that highlighted institutional racism, among other challenges. Health equity impacts business outcomes including workforce participation and productivity, consumer expectations, healthcare costs, and more.

Health equity cannot be addressed without an integrated focus on the economic, social, and environmental conditions beyond healthcare—the social determinants of health—as well as the structures, cultures, and technologies that influence care and well-being. Advancing health equity and reducing racial disparities in health-related outcomes requires coordinated action across all priority pillars, which reflect social determinants of health. The following section details how employers can support inclusive growth within health equity and the potential impact of making such investments.

Hispanic residents are 14-43% more likely to not have health insurance coverage than white residentsDD

Life expectancy for Black newborns is more than a decade lower than white newborns in the regionDD

Black infant mortality rates are 85-200% higher than those of white residents; D.C. has the highest rate with 13.9 deaths per 1,000 live births among black residentsDD

Food insecurity is a significantly larger challenge for communities of color - Black residents are 93-187% more likely to be receiving SNAP assistance than white residents DD

Solutions
Health Equity
Accessible and Effective Health Care Ecosystems
  • Increase affordability and access to equitable care
    Solution 1 Increase affordability and access to equitable care Expand access, awareness, and engagement with quality, affordable and equitable health and wellbeing services, especially in communities of color

    Access to equitable and affordable health insurance and wrap-around well-being services is critical to achieving health equity in the region. Access is constrained by several factors, including affordability of employer-sponsored health benefits, eligibility requirements for employer coverage, and restrictive plan policies or networks. It is important that access to services is equitable across geographies and includes providers who focus on providing high-quality care to diverse populations. To improve access for underrepresented communities and bridge physical and socioemotional barriers to care (e.g., lack of trust in the healthcare system resulting from historical mistreatment), employers should invest in strengthening connectivity to the region’s health care and well-being resources and increasing transparency into disparities in health outcomes to inform targeted interventions.

    The health equity recommendations in this solution will enhance access to affordable health and well-being services, improve regional health outcomes, provide a healthier, more productive working population, and enhance brand value within the community. Furthermore, making these investments will boost the region’s network of community-based healthcare services, expanding access to equitable care for all.

    Recommendations

    Recommendation 1 Integrated Employer Health Expand quality, accessibility, and availability of subsidized healthcare, mental/behavioral health, and well-being benefits to employees

    Employer health coverage is foundational to affordability and accessibility of health and well-being services. Roughly 55% of employees across the Capital Region are covered by employer-sponsored health plans. However approximately 20% of employees at companies offering employer-sponsored healthcare are ineligible, often because they are part-time or temporary workers273—roles more commonly filled by Black and Hispanic workers.274 Employers are positioned to increase care accessibility for these individuals, either through direct eligibility in employer-sponsored plans or through annual subsidies to support securing coverage in the marketplace.

    The need extends beyond just employer health coverage eligibility: the COVID-19 pandemic has underscored the need for reliable and accessible physical and mental health and well-being coverage. Over 50% of people report delaying care due to time constraints or transportation barriers275 and nearly half of employees say that mental health support is difficult to find or access;276 currently, only 32% of employees report that mental health services are covered by their insurance.277 Improvements in employee health and well-being benefits—and resulting health outcomes—can impact the bottom line by creating long-term cost savings, improved productivity, and increased employee satisfaction and retention.

    Expected Impacts

    • Community: Expanded coverage and accessibility of health and well-being services can improve overall community health by incentivizing people to get the care they need without concern for prohibitive costs Increased coverage reduces the burden of healthcare spending and provides families with improved financial security and additional disposable income to spend on goods and services within the local economy278
    • Private Sector: Employees with health insurance take approximately 75% fewer sick days than uninsured workers279

      Improved health coverage can increase employee retention—56% of employees said health coverage is a key factor in deciding to stay with their employer280

    Efforts in Progress

    • National Bright Spots: Morgan
      Health
      , a JPMorgan Chase & Co. business, is focused on improving the quality, efficiency, and equity of employer-sponsored healthcare through investments, partnership, benefits improvements, and thought leadership Deloitte’s
      Integrated Mental Health Services
      provides employees with on-demand, concierge mental health care and counseling

    Implementation Considerations

    • In addition to broadening health plan eligibility, employers can consider full or cost-shared subsidies to support access to additional health and well-being activities

    • Partnerships with digital care providers can alleviate logistical burdens and offer a platform for on-demand coverage for clinical, mental health, and well-being needs

    • Employers should make sure that health plan offerings have equitable accessibility and affordability across employee types and geographies and educate employees on updates to offerings to encourage use of services

    Recommendation 2 Data Collection Improvements Include standardized race metrics in data collection and analysis to increase understanding of equity-related health and well-being metrics

    Collecting and analyzing accurate race and ethnicity data is crucial to both understanding disparities in health outcomes and developing targeted interventions to promote equity. However, flaws in data collection and lack of transparency in reporting may foster or perpetuate mistrust. Historic efforts to standardize race, ethnicity, and language (REaL) data have not been comprehensive. Further, when collected, REaL data has not been used to drive equity, but rather has often harmed historically underserved populations through biased AI and race-based algorithms; these algorithms routinely deprive Black patients of necessary treatment, such as adjusting risk scores for race, leading to lower risk scores than white counterparts and delayed access to some types of care.281

    While sharing REaL data is optional for employees, businesses can foster trust with employees by encouraging self-reporting, being transparent with how data will be used, and normalizing data collection. Increased data sharing within the business community can help strengthen health equity; this may include working with insurers to pair REaL and health outcome data to predict and respond to health deficiencies or population health risks or creating a repository to inform an organization’s health equity strategy. When adopted broadly, improved data infrastructure and data management practices can drive the cross-sector agenda for health equity and support key performance indicator (KPI) measurement of existing interventions.

    Expected Impacts

    • Community: Normalization of REaL data collection will encourage voluntary reporting at points of care, enhancing overall community data collection

      Data sharing with health organizations will help identify disparities in care, enabling organizations to create targeted plans to reduce inequities in care 282

    • Private Sector: Enhanced understanding of health and well-being outcomes and benefits enrollment allows employers to understand the degree to which services are reaching employees and can provide insights that enable employers to choose health plans and benefit offerings that better meet employees’ needs

    Efforts in Progress

    • National Bright Spots: California Health Care Foundation’s Free The Data Initiative is undertaking a pilot program to give community members access to aggregate-level local health data to raise awareness of key health issues

    • The Healthy

      Business

      Coalition
      is a collaborative initiative among Businesses for Social Responsibility (BSR), the Robert Wood Johnson Foundation, and a group of leading companies that are dedicated to realizing the promise of the private sector’s ability to improve population health

    Implementation Considerations

    • To affect change at scale and optimize the impact of data sharing, businesses should utilize standardized terminology for REaL data collection (e.g., Department

      of

      Health

      and

      Human

      Services

      data
      standards)

    • Businesses should be transparent about data sharing, including how and why employee data will be used; organizations should also be mindful of potential privacy laws or restrictions pertaining to how data can be shared

    • Businesses can leverage REaL data to understand disparities in enrollment and/or participation in health plan offerings and well- being benefits within their organization

    Recommendation 3 Resource Matchmaking to Support Community Care Provider Needs Collaborate to match business expertise, assets, and services to non-clinical needs (e.g., operations, marketing, technology, etc.) of community-based, healthcare and well-being providers

    The business community can offer pro-bono professional services to community-based health clinics and well-being service providers to address key operating needs, such as data analytics, technology, marketing, troubleshooting, legal support, and more. Providing these services will enable community health workers and nonprofits to focus on service delivery rather than back-end operational functions. As of September 2021, 53% of nonprofits are experiencing increased demand for services, but one-third have had to cut programming, and 47% have seen a decrease in funding.283 Within the nonprofit realm, community care providers are particularly important, as they provide care to uninsured and underinsured community members.284

    To maximize effectiveness, organizations that understand the local healthcare nonprofit and business landscape can collaborate to best connect needs from community clinics and nonprofits with businesses that have the appropriate assets to support them (e.g., employee or technical expertise, funding, etc.). To maximize efficiency, organizations could consider developing or leveraging an existing technical platform to supplement matchmaking.

    Expected Impacts

    • Community: With back-end operational support, community health and well-being providers can focus limited funding on programming to meet increasing demand, allowing community members retain quality sources of care and well- being services
    • Private Sector: Matchmaking makes it easier for businesses to identify where they can best support community organizations, saving organizations time and resources that can then be focused on providing direct support to the community

      Increased community involvement can increase brand value—roughly 82% of consumers consider corporate social responsibility when determining where to purchase of goods and services285

    Efforts in Progress

    • National Bright Spot: Catchafire utilizes a data-driven platform to partner with corporations, foundations, and grant makers to match nonprofits with professionals or organizations who can help meet their needs

    Implementation Considerations

    • In addition to other areas of expertise, the business community can support measurement and reporting so that nonprofits can more accurately demonstrate their impact and, as a result, access additional funding opportunities to maintain and expand their services

    • Nonprofit board membership can be a part of matchmaking, specifically for employees who can provide expertise to guide organizations. One in three nonprofits say their board does not understand financial reporting, highlighting a need for more business leaders308

    • Implementing a technology platform to support matchmaking will likely require a single organization to take ownership of the process and platform, while working closely with additional organizations as collaborators

  • Improve maternal & infant health and well-being
    Solution 2 Improve maternal & infant health and well-being Decrease maternal and infant mortality rate, strengthen maternal wellbeing, and bolster early childhood development for residents

    Significant racial disparities in health outcomes for infants and pregnant women highlight a need for change in how we support and offer care in our communities. Maternal and infant health and well-being determines the health of future generations and can shape future healthcare challenges.286 Racial disparities in maternal and infant health outcomes stem from a variety of causes, namely increased barriers to care for people of color, chronic stress from structural racism, and disparities in care resulting from underlying provider bias.287 In our region, Black infant mortality rates are 85-200% higher than those of white infants and life expectancy for Black newborns is more than a decade lower than that of white newborns.288 Employers can enhance employee health and well-being benefits to provide more support for pregnancy, postpartum, and infant care, helping to improve maternal and infant health outcomes. Employers can accomplish this by investing in three areas:

    • Expanding maternal health benefits to include services that support the entire maternal health journey

    • Incentivizing employees to attend regular health screenings

    • Providing cohort support for employees during pregnancy and early childhood

    These benefit enhancements support employees and their families before, during, and after pregnancy, improving health and well-being outcomes and lowering healthcare costs for employers.

    Recommendations

    Recommendation 1 Maternal Health Benefits Expand employer-provided health benefits, like home visits and doula coverage, that enhance the maternal health journey and improve outcomes

    Washington D.C.’s maternal mortality rate is twice the national average289 and, across the U.S., mortality among Black mothers is twice as high as it is for other populations.290 In the U.S., for each pregnancy-related death there are 70 “near misses” resulting in severe maternal morbidity; these “near misses” are even more common among residents of low-income zip codes.291 Furthermore, infants in our region also suffer disproportional outcomes: Richmond, Baltimore, and D.C. have higher annual rates of low birth- weight newborns (11.9%, 11.0%, and 10.0% respectively) than the national average of 8.2%.292 This is higher in predominantly Black neighborhoods—in D.C.’s Ward 8 the rate increases to over 14.4%.292

    Several interventions that can be offered via employer benefits or subsidies have shown to improve maternal and infant outcomes, namely home visiting programs,EE the use of doulas,FF and expanded postpartum services.GG Within postpartum care, screening and providing support for perinatal mood and anxiety disorders (PMADs) is particularly important for supporting maternal recovery, maternal transitions back into the workplace, and reducing the overall cost of perinatal care. PMADs cost an average of $32,000 per mother affected without treatment.293 By providing coverage for additional maternal health services, employers empower caregivers to access holistic care, enhance their preparation for parenthood, and support maternal mental health prior to and during their return to work.

    Expected Impacts

    • Community: Home visits support pregnant individuals and new parents to promote infant and child health, foster educational development and school readiness, and increase mothers’ participation in the workforce294

      Doula services mitigate the effects of social determinants on birth outcomes by increasing health literacy, reducing perceived barriers to care, providing social support,295 and reducing the likelihood of low birthweight infants and C-sections296

    • Private Sector: Home visit programs decrease the risk of postpartum depression, leading to improved maternal mental health when mothers return to the workplace297

      Home visits298 and doulas299 are associated with reductions in medical costs, which yields cost savings to employers that are self-insured (i.e., employers who pay the cost of claims directly to their insurer)

    Efforts in Progress

    Implementation Considerations

    • Benefits can be distributed through direct inclusion in health plans or via a subsidy to allow employees to select the provider that best fits their needs

    • Once coverage is established, employers should actively communicate new maternal programming coverage to encourage employees to use the benefit

    • Accessibility of programs may differ across regions; however, as demand for services increases because of expanded coverage, additional programming and/or new service providers may be needed

    Recommendation 2 Screening Incentives Implement partnerships and internal policies that encourage employees to attend regular pre/postnatal check-ins, lactation consults, and mental health screenings/postnatal check-ins , lactation consults, and mental health screenings

    Babies of mothers who do not get prenatal care are five times more likely to die and three times more likely to have a low birthweight,300 and mothers without prenatal care are five times more likely to die during pregnancy than those who receive prenatal care.301 Health screenings play a vital role in the early identification and treatment of issues associated with adverse maternal and infant health outcomes. The underutilization of health screenings and services can negatively impact progress toward improving maternal and infant health outcomes (e.g., infant and maternal mortality, low birthweight, preterm birth).

    Despite the benefits of screenings, 26% of women report needing additional time off for prenatal visits, but not asking their employer due to fear of repercussions.301 Health services for mothers and infants account for one-fifth of large employers’ medical spend, with higher costs for mothers who do not have early prenatal care (on average $1,000 higher hospital costs).203 The business community is positioned to address the key barriers that prevent their employees from accessing these services and to tailor policies and incentives to mitigate logistical barriers, enhance workplace culture, and remove stigma.

    Expected Impacts

    • Community: Increased participation in screenings can reduce infant mortality and low birth weight among Capital Region babies, and lead to improved maternal outcomes among mothers

    • Private Sector: Employees are more likely to vocalize their needs, seek care, and attend pre- and post-natal screenings. This also builds a workplace culture of trust and support.

      Employers save on healthcare costs through reduced employee medical spend302

    Efforts in Progress

    • Regional Bright Spot: The Healthy

      Mom,

      Healthy

      Baby
      program is a collaboration between the

      Capital

      Area

      Food

      Bank and

      Mary’s
      Center
      in Maryland. The program is funded by UnitedHealthcare and provides healthy food deliveries, virtual nutrition education, and virtual prenatal health screenings to high-risk pregnant individuals

    • National
      Bright Spot:
      Anthem’s
      Future Mom’s Program
      is offered to expectant members as part of select Anthem health plans. The program provides support during pregnancy and after delivery offers members free video visits lactation consultants, counselors, and/or registered dietitians

    Implementation Considerations

    • After workplace policies are established, employers should socialize policies and aim to shift workplace culture to better enable and empower women to fully utilize new benefits

    • Policies should consider that not all women will be comfortable disclosing their pregnancy in the early stages, and therefore should not require disclosure to HR

    • Employers can also contemplate adding coverage for employees to utilize the services of innovative maternal health startups, such as Maven
      Clinic
      , that offer virtual perinatal services to ease logistical barriers to care

    Recommendation 3 Cohort Support Partner with community health providers and/or internal HR departments to create employee groups that provide education and support for employees/families during the pregnancy and early childhood journey

    Roughly 90% of mothers do not feel supported by society303 and approximately 70% of parents believe “being a good parent” is their biggest challenge.304 Cohort support is a proven model for navigating pregnancy and early childhood. Group perinatal care has been shown to improve patient education and provide opportunities for social support while promoting risk screenings and physical assessments necessary for individual prenatal care.328

    66% of mothers and 89% of fathers work outside the home.306 Both mothers and fathers (50% and 39% respectively) say being a working parent makes it harder to advance in their careers.307 Employers can establish partnerships or develop internal resource groups to offer cohort support to pregnant employees and new caregivers, creating a supportive and inclusive environment that improves both health outcomes and employee satisfaction.

    Expected Impacts

    • Community: Cohort support models have demonstrated decreased levels of postpartum depression308 and community members participating in cohort programs are likely to experience increased confidence in parenting skills309

      Increased community engagement during the first year postpartum protects against delayed child development333

    • Private Sector: Participation in parental groups is expected to increase mental well-being and feelings of social support for employees navigating parenthood310

      Peer support may also help employees navigate the impact of parenthood on their careers

    Efforts in Progress

    • National
      Bright Spots:
      McKinsey’s
      Local Moms Leads
      program designates senior leaders in local offices to counsel new and expecting moms on navigating the workplace and organize group discussions on childcare topics

    • Under Armour’s
      Parents
      for Professional Growth
      provides information, networking opportunities, and support for working parents, as well as opportunities to advocate for new policies and resources to support the career progression of parents

    Implementation Considerations

    • Larger employers can consider implementing cohort support through employee resource groups. Smaller employers can consider teaming with other local employers to form cohort groups

    • While cohort support is powerful, employers should also consider partnering with local healthcare and wellness organizations to provide additional support and education to new parents, as well as tangible resources (e.g., newborn care, breastfeeding supplies) to parents participating in these programs

    • Employers can encourage participation in cohort groups by providing break time to attend meetings and fostering a culture that supports involvement

  • Bolster food & nutrition security
    Solution 3 Bolster food & nutrition security Improve access to quality food, food resources, and public food benefits

    Access to quality food and nutrition education are foundational to advancing health equity; yet many within our region suffer from systemic disinvestment in the food ecosystem that disproportionately impacts residents of traditionally underserved communities. In addition to lacking proximity and affordability of healthy food, communities of color experiencing poverty face barriers to accessing public food benefits, encounter stigma and discrimination in stores, and may lack the resources to obtain nutritious foods.

    These investments will expand access for food-insecure community members and improve employee health outcomes and lower medical costs for employers. Food security can also improve economic mobility as food-secure individuals are more likely to be able to hold a steady job or pursue education and professional training.

    Employers can advance food security by investing in two key areas:

    Recommendations

    Recommendation 1 Access to Healthy Foods Partner with food assistance programs and providers to expand access to healthy food and amplify food assistance programs

    In the Capital Region, between 60% and 80% of residents do not live within a half mile of a grocery store, compared with 50% of the U.S. population.3 Lack of access to healthy food in under-resourced communities is often a result of systemic prioritization of food supply investments to wealthy communities, creating structural barriers to food and nutrition security. In Baltimore City, 1 in 4 people are food insecure.312

    Individuals living in food deserts have a higher risk of obesity and chronic disease due to lack of consistent access to nutritious food.313 Food insecurity also effects employers: loss of productivity from inconsistent nutrition results in an estimated $5.48B annual loss to the U.S. economy314 and food-insecureHH employees see an estimated additional $1,863 in medical costs annually.315

    While there are existing resources available for food-insecure families, some of the main challenges are centered on accessibility— for both families trying to navigate resources and hunger-relief organizations attempting to secure food. Businesses can directly invest in local food ecosystems by partnering with existing food assistance programs to expand capacity and scale impact (e.g., through funding, providing free space, professional services, etc.). Furthermore, employers can support food access by lending expertise to help develop or refine food systems technology—including software and registration systems. These solutions c an reduce barriers to accessing food or registering for food benefits.

    Supplemental Nutrition Assistance Program (SNAP) Enrollment:
    In Virginia, only 72% of eligible SNAP recipients are enrolled in the program (compared with the national average of 82%).
    340

    SNAP-eligible individuals commonly report a lack of computer access and difficulty navigating the application as barriers to enrollment
    316

    Expected Impacts

    • Community: Families across the region will have increased food security and reduced chronic disease risk associated with diet317

    • Private Sector: As food security increases, employee productivity improves318

      Employers save on healthcare costs through reduced employee medical spend, as employee health improves with adequate access to nutritious foods319

    Efforts in Progress

    • Regional
      Bright Spot:
      D.C.
      Central Kitchen’s Healthy Corners

      Programs
      partners with corner stores in low-income communities to offer fresh, affordable produce

    • National
      Bright Spots:
      DoorDash’s

      Project

      DASH allows community organizations to leverage existing DoorDash logistics to increase access to meals, groceries, household items, and school supplies. In Baltimore, United Way of Central Maryland leveraged this infrastructure to deliver meal kits to at-risk seniors

    • Kaiser
      Permanente’s


      Food

      for

      Life
      previously utilized texting campaigns to alert members of their plans that they are eligible for food benefits and assist them in enrollment

    Implementation Considerations

    • Investments should target programs that serve known food deserts in the Capital Region, specifically in Black and Hispanic communities

    • Businesses can consider scaling emerging and innovative technology that connects food suppliers with excess food to community members

    • Employers can consider leveraging their process optimization skills or technological expertise by partnering with public benefit programs to improve existing enrollment processes (e.g., SNAP, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

    Recommendation 2 Public Food Benefits Advocate for increased funding and expanded eligibility for public food benefits

    Public food benefits are critical interventions that are proven to help lift people out of poverty.320 Research shows that food benefits are highly effective at reducing food insecurity and, for low-income children receiving benefits, food benefits improve long-term health, academic performance, educational attainment, and economic self-sufficiency.319

    Food insecurity is a significantly larger challenge for underrepresented communities—Black residents are 93-187% more likely to be eligible for and receive SNAP assistance than white residents
    3

    Even with the October 2021 increase to SNAP benefits, there is still a gap between the provided per meal allocation and the cost of a moderately-priced meal in the Capital Region—ranging from 11% in Richmond and Baltimore to 26% in D.C.320 Furthermore, key population groups are ineligible to receive benefits or can only receive benefitsII for a limited period of time, including most students,321 unemployed adults without minor children,322 and in Maryland, individuals with former drug convictions.323 Yet, these populations demonstrate high levels of need—roughly 1 in 3 university students324 and 91% of recently released felons325 are food insecure.

    Research suggests that nationally 1 in 9 full-time workers may live in poverty.326 Increased funding and expanded eligibility can scale the impact of public food benefits, further alleviating food insecurity and closing the benefits gap for historically ineligible individuals. Businesses can engage in coordinated advocacy to support expanded eligibility and financing of food benefits to improve food security—and thereby productivity and health outcomes—for their employees and community.

    Expected Impacts

    • Community: Expansion of public food benefits will reduce food insecurity among community members and provide additional dollars to spend on food within the local economy327

      Food benefits lead to a reduction in the number of community members experiencing poverty. In D.C., it’s estimated that SNAP keeps 21,000 people, including 10,000 children, out of poverty annually328

      Increased benefits may allow for more nutritious diets and address benefit gaps, such as accounting for food allergies which disproportionately effect Black and Hispanic children329

    • Private Sector: SNAP benefits have demonstrated direct ties to increased economic activity—every $1 invested in SNAP generates ~ $1.70 in economic return319

    Efforts in Progress

    • Regional Bright Spot: D.C.

      Hunger

      Solutions
      and

      Maryland

      Hunger
      Solutions
      set annual policy agendas that aim to reduce food insecurity in the region

    • National Bright Spot: During the COVID-19 pandemic Anthem reached out to Medicaid beneficiaries to help newly-eligible and at- risk members enroll in SNAP and WIC

    Implementation Considerations

    • In parallel with advocacy, businesses can consider internal programs to address employees’ basic nutrition needs, such as subsidized food (e.g., free or reduced cost meals and/or snacks on-site), inclusion of food as medicine in health plans, and subsidized farmers markets at offices

    • Employers should work toward paying family-sustaining wages (
      as mentioned in Pillar 2) to help keep families out of poverty and reduce their need to rely on supplemental public benefits to feed their families

  • Enhance community resiliency
    Solution 4 Enhance community resiliency Partner with existing community initiatives to address health and wellbeing needs and improve access to services

    Disparities in COVID-19 morbidity, prevalence of preventable chronic disease, public health benefit participation rates, and life expectancy at birth highlight the systemic disinvestment in the health of historically underserved communities. The business community can play an important role in

    supporting historically underserved communities in the region, enabling community members to shape a health ecosystem that best serves them. Furthermore, through improved connectivity between community resources, the private sector can support a more proactive health system that identifies needs, connects community members to resources, and measures progress at scale.

    Employers can enhance community resiliency by investing in three key areas:

    • Supporting and/or convening community associations

    • Providing alternative or unused physical space to serve employee and community members’ health and well-being needs

    • Scaling up a region-wide coordinated care network

    These actions will advance the ability to understand and meet community members’ health needs, leading to better health outcomes. Through these investments, employers will also continue to build the value of their brand at a local level and support improved health and productivity among employees residing in these communities.

    Recommendations

    Recommendation 1 Community Associations Support community-led associations in historically underserved neighborhoods that empower community members to identify, design, and implement solutions for key health needs

    The importance of engaging community members has been documented throughout this report; for change to be effective and sustainable, the impacted community must be at the center of the process. The
    Biden
    administration
    recently took action to recognize the importance of community voice at the federal level, requiring federal agencies to consult with members of communities historically unrepresented or underserved in federal programming.330

    Community associations bring together representative community members to work towards a common goal. That goal may look different depending on how the association or board is formed; for instance, a corporation may convene a community advisory group to understand community needs for a specific project, whereas some communities may form their own associations to proactively address problems in their neighborhoods. However, when community advisory groups are convened by corporations, community members often do not trust the convening institutions due to historical disinvestment or they may not have the resources to become actively involved. The business community has an opportunity to rebuild trust and enhance health equity efforts across communities by making financial investments to support community-led associations, with a focus on incorporating perspectives from communities whose voices have not been represented historically, such as communities of color.

    Expected Impacts

    • Community: Community advisory boards amplify the voices and needs of traditionally underserved communities, allowing them to access valuable funding and resources that can improve their health331

      Community-engaged research and advisory councils can help organizations uncover root causes of issues to design targeted interventions330

    • Private Sector: Community advisory boards can help businesses build trust in communities and better direct grant dollars or organizational resources to points of the greatest impact331

    Efforts in Progress

    • Regional Bright Spots: Georgetown
      University’s Office of Minority Health & Health
      Disparities
      Research
      convenes a community advisory council with members representing all Wards of the District, with a particular focus on low-income areas East of the River. Georgetown utilizes the community advisory council in collaboration with community based partnerships to address cancer disparities through research, education, and service.

      In Washinton, D.C., the Southwest

      Neighborhood

      Assembly (SWNA) aims to improve the quality of life for its more than 12,000 residents. SWNA has a variety of programming efforts including working to amplify community voice and task forces that focus on education, health and welfare, recreation and employment and transportation

    Implementation Considerations

    • Community associations are most impactful when they demographically mirror the communities they represent; this avoids disproportionately overemphasizing the needs of subsets of a population

    • Corporations convening community groups to solicit input to programming or services should aim to compensate participating members; this allows members of communities to participate without undertaking an additional financial burden

    Recommendation 2 Repurpose Unutilized Space for Health Care Utilize available corporate or retail spaces to offer accessible and convenient healthcare and/or well-being services to employees and/or community members/or well-being services to employees and/or community members

    Residents of the Capital Region are less likely to live within 5 miles of a hospital than their national peers.3 To enhance access to healthcare and wraparound services, communities need flexible care models with physical locations that are accessible and trustworthy. These locations can be alternatives to traditional hospital and provider locations, which are not always easily accessible to all employees and community members due to location, proximity to public transportation, and operating hours, among other factors.

    Businesses can leverage their physical footprint and available spaces to expand access to care in underserved communities through on-site healthcare and well-being services (e.g., vaccinations, basic primary care services, fitness activities), or the provisioning of space outside of operating hours to provide such services via partnerships with care delivery organizations.

    Employers
    lose
    productivity time
    when employees must travel to seek medical care during working hours; an average patient visit results in roughly 2
    hours of lost working time
    332

    Expected Impacts

    • Community: Individuals experience increased accessibility of care and reduced barriers to care

      Access to primary care has been shown to improve health outcomes and decrease hospitalizations.333 The average cost of a 3-day hospital visit in the U.S. is roughly $30,000334

    • Private Sector: By offering accessible healthcare, employers can expect to see improved health, lowered healthcare expenditures, and increased productivity among employees335

    Efforts in Progress

    • Regional
      Bright Spots:
      United
      Way
      of
      the National Capital Area
      is working with partners across the
      region to increase accessibility of COVID-19 testing and
      vaccinations by utilizing churches, apartment complexes, malls, and
      more, as alternative sites of care

    • MobileMed
      in Montgomery County, MD offers care through multiple mobile van
      locations. They collaborate with faith-based and cultural
      organizations for extensive outreach and engagement and provide
      comprehensive primary care, proactive management of chronic
      diseases, integrated behavioral health, and preventive screening

    Implementation Considerations

    • Employers who have or are developing on-site employee wellness centers can consider opening these spaces to the greater community and/or leveraging them to provide access to after-hours services, when possible, for greatest impact

    • Employers can consider partnering with local nonprofits or provider groups to provide services in these wellness spaces (e.g., clinical, mental health, or other well-being services) rather than hiring their own providers

    • Opening employee wellness centers or providing unused space for community clinics is unlikely to result in financial profit, but businesses can consider a broader return on investment through medical cost savings, increased proximity to customers, and brand reputation

    • Employers pursuing this should work closely with their internal legal and security departments to mitigate any potential risks when designating space for these services

    Recommendation 3 Region Wide Coordinated Care Platform Scale existing coordinated care network(s) that aggregates care, wrap-around services, and public benefits across the region to help employees and other community members better understand/access these resources/access these resources

    Social determinants of health (e.g., health-related behaviors, socioeconomic factors, and environmental factors) can account for 80% of individual health outcomes.336 Identifying and navigating services can be a persistent challenge for community members, especially those who lack access to a primary care provider, such as low-income and front-line workers. While there is an abundance of resources available, lack of awareness and complexity of enrollment present barriers to utilization. Amplifying and extending existing care coordination solutions to create a region-wide network can better connect individuals to local services and resources and improve their autonomy in managing their own health.

    The business community can support this effort by pooling investment funds and/or contributing employee expertise to scale up the development of a single unified, robust, technology platform to support both community members and community health providers with care navigation. The platform will enhance health and community-based organization’s understanding of available offerings by inventorying resources, ease navigation barriers by allowing organizations to make referrals between service providers, and facilitate better understanding of community members’ support networks by tracking patient outcomes across service providers. When employees are able to access these services, their overall health and well-being improves, leading to productivity gains at the employer level.

    Expected Impacts

    • Community: Community members experience reduced emergency department visits and hospital admissions.337

      Increased awareness and referrals result in improved access to community resources (e.g., low-cost healthcare, housing financing and improvement providers, employment agencies, transportation assistance agencies, etc.)

    • Private Sector: Improved accessibility of community resources leads to a reduction in employees’ social needs (e.g., stable housing, consistent food supply), facilitating better overall health and allowing employees to focus more on work

    Efforts in Progress

    • National Bright Spot: NCCARE360
      is the first statewide coordinated care network to electronically connect those with identified needs to community resources and allow for a feedback loop on the outcome of that connection. Funding is provided by a public-private partnership between NC Department of Health and Human Services and the Foundation for Health Leadership and Innovation

    Implementation Considerations

    • Where possible, businesses should look to enhance existing community referral platforms, as opposed to supporting development of net-new tools

    • Successful coordinated care platforms often utilize a group of implementation partners—separate entities that join together to support aspects of the platform such as technical upkeep and maintenance, real-time service navigation, and community-based organization inventorying. Businesses can support the convening of implementation partners by providing funding and expertise
    • Buy-in from community services organizations and healthcare entities is crucial to platform adoption and success

    • The platform should allow for communication between community services organizations and clinical providers to close the loop on referrals and enhance understanding of needs; both stakeholder groups have indicated this as a key feature for success in past studies338

Case Study: CityBlock

CityBlock is a community-based health program that leverages technology to deliver personalized, high- touch care to low-income residents with multiple health concerns. The organization offers physical, mental, and social services and provides integrated care benefits in the following ways:

  • Flexible Care Options
  • CityBlock members can access care virtually, via home visits, or at community care sites
  • Mental Healthcare
  • Psychiatrists and therapists work with members to help manage common mental health issues, as well as the stress associated with chronic medical conditions
  • Community Support

Recognizing that health extends beyond the clinic, CityBlock pairs members with Community Health Partners that help them navigate the care ecosystem from food and transportation to stable housing and reliable means of income

CityBlock works closely with insurers to provide care to targeted populations. Employers should consider working with their insurers to include CityBlock-like services within their plan offerings as they strive for integrated health benefits

Case Study: Unite Us

Unite Us is an outcome-focused technology company that builds coordinated care networks connecting health and social service providers with national operations. Unite Us’ software improves coordination, tracks outcomes, and helps standardize data sharing between payers, providers, government services and social services.

Unite Us’ infrastructure provides both a person-centered care coordination platform and a hands-on community engagement process, working hand-in-hand with communities to ensure services are delivered to the people who need them most.

Partners in the network are connected through Unite Us’ shared technology platform, which enables them to access a variety of functionality in a centralized ecosystem, including:

  • Sending and receive electronic referrals
  • Addressing people’s social needs
  • Tracking every patient’s total health journey
  • Reporting on all tangible outcomes across a full range of services

The platform has a coordinated care network across the Capital Region, built in partnership with Kaiser Permanente and EveryMind, and just received $10M in CARES Act funding in Virginia to become the preferred coordinated care referral system in the state. Through Unite Us DMV, which includes the Mid-Atlantic Community Network funded by Kaiser Permanente, partners are able to send and receive secure, electronic referrals across the Capital Region and surrounding states, ensuring communities and individuals can seamlessly access much-needed resources and services across state lines.

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