Promoting health equity through primary care

Managed care organizations (MCOs) are investing heavily in health equity strategies to reduce disparities among population groups defined by factors such as race or ethnicity, gender, education or income, disability, geographic location, and sexual orientation. As the Institute for Medicaid Innovation noted in the 2021 Annual Medicaid Health Plan Survey, most MCOs employ dedicated staff and/or teams focused on addressing health disparities, health equity, racial equity, and structural racism are formal health equity plan in 2020 with more than two-thirds1

Most MCOs also have screening tools and processes and provide services and supports to meet members’ social needs that may be barriers to health (also known as social determinants or social drivers of health or SDOH). . Health equity strategies are typically directed at internal health plan staff, provider groups, and member populations, with the most common population strategies including “pregnant individuals, LGBTQ+ members, children and adolescents, and people of color.”1

Managed care programs bring value by reducing costs by addressing access and quality of health care services – with a foundational focus on primary care services for prevention, chronic disease management, and coordinating testing and specialist care when needed.

All managed care members are eligible for primary care services, and most health plans automatically assign members to a primary care physician if they do not choose one themselves. Nevertheless, many factors contribute to members in the identified population not accessing primary care, such as health literacy, language barriers, cultural beliefs, structural racism/bias, transportation, etc. For example:

  • Black/African American and Hispanic/Latino were more likely than white Americans to lack a usual source of care as of 2018.2
  • Those living in rural areas are less likely to seek care due to fewer health care providers, medical facilities, and transportation options than those living in urban areas.3
  • People with intellectual and developmental disabilities experience lower rates of preventive screening.4

Having a panel of primary care providers available or assigned to members is also insufficient. It is critical for health equity strategies to go beyond philanthropy and include population-centered systemic solutions to effectively inform and engage members in primary care provided by culturally and technologically trained providers and their Be prepared to meet needs.

Ideally, the strategy is driven by strong national health equity leadership with local clinical and quality teams armed with meaningful data and a shared culture of inclusivity. This enables health equity strategy to be adapted to market specifics and maximize effectiveness, providing solutions that address the concerns of members, primary care providers, and health system stakeholders.

Examples of opportunities include the following:

  • MCO members can support engagement by identifying cultural beliefs and aligning communication and outreach strategies, offering language assistance resources, engaging trusted community partners who can help increase understanding of the population’s care needs, and facilitating care (such as cultural forms focused community organizations, LGBTQ+ organizations, disability support organizations, family-)support programs, etc.), customizing member incentives to the interests of different populations, and addressing transportation and other SDOH barriers.
  • MCOs can support primary care providers By providing information on disparities relevant to clinical disciplines and populations of focus; training on cultural humility, identifying unconscious bias, and improving provider-patient communication; ensuring awareness of appropriate language assistance resources; funding to enhance patient access and experience (accessible equipment for members with disabilities, mobile clinic support, advanced laboratory and other testing resources); and providing value-based payments and incentives for health equity activities and outcomes.
  • MCOs can support health systems By identifying reliable community resources that can enhance understanding of population needs and facilitate access to care, invest in SDOH infrastructure, access and care to members using patient navigators and community health workers access and support capacity development through minority and disability-focused scholarships. and loan forgiveness programs, as well as medical school courses and specialized clinic rotations.

Advancing health equity is central to Eleven’s Health’s organizational purpose of improving the health of humanity. But we are not alone in our understanding of the value that such efforts have in increasing the quality of care for our members and ultimately affecting the overall cost of care. When I first entered industry in 2015 after years of public service, I was both excited and skeptical when a venture leader told me, “We do Well by doing this Good, Promoting health equity through engaging members in primary care that is responsive to their needs and preferences is a great example of that motto in action.


1. Moore JE, Adams C, Glenn N, Landucci R, Serino N, DePriest K. Medicaid Access and Care in 2020: Results from the Institute for Medicaid Innovation’s 2021 Annual Medicaid Health Plan Survey. Institute for Medicaid Innovation. Published on November 2021. Accessed January 20, 2023.

2. Hill L, Arteaga S, Haldar S. Key facts on health and health care by race and ethnicity. Kaiser Family Foundation. Published on January 26, 2022. Accessed January 20, 2023.

3. Elspach JG. Implicit bias in patient care: An endemic blemish on quality care. Crit Care Nurse. 2018;38(4):12-16. doi:10.4037/ccn2018698

4. Escudé C. Advancing health equity and reducing health disparities for people with disabilities in the United States. health matters. Published on October 20, 2022. Accessed January 20, 2023.


Leave a Comment