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Well-being and Workforce Strategy

Health Care Access

Large employers have a unique opportunity to lead the charge in improving access to care for marginalized communities. Taking a broad lens to develop targeted interventions that prioritize affordability, culturally conscious care and high-quality services, employers can realize the value of promoting health equity.

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October 31, 2023

Employer Guide to Health Equity
Employers play a major role in setting the stage for health equity around the world.
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Large employers have a unique opportunity to lead the charge in improving access to care for marginalized communities. Taking a broad lens to develop targeted interventions that prioritize affordability, culturally conscious care and high-quality services, employers can realize the value of promoting health equity.

KEY EMPLOYER STRATEGIES

  • 1 | Increase access to high-quality, affordable physical and mental health care.
  • 2 | Collaborate with plans, providers, and where appropriate, government health care systems, to align incentives, coverage and payment with health equity outcomes.

Below are ideas for action related to each key strategy. Implementing a holistic approach - and when possible, a global approach - will promote equity and consistency throughout the organization.


1| Increase access to high-quality, affordable physical and mental health care.

  • Benefits equity assessment: Conduct a benefits equity assessment to identify gaps in access to care for marginalized populations globally. Look for disparities in engagement, prevalence of conditions and treatment adherence, as well as benefit design choices, such as coverage for gender-affirming care or access to neurodiverse-affirming therapy, that can impact the ability of different employees to reach their highest health potential.
  • Global consistency: Establish a global core benefit standard that aligns with the company’s diversity, equity, inclusion and belonging (DEIB) and health equity priorities. Global consistency enables employers to close gaps in coverage while effectively managing costs, maneuvering through local obstacles and removing barriers associated with access and affordability for employees. Creating global standards for benefits associated with leave and time away, preventive services, mental, physical and financial health, LGBTQ+ care and/or family building can be an incredibly meaningful step toward health equity—and no small feat to accomplish. To create such a strategy, employers need to do an audit to identify benefit gaps, determine what areas they can impact and prioritize areas of focus across a multiyear strategy.
  • Access to high-quality specialists: Where economically feasible for the organization, provide access to Centers of Excellence (COEs), medical travel benefits and/or second-opinion services to give all employees access to high-quality health care specialists regardless of geographical or financial barriers. Once implemented, assess the impact on closing health equity gaps. For example, evaluate if a maternity COE is improving care and outcomes for Black birthing parents, or if travel benefits are being equitably used by different employee populations and resulting in meaningful health outcomes.
  • Virtual and on-site care: Utilize telemedicine, virtual care and on-site and mobile clinics to provide health care access where feasible to employees who may experience barriers such as time, transportation or geographical limitations, such as those living in rural communities or earning lower wages. Such barriers can lead to delayed or unmet health care needs. Also, ensure that on-site and virtual offerings are tailored to the needs of hourly workers through after-hours availability and scheduling flexibility. Again, assess if virtual and on-site care offerings are reducing disparities in engagement, experience and health outcomes among marginalized populations.
  • Enhanced out-of-network (OON) coverage or supplemental insurance: When necessary, provide enhanced OON coverage (e.g., paying OON providers in-network rates to defray the costs for employees) or supplemental insurance, particularly for mental health providers and/or specialists who meet the unique needs of marginalized populations.

Employers in Action

Cognizant Offering Interest-Free Health Loans: Cognizant aims to support colleagues with their health and well-being through a range of health care benefits. They acknowledge that there are certain elements of an associate’s health that may not be covered by the current array of health benefits. To address this need in the UK, the company offers an interest-free health loan to help fund the cost of treatments not covered by Cognizant’s private medical insurance, such as fertility treatment, gender reassignment surgery, dental implants and cosmetic surgery associated with gender-affirming care. By reducing financial barriers that would have prevented employees from managing their health care expenses effectively, Cognizant allowed participants to prioritize their well-being, regardless of their financial resources.

Linde Supporting Employees Reaching Out-of-Pocket (OOP) Maximums: Years ago, Linde decided to base its OOP maximum on employee salary through a six-tier schedule. After analyzing medical and pharmacy claims, certain families were consistently hitting their OOP maximum. Linde realized that even though the OOPs were pay based, hitting that number each year was still financially burdensome. So, the team determined who met their OOP spending for two consecutive years and then offered these individuals a plan called the Out of Pocket Relief Plan. This new plan covered health expenditures at 100% once the employee had reached their deductible. By eliminating the financial burden for employees with severe medical conditions who consistently incurred high medical expenses, Linde has ensured that access to necessary health care remains consistent and affordable for those with severe medical conditions consistently incurring high medical expenses.


  • Assessment of health care affordability: Examine health care utilization to determine if members are acting in a way indicating they may be underinsured (e.g., avoiding treatment, forgoing prescribed medications). These can be signals that some employees are having difficulty affording out-of-pocket costs. Avoiding or deferring appropriate care can further exacerbate health inequities.
  • Income-based coverage: Adopt a sliding scale model for health insurance premiums based on income levels to alleviate the financial burden on vulnerable and marginalized populations. Moreover, employers can improve affordability for low-income families with limited funds available for higher out-of-pocket spending by providing targeted HSA contributions for those participating in high-deductible health plans or access to low-deductible health plans.

Large Employers in the U.S. Aim to Improve Access and Affordability

92% have COEs

70% offer no or low-cost virtual counseling

69% design pharmacy benefits to improve patient affordability

68% offer a health plan option with lower deductibles or coinsurance

53% have on-site clinics

38% offer wage-based cost sharing

For more large employer benchmarks, review the 2024 Large Employer Health Care Strategy Survey Report.


  • Equitable access to medication: Aim to integrate equity into formulary design decisions by evaluating if/how choices to cover or not cover medications and treatments may disproportionately impact different populations. Also, employers may consider auditing processes to identify and prevent potential vendor/provider biases, such as looking at prescribing patterns and prior authorization approval rates by demographics. Employers can also take steps to address pharmacy deserts by offering a mail order pharmacy option. Lastly, to help address affordability, employers can aim to educate employees that income-based assistance may be available through co-pay assistance programs offered by manufacturing companies. Local government and community organizations may also offer income-based financial assistance for prescriptions and treatments.
  • Supplemental insurance, stipends and loans: Where public health care options exist (predominantly outside the U.S.), offer supplemental insurance to address existing exclusions and establish global consistency. For example, if gender-affirming care or domestic spouse coverage is not available through public health care, employers can provide coverage through supplemental insurance, where legally possible. Captives can help employers overcome local barriers and provide control over cost and design. Alternatively, employers can consider a stipend, reimbursement or interest-free loan equivalent to the benefit.
  • Time away benefits: Offer paid sick and medical/disability leave to promote financial support and job security when employees need to take time off for medical reasons. Globally, employers can top off benefits offered by government programs to ensure that employees are 100% paid and do not have to choose between financial security and health care engagement. Additionally, ensure that relationships eligible for leave match an organization’s DEIB philosophy, such as including domestic partners or chosen family.
  • Critical illness insurance: Offer critical illness insurance (also known as dread disease insurance) where globally available. This benefit provides policyholders a lump sum payment if an employee or covered dependent is diagnosed with certain serious and life-threatening conditions, including cancer, strokes, transplants and more. It can provide needed financial security during what are often difficult health experiences with large costs.
  • Employee Assistance Programs (EAPs): Establish EAPs (or similar dedicated mental health services) available to all employees at no or reduced cost, regardless of benefits eligibility, position or location, and ensure that the program provides equitable access to mental health care professionals and offers provider-patient concordance – when patients and providers have a shared identity – for interested patients. Where feasible, work with service providers to increase language and cultural alignment.
  • Financial security benefits: Implement financial well-being benefits to reduce financial barriers for those seeking medical care or purchasing medications. Offering an emergency savings account and automatically enrolling employees, when permitted, can help them save for unexpected medical expenses. Employers may also consider providing employees with the option to access earned wages before payday.

Examples of Global Access and Affordability Challenges

Access and affordability are cornerstones to achieving health equity, and both are challenges for employers worldwide. Below are a few examples of barriers across the globe. It is important to note that employers are not responsible for solving these problems; rather, awareness and understanding of local challenges and how they affect a company’s workforce can inform benefits design and implementation, as well as advocacy efforts.

China

  • Rural quality deserts: Large and midsized cities often have better access to high-quality medical care and resources than rural communities.2
  • Underinsured: Individuals living in rural areas were more likely to have low-coverage insurance (72%), while individuals in urban areas had the highest proportion of high-coverage insurance (39%). There is also a relationship between education and insurance type; those with a college or above education are more likely to have high-coverage (46%) compared to those with high school (27%), primary school (12%) or no education (10%). It’s noteworthy that those with high coverage are more likely to engage in regular checkups, primary care and inpatient care.3

India

  • Provider shortage: In 2022, there was only one government-employed medical doctor for over 10,000 people.4
  • Lack of hospitals and beds: There was only one state-run hospital for over 90,000 people in 2022, and the hospital beds-to-people ratio was .5 per 1,000 people.4
  • Rural disparity for specialized care: A lack of specialized care in rural areas is a challenge. In 2022, there was a nearly 80% shortage of surgeons, physicians, gynecologists and pediatricians in India’s rural community health centers.5

Mexico

  • High out-of-pocket medical expenses: It is estimated that more than two million households spend over a third of their income on medical costs every year.6
  • Provider shortages: There are only 1.95 doctors per 100,000 people, while the Organisation for Economic Co-operation and Development (OECD) recommends at least 3.2 doctors. Additionally, there are only 2.85 nurses per every 100,000, while the OECD recommends at least 8.8 doctors.7

United Kingdom

  • Provider shortage: Staff shortages and underfunding of the National Health System has led to long wait times, with many low-income patients waiting over a year for treatment.8

United States


2 | Collaborate with plans, providers, and where appropriate, government health care systems, to align incentives, coverage and payment with health equity outcomes.

  • Data-driven approach: Establish and communicate the expectation that vendors provide accurate and timely data in a digestible format to enable analysis and identification of gaps in offerings to determine disparities in engagement, treatment adherence and outcomes, where legally permissible. Outside the U.S., captives can provide a means to data employers might not otherwise be able to access.
  • Vendor selection and shared goals: Use the Request for Proposal (RFP) process to make vendors aware of company expectations and commitment to promoting cultural competence, diversity training for staff and initiatives to engage underrepresented communities, with the goal of bridging gaps in health care access and improving overall health equity.
  • Vendor partner accountability: With new and current partners, establish shared health equity goals and maintain accountability through regular interactions and reports/ metrics related to equitable distribution of services, health outcomes across the globe and reduction of disparities.
  • Value-based care: Where feasible, explicitly address equity through a value-based care approach incorporating reporting requirements and financial incentives that align with reducing inequities. When negotiating with potential partners, employers can also consider the inclusion of language related to assessing and addressing social needs, as well as reporting on provider training and engagement in health equity improvement.
  • Provider metrics: Encourage, and where possible, require vendor partners to use publicly accessible quality measures such as HEDIS (Healthcare Effectiveness Data and Information Set), CAHPS (Consumer Assessment of Healthcare Providers and Systems) and ICHOM (International Consortium for Health Outcomes Measurement) to evaluate provider quality and focus on health equity. By analyzing metrics like the CAHPS Cultural Competence measure, employers can gauge how successfully providers communicate and interact with patients from diverse cultural backgrounds. They can then mobilize this data to select plans and providers with higher scores, indicating that they are more capable of delivering care tailored to the needs of specific employee populations.

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TABLE OF CONTENTS

  1. Increase access to high-quality, affordable physical and mental health care
  2. Collaborate with plans, providers, and government health care systems