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Fighting Health Disparities With Unconventional Weapons

At the State of Reform conference for North Texas, leaders discuss how they improve health via social determinants.

Before COVID-19 hit Texas, nearly 18 percent of adults across the state lacked health insurance, the highest uninsured rate in the nation. When the pandemic caused historic layoffs and bankruptcies, the number of uninsured jumped to a shocking 29 percent of adults under 65, according to consumer health advocacy group Families USA. That’s 8 million Texans with no coverage in the middle of a pandemic.

At the 2020 North Texas State of Reform Virtual Health Policy Conference, health executives gathered to discuss the current crisis and possible solutions. During a panel focused on social determinants of health’s role in shaping healthcare, Elena Marks, chief executive officer of Episcopal Health Foundation, moderated a discussion about health disparities of race and demography. Michelle Bentzien-Purrington, vice president of long-term services and supports at Molina Healthcare of Texas, and Shara McClure, divisional senior vice president of BlueCross BlueShield of Texas, shared their insights.

The facts are grim. Although 71 percent of Texans do receive health insurance, the low-income families among them still face financial barriers when seeking care. BlueCross BlueShield’s Shara McClure discussed problems faced by individuals who are enrolled in healthcare, but can’t cover co-payments or deductible fees. The healthcare insurer’s investment and partnership with organizations like Sanitas Medical Center allows patients opportunities for primary care, urgent care, and bilingual services without having to worry about additional fees.“With this product, individuals can visit the Sanitas clinics for their primary care with no cost share and zero co-pay,” McClure says. “We think that helps with the barrier.”

While financial support ultimately comes out of BlueCross BlueShield’s revenue, these services are sustainably funded through premium medical loss ratio (MLR) in an effort to serve surrounding communities in need, McClure says.

In addition to lacking health insurance and the inability to afford co-pays, Molina Healthcare Vice President Michelle Bentzien-Purrington has seen the adverse effects of housing and transportation disparities, especially on low-income senior citizens and pregnant women.

Through the healthcare organization’s partnership with Prospera Credit Unit, Bentzien-Purrington says they have been able to serve low-income individuals with outreach solutions intended to build communities. Molina Healthcare pairs people at Prospera facilities with health care professionals to identify medical and social needs that are unmet.

“We help people on a case-by-case basis,” Bentzien-Purrington says. “As a result, we have seen a reduction in emergency department utilization and avoidable hospital admissions. Even more importantly, we see older adults staying in their communities rather than being admitted to long-term care institutions.”

In other parts of the state, Molina Healthcare has worked to lower the percentage of low birth weight babies. In the Houston area, nearly 10 percent of babies are born below a healthy weight, according to Bentzien-Purrington. One likely cause of this problem is the lack of options provided to low-income expecting mothers who cannot afford to transportation medical visits. These issues have been exacerbated by the pandemic, as many individuals aren’t comfortable riding public transit.

To address this growing need, Molina Healthcare works with children’s policy non-profit Texans Care for Children to pilot non-emergent transportation for pregnant mothers who need it on short notice, including discharge planning and transportation after the baby’s birth.

“It sounds like a small thing,” Bentzien-Purrington says. “But providing a safe ride home for a woman and her baby and solving that transportation barrier is about providing access to care and services, which directly affect the low birth weight baby percentage.”

Regardless of COVID-19, Texans face many other health disparities due to race and demography. In 2018, BlueCross BlueShield of Texas began to study COPD and chronic kidney disease, with specific focus on their disproportionate effects on African Americans and Hispanics.

Through BlueCross BlueShield’s Healthy Kids Healthy Family program, interventions were designed in multiple communities to reduce the prevalence and severity of these issues. After approximately $13 million in investments, the healthcare provider has seen major results.

“We pretty quickly saw $6 million to $12 million in savings, because prevalence costs,” McClure says. “People were establishing relationships with health care providers and primary care physicians. Keeping people out of the emergency room is a major driver.”