Where do DEI and healthcare meet?

Employee benefits are often evaluated on a corporate balance sheet in terms of value — the delta between positive outcomes and financial outlays. But for many companies, the benefits they provide to employees also embody the company's own fundamental values. 

In the wake of a resurgent social justice movement — and supported by research that shows a strong correlation between a company's diversity in leadership and its economic performance — many companies have embraced diversity, equity and inclusion (DEI) as a core organizational value. Some have done so in consultation with their producer partners. 

Beyond public relations statements, this commitment is exemplified by a steady increase in the establishment of diversity councils and chief equity officers in boardrooms across the world. These companies are banking on the promise of more inclusive, informed and creative workplace environments bolstering their bottom line and competitive edge.

Of these three "DEI" concepts, "equity" is perhaps the most abstract notion. Not to be confused with its close cousin, "equality," equity prioritizes identical outcomes rather than identical resources.

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With the COVID-19 pandemic having laid bare certain fundamental health disparities, employee health has emerged as a central focus in the drive toward equity. Optimal health and well-being is, after all, the ultimate outcome, with the potential added bonus of improved employee engagement and productivity. 

Furthermore, academics have been tracking social determinants of health: factors that are directly correlated with the quality of a community's overall health, such as economic stability, housing, transportation, nutrition and race or ethnicity. This groundwork provides the basis for interventions that employers, as investors in their communities, can bring to bear.

Finally, self-insured health plans also have the advantage of copious data that can be used for analysis and improvement — or so it would seem. 

Following the premise that health plan data can be leveraged to address racial and ethnic disparities and thereby advance health equity, the American Benefits Council teamed with the Urban Institute and the Deloitte Health Equity Institute, with support from Elevance, to study the issue.

Some findings were unsurprising. Racial and ethnic data remains incomplete, inconsistent and not easily shared across different entities in the healthcare sector. This makes it difficult to identify and track health inequities and evaluate efforts to reduce them. These barriers are steep and will be difficult to surmount. Aside from the obvious technical interoperability challenges and lack of standardized data collection, there are concerns about legal impediments and litigation risks with collecting and sharing such data. The same goes for deeply embedded societal challenges rooted in a lack of trust and trustworthiness.

In conjunction with the project, Deloitte conducted an online survey of more than 3,300 adults regarding their willingness to share various types of data across different organizations and systems. The firm found that while 79% of respondents said they were comfortable sharing race and ethnicity data with their insurance providers, 59% also cited concerns about sharing such data with their "healthcare provider, insurance company and/or community-based health organization" due to discomfort about how the information would be shared or sold to others without their consent.

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Meanwhile, employer confidence is at the center of our most surprising finding. A legal analysis conducted by two well-respected employment and benefits law firms found "no state and federal laws that bar employers, third-party administrators or group health plans from collecting and sharing race and ethnicity data for a permitted purpose, such as reducing health disparities." Nevertheless, an informal survey of American Benefits Council companies found that a majority of employers are largely hesitant to do so. They commonly cite a lack of clarity around legality and permissibility, and the corresponding concerns about employer/employee relations and the risk of litigation.

Eliminating these misconceptions is critical for ensuring more data sharing by employers, but it goes beyond a mere educational campaign. Clarification from the federal government, preferably through a joint effort incorporating the numerous relevant agencies and set of data reporting standards and guardrails, would help move the needle. In essence, it would signal to employers that collecting and sharing this data is not just permissible, but actually encouraged.

Trust is an essential component of any employee benefits program. Workers and their families need to feel confident that their healthcare coverage and retirement savings will be there when needed. National surveys over the previous two election cycles tell us two things, consistently: first, employer-provided plans are far more trusted than other sources of health and financial security, such as the government or individual market. That said, when employers are named as the "most trusted" by just 53% of those surveyed, there is room for improvement. 

As a key stakeholder in providing affordable, high-quality benefits to American families, employers have the stature and opportunity to make strides toward real health equity with sound counsel from their brokers or advisers. We're looking to the federal government to light the way. That's not just delivering value — it's delivering on the values we all share.