April 30, 2021
Disparities in health access and outcomes by age, race, ethnicity, nationality, gender identity, education level and other demographics persist within health care systems worldwide, as evidenced in varying maternal mortality rates and chronic disease burden, among other issues. Efforts to address these disparities have focused on providing equal access to care and engaging higher-risk populations as early as possible in their care journeys. However, the degree to which employees feel empowered to seek the services of medical providers or utilize other targeted solutions depends on their overall comfort and trust. Cultural attitudes toward health and related health care services and programs often influence how and when individuals interact with the health care delivery system, underscoring the importance of adopting a culturally conscious approach to benefit strategy and communications.
As employee populations grow more diverse, acknowledging the continuum of cultural consciousness and designing the benefit programs in culturally competent ways and avoiding a “one size fits all approach” will enable employers and their partners to better engage and support their member populations in their health and well-being. Movement along the cultural consciousness continuum requires an organizational shift from diversity awareness to cultural competency. Embracing cultural humility as an organizational commitment and promoting overall equity requires continual self-evaluation and assessment. Cultural competency alone will not solve health care disparities and other health equity gaps, but it can help mitigate them by fostering a more transparent and trusting relationship between employers and their employees, as well as health and benefit program providers and clinicians.
Cultural consciousness is particularly important within employee benefits, as cultural attitudes toward health and health care can have significant health and well-being consequences. Employers, their vendors and medical providers themselves can support employees/patients better if they act and communicate in culturally competent ways.
Below are the steps employers should consider as the strive to communicate about and provide culturally competent services.
A gap analysis is a great place for many employers to start. In doing so, some employers may choose to leverage the resources of external consultants, particularly those who specialize in equity, diversity, and inclusion (EDI) and can take a holistic look at an organization’s suite of programs. This inventory can help employers gauge their current programs objectively and determine how effective they are in meeting the diverse needs of their entire workforce. This inventory can also reveal where gaps may exist and how to bridge them. Finally, such a specialized review can provide tangible suggestions and recommendations for adjusting benefits to better support EDI initiatives.
Assess Communication Strategy
For employers, the most natural place to start working toward achieving cultural competency as it relates to their health and well-being strategy is by reviewing internal benefit communications as well as the processes used to create and disseminate them.
When launching communication campaigns in any medium (email, intranet, home mailings or otherwise), using inclusive language and accessible formats to better engage target employee populations is crucial.
- It is essential not to inadvertently alienate employees by using coded or tone-deaf language; featuring team members with varied perspectives on communication teams (and pushing for partners to do so as well) can prevent the dissemination of messages that end up ostracizing target populations or otherwise discouraging them from engaging with solutions or initiatives.
- Occasional communication missteps are unfortunate but largely unavoidable. Building credibility and trust among employees depends on being accountable for these missteps when they occur. Assuming responsibility for mistakes shows a commitment to transparency and is an indication that the employer is willing to learn from them and improve going forward.
Steps towards achieving cultural competency include:
- Consider trainings for communication teams on addressing implicit biases to better inform how messages are framed and positioned. This can also assist in developing more effective, targeted, culturally competent messaging that is based on the characteristics of the target populations.
- Leverage relationships with employee resource groups (ERGs) and garner and integrate feedback on key communication campaigns to disseminate information on benefits in a way that resonates best with the various demographics of your employee population.
- Consider collecting feedback on an ongoing basis via broader employee surveys and other qualitative methods (e.g., focus groups and interviews) to demonstrate your company’s commitment to engaging employees sincerely and authentically. To the extent it is feasible, integrate the feedback into future communication strategies.
Communications and programmatic decisions related to health and well-being benefits are the joint effort of employers and the multiple partners they work with. Therefore, an assessment of cultural consciousness and efforts to achieve cultural competency would be incomplete if it did not include a review of the policies and offerings of external partners who engage directly with the employees to support them in their health and well-being journey.
Here are some questions and considerations to discuss with your partners when evaluating your benefit offerings to ensure that the employees most likely to benefit from programs feel empowered to take advantage of them:
Provider Networks and Centers of Excellence (COEs)
In an ideal world, provider networks should feature panels of diverse clinicians who reflect and understand the diversity of the workforce and patients they serve. Some populations are more reluctant to seek care if their providers do not come from a similar background or if they feel their providers may not understand their unique needs.
Steps toward achieving cultural competency in offerings managed by health plan, providers and other partners include:
- Ensure that provider directories are regularly updated with information relevant to members seeking in-network clinicians with similar backgrounds. Such information may include expertise/subspecialty (e.g., LGBTQ+ health care competency) as well as language(s) spoken by the provider and/or staff and pictures of providers.
- Evaluate health plan generated member communications as well as processes to reach culturally diverse audiences; for example, ensure that active efforts (e.g. awareness campaigns, etc.) are in place to engage those who are not regularly completing preventive screenings or immunizations.
- Evaluate if high-quality providers are in-network and/or accessible to the LGBTQ+ population. Consider implementing COEs for transgender health needs, particularly for those seeking fertility treatments.
- Provide inclusive family planning benefits (e.g., adoption/surrogacy coverage and/or reimbursement).
- Promote enrollment of employees of all backgrounds in clinical trials and ensure that the costs associated with participation are covered. This will help address the lack of diversity among participants in clinical trials.
Virtual care has been touted as a rapidly growing and evolving means to address access gaps for those living in communities where physician office locations may be geographically dispersed, making it difficult for patients with limited access to transportation to reach them. Virtual solutions also offer a more convenient way to access care for those less able to take time off for office visits. However, availability of virtual services does not necessarily equate to members having the ability to access, as broadband access is still not yet universal.
With these issues in mind, steps to take to achieve more widespread use of virtual solutions include the following:
- Consider implementing flexible operation hours for telemedicine services (or the availability of 24-hour hotlines), as well as support for multiple languages. Doing so takes the needs of multilingual workers and those who may work nontraditional shifts into account.
- Some employees feel more comfortable with calls and texts versus video visits. Evaluate which modalities are supported within your virtual solutions and how visits are triaged to ensure that members receive the appropriate level of care for their concerns.
- Assess technology barriers within your population and analyze utilization patterns to assess if virtual solutions meet the needs of those impacted by access challenges.
Navigation, concierge and second-opinion services
Concierge programs aim to support members who may have received a complex diagnosis or otherwise need help getting to the right provider at the right time. Second-opinion services often catch inaccurate diagnoses, preventing unnecessary surgeries or other treatments from being administered to those who may not actually need them. Shared decision making when making treatment decisions is also essential. However, some populations may be more reluctant to question their providers as they determine their diagnosis and treatment. Therefore, vendor partners should prioritize empowering employees to not only seek navigation services and second opinions, but also to ensuring that the guidance they receive is appropriate to individual circumstances and preferences.
Steps toward achieving cultural competency for these services include:
- Concierge/navigation programs should be staffed by representatives of various races, gender identities and cultural backgrounds so that members feel comfortable engaging and sharing their health information with them.
- Vendors should ensure that adequate counseling is provided to members (using inclusive language and accessible formats), making it easier for them to understand their diagnosis and treatment options, as well as implications for their quality of life going forward.
Mental/Behavioral Health Services
Mental health stigma has deep cultural and societal roots and has long been an obstacle to members seeking needed services to address their emotional well-being. These stigmas may also contribute to the higher likelihood that Black, Latinx and Native American people with mental health needs experience involuntary hospitalizations as a result of seeking care.
Below are some strategies to explore as you develop a mental health strategy centered in equity, diversity and inclusion:
- Conduct campaigns promoting behavioral health services must acknowledge these “attitude roots” and leverage trusted messengers to empower members to seek earlier interventions before their concerns become significant enough to impact daily tasks and responsibilities.
- Consider engaging community-based organizations to elevate the voices of trusted community leaders (e.g., barber shops, local business owners, church officials, etc.) when discussing the importance of seeking help for behavioral health concerns. Testimonials that come from members of under-resourced communities tend to resonate better than broader communication efforts and storytelling.
- The prevalence of serious mental illness (SMI) among people of Black, American Indian/Alaskan Native and Hispanic descent tends to be higher than in white populations, although they are less likely to receive ongoing treatment for depression and other mental health conditions1. When implementing enhanced mental health networks or initiatives, ensure that the benefit features enough visits to adequately address members’ situations, as well as proactive follow-up by the provider/platform to maximize overall adherence to treatment/therapy regimens.
- Conduct trainings for managers on how to address mental health stigma and engage employee resource groups (ERGs) to target messaging on sources of stigma related to cultural values.
- Provide specific accommodations to employees in the workplace who are non-neurotypical (including those with Autism Spectrum Disorders [ASDs] or other developmental differences), including scheduling flexibility and the ability to adapt their workspace.
Employers have more control over services offered on-site, whether internally operated or in partnership with external vendors. This provides opportunities for staffing such sites with providers who are more conscious about cultural barriers and diverse needs of specific populations. Some examples include:
- Offering on-site clinics, which can facilitate access to primary care for employees and their families who may not otherwise visit PCPs regularly.
- Removing barriers to accessing services, such as by offering scheduling flexibility, after-hours availability and providing virtual services via on-site clinical staff.
Steps towards achieving cultural competency for on-site service offerings include:
- Ensure that clinicians and other staff operating on-site facilities are diverse in their cultural backgrounds and demographics.
- Design targeted communication campaigns on preventive screenings that can be done on-site to address limited access to transportation and other barriers.
- Design on-site offerings around the needs and schedules of hourly workers.
Cultural humility, as defined above, is the highwater mark with respect to committing to continuous self-evaluation and ensuring that all communities feel empowered to seek the care and services they need to maintain a healthy and fulfilling lifestyle. Conducting a comprehensive evaluation of health and well-being benefits will not only reveal areas for improvement in more effectively engaging members in their health but can also build a more trusting and transparent relationship with your employee population as a whole.