Guest Blogger: Bob Cohen, Esq.; Policy Director, Citizen Action of New York

• A primary care physician failed to find a woman’s breast lump, because the physician always examined her as she sat in her wheelchair.
• Nineteen percent of physicians questioned in a 2007 study reported that they were uncomfortable treating LGBT patients.
• Black New Yorkers have a much higher mortality rate than other groups of New Yorkers, while Hispanic adults have the highest rates of asthma of any group of New Yorkers.

As the four expert panelists at a September 7^th Stakeholder Meeting sponsored by the New York State Health Benefit Exchange explained, people of color, women, people with disabilities and other traditionally underserved groups often receive an inferior quality of care from the health system, sometimes resulting in poorer health outcomes.  The Stakeholder Meeting was designed to begin a public discussion on the problem of health disparities and how to address it through the exchange.

The agenda and some of the powerpoint presentations from the meeting are available here.

If you missed the meeting, you can watch a webcast here.

The presentations by the diverse group of panelists had two complementary themes:

• Health care exchanges can begin to address health disparities by enrolling more residents and targeting enrollment efforts to key constituencies like people of color and immigrants.   Data indicates that the lack of health insurance is a major reason for health disparities.  It follows that if the state enrolls over one million additional New Yorkers through the Exchange as projected and targets its enrollment efforts to traditionally underserved groups, one result will be better health outcomes for all New Yorkers, particularly members of traditionally underserved groups.

• However, added enrollment, while extremely important, is not enough.  According to the panelists, many factors play a role in discouraging people of color, gays and lesbians, the disabled and members of other traditionally underserved groups from seeking care or receiving quality care. These factors include, among many others: a lack of understanding by doctors and other providers of their particular needs, long wait times for appointments with doctors and other providers, lack of cultural competence or language access, and lack of availability of doctors and other health professionals at times when working people can go to appointments.

Starting in 2014, the Exchange will present an enormous opportunity for New York to address the needs of these groups and to reduce health disparities.  HCFANY has proposed that the Exchange consider a number of steps, including: targeted enrollment; collecting and analyzing data on health disparities; outreach, Navigators, and consumer assistance program that uses community-based organizations to reach underserved communities;   and cultural competency training.

Participants at the Stakeholder meeting had plenty of feedback for the Exchange – so much so that the time for comment ran out before the comments did. To allow consumers to continue the conversation, the Exchange has asked stakeholders to submit written comments addressing three questions:

1. The insurance exchange will have a number of consumer assistance features that will enable consumers to choose a health plan that works for them. These features include a call center/hotline, website portal, and navigators and other consumer assistors. To ensure that hard to reach and vulnerable populations know about, feel comfortable with, and can access these services, what are examples of consumer service functions that have been successful in other settings? What made them successful?

2. The Exchange will review network adequacy, including the availability of Essential Community Providers, of insurance plans.  What are some of the best practices to ensure that hard to reach and vulnerable populations have access to health services such as primary care, vision and dental care?

3. Data collection is an important tool for documenting health disparities on a population level.  What are best practices on data collection (at the insurance plan level) to reduce disparities? What kinds of data should be collected, from whom should it be collected, and how should it be reported?  Are there best practices on translating data into practice? If consumers are sensitive to providing personal data, how can this be addressed?

If you would like to submit comments on these questions, you can do so through the page with the meeting webcast.  To view the meeting or to submit a comment, click on “Click here to play” under Health Benefit Exchange Stakeholder Meeting heading. Once the meeting site is accessed, comments can be submitted by selecting the “Participate” tab.

HCFANY will be submitting comments on these issues and more, and asking the Exchange to establish an ongoing process to identify and implement ways that the Exchange can increase health equity for all New Yorkers.