SummaryVerizon adopted a policy related to selection of health plans and vendors that emphasizes the applicant's ability to identify and/or address health-related disparities among employees, family members, and retirees. Verizon and its selected vendors then work together to analyze extensive, aggregate data to identify disparities, and to offer a range of programs and services to reduce them. This initiative has significantly enhanced access to important health information and screening services for racial and ethnic minorities covered by the company.Suggestive: The evidence consists of post-implementation data on the number of minorities covered by Verizon who have received health information and/or screenings, with data generally supplied by the company's vendors.
Date First Implemented2003
Vulnerable Populations > Racial minorities
Problem AddressedSignificant health disparities exist between white and nonwhite Americans. For employers, especially those with diverse workforces, these disparities can increase absenteeism, employee turnover, and the costs of health benefits, and reduce productivity. Companies can reduce health disparities and their associated problems by proactively identifying the most significant gaps in care and implementing programs to address them, but relatively few companies have the information or skills needed to do so.
- Significant disparities between white and nonwhite Americans: African Americans, Hispanics, and other minority groups experience higher rates of chronic illnesses such as diabetes, cancer, and cardiovascular disease than whites, regardless of economic and health insurance status.1 These disparities often have a gender component, with minority women facing higher risks than white women. For example, Hispanic women are more likely to be diagnosed with advanced cancer than white women, and breast cancer is the leading cause of death for Hispanic women and some groups of Asian-American women (who have among the lowest mammography screening rates of all women in the United States).2 Verizon, with a workforce of nearly 190,000 people that includes more than 36,000 African Americans and 19,000 Hispanics, has documented many health disparities among its employees. (See the Description of the Innovation section for more details.)
- Negative effects for employers: Health disparities have major financial implications for employers. They can drive up the costs of providing health benefits; reduce productivity; and drive up absenteeism, turnover, short- and long-term disability costs, and workers' compensation claims.2 At Verizon, overall health care costs exceed $3.5 billion, so it is critical to ensure that this investment includes a multifaceted approach to managing costs and quality.
- Missed opportunity to address disparities: Companies that put in place proactive programs to identify and reduce health disparities (e.g., prevention, screening, and treatment programs specifically designed to reach certain ethnic and racial groups) can potentially reduce the costs of medical claims for serious conditions. Yet relatively few companies have the information or the skills needed to identify and address disparities on their own, and even fewer look for such capabilities when selecting vendors.1
Description of the Innovative ActivityVerizon adopted a policy related to selection of health plans and vendors that emphasizes the applicant's ability to identify and/or address health-related disparities among employees, family members, and retirees. Verizon and its selected vendors then work together to analyze extensive, aggregate data to identify health disparities, and to offer a range of programs and services aimed at reducing them. Key elements of Verizon's disparity-focused selection policy and the resulting information, programs, and services it has generated are outlined below:
- Heavy emphasis on disparities in selection process: Verizon explicitly considers vendors' willingness and ability to identify and/or address health disparities when renewing contracts or choosing vendors for new health-related services. Verizon's requests for proposals (RFPs) include a series of disparities-related questions, such as whether disease management programs include culturally targeted components, how communication materials specifically address cultural health concerns, and if the health plan or vendor can collect racial or ethnic data that will allow for the development of culturally sensitive programs or initiatives (and if so, how such data are collected). For health plans, Verizon also asks for a description of the racial and ethnic makeup of their physician network. These questions typically have been part of a larger questionnaire that vendors fill out covering their scope of services. In making its decisions, Verizon heavily weighs the responses to the disparities-related questions. For example, Verizon has used these questions to help in selecting health plan vendors since 2005, when the company began consolidating the number of insurers it uses nationwide through long-term contracts (3 to 5 years instead of 1 year). Health plans that make identifying and addressing disparities a priority align with Verizon's health care objectives.
- Selection of vendors able to collect, analyze data on race and ethnicity: As part of its selection process, Verizon chooses insurers and other vendors that proactively encourage enrollees to voluntarily report their race and ethnicity and have the ability to capture and analyze this information in conjunction with claims data. For example, in 2006, Verizon contracted with WebMD to set up a customized portal that employees and retirees use to access health information. When employees and retirees sign up, they are invited to respond to a questionnaire that covers health history and their race and ethnicity. Employees complete the assessment annually, and WebMD supplies information in aggregate form to Verizon, including demographic breakdowns of data on workforce health.
- Use of information to identify disparities: Information from health plans and vendors has allowed Verizon to identify health disparities among employees, family members, and retirees, as described below.
- Cancer screenings: Significant racial and ethnic disparities have been found in the percentage of Verizon-covered individuals receiving cancer screenings. For example, a higher percentage of minority women than white women were due for mammograms and Pap smears.
- Chronic diseases: Significant racial and ethnic disparities have been identified in the percentage of Verizon-covered individuals with chronic diseases, such as heart disease, diabetes, and breast cancer.
- Disparities-related programs and services: Once health disparities have been identified based on aggregated data, Verizon works with its selected vendors to develop programs and services specifically designed to address them. For example, through WebMD, employees routinely receive a health assessment with advice on ways to improve their health, along with e-mails tailored to their racial and ethnic background. In addition, data on race and ethnicity have been used by vendors to set up prevention and screening programs specifically targeted at identified disparities. Examples include the following:
- Health plan–based mammography initiative: In 2008, a health insurer (Aetna) launched the Breast Health Education Disparities Initiative, which sent a letter to minority women covered by Verizon who had not had a mammogram in the previous 15 months. In another program, a different insurer (Anthem Blue Cross/Blue Shield) sent out a fact sheet to 81,000 women ages 35 and older encouraging them to get a mammogram. The sheet included facts about breast cancer, with an emphasis on disparities in screening rates between minority and white women.
- Onsite breast cancer screening: Since 2006, Verizon has contracted with external providers in eight states (Arizona, Georgia, Maryland, New Jersey, New Mexico, Ohio, South Carolina, and Virginia) to offer onsite mammography screening to employees. The company targeted locations with large numbers of minority women ages 35 and over. In 2011, Verizon expanded this service to locations in Florida and Texas.
- Free screening through diagnostics company: Verizon runs a "know-your-numbers" campaign to raise awareness of the importance of being aware of key health metrics, such as body mass index (BMI) and cholesterol, blood pressure, and blood sugar levels. The company contracted with a diagnostics manufacturer (Quest Diagnostics) to offer employees free screening tests in each of these areas. Hosted by health and wellness coordinators and employee volunteers, screenings are available to employees at more than 90 locations. Employees can access the results online within 4 days of the test, and receive a full report by mail within 10 days. Aggregate analysis of screening results is helping Verizon identify the extent of prediabetes and prehypertension, especially within the minority population, and develop programs to address gaps in care and health outcomes.
- Future programs: In coming years, Verizon plans to implement programs aimed at reducing the rate of diabetes and cardiovascular disease among minority employees and dependents. In addition, new analysis capabilities will allow Verizon to assess how gaps are closing among various minority groups for certain preventive screening and condition care protocols.
Context of the InnovationVerizon, a provider of communications and entertainment services based in New York City, provided health care benefits totaling $3.55 billion in 2011 to nearly 800,000 employees, retirees, and family members. Verizon's workforce of nearly 190,000 individuals includes more than 70,000 women (41 percent of the workforce), roughly 36,000 African Americans (18 percent), and approximately 19,000 Hispanics (10 percent).
The impetus for this program was the 2003 Institute of Medicine (IOM) report entitled Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, which documented poorer health and access to care among minorities and made recommendations for addressing these disparities among the insured population. Recognizing the potential presence of similar disparities and their negative consequences at Verizon, employee health policy leaders at the company made the decision to study the report carefully and implement relevant recommendations for addressing these disparities.
ResultsThe program has significantly enhanced access to important health information and screening services for racial and ethnic minorities covered by Verizon.
Suggestive: The evidence consists of post-implementation data on the number of minorities covered by Verizon who have received health information and/or screenings, with data generally supplied by the company's vendors.
- Greater access to health information: More than 80 percent of eligible employees have enrolled in the WebMD program, with more than 95 percent reporting their race or ethnicity at registration. As a result, these individuals can receive personalized, confidential health information specific to their racial and ethnic background. For example, in 2011, over 35,000 targeted e-mails were sent to registered WebMD users to promote breast cancer screenings. The messages, describing the disparities in breast cancer risk prevalence and mortality rates, were tailored to four distinct audiences: African-American women, Hispanic women, Asian women, and all other women. Messages were also sent to the registered male audience encouraging them to "check in" with the women in their lives to make sure they are up to date on their screenings.
- Enhanced access to screening services: Verizon's breast cancer screening initiative with Aetna identified 500 minority women overdue for a mammogram, 51 percent of whom subsequently received the test. Verizon's onsite mammography screening program usually serves 200 to 300 women each year and reached a high of 500 women in 2011, an increase that resulted from adding locations where a high percentage of minority women work. In addition, the free biometric screening program at 90 locations has provided thousands of minority employees with critical health information (e.g., BMI, cholesterol, blood sugar, blood pressure), and many of these employees have used this information to improve their health through lifestyle changes and/or medical treatment. Verizon is now in the process of gathering aggregate data to assess whether gaps are closing among minority groups as a result of these interventions.
Planning and Development ProcessKey steps included the following:
- Identifying program goals: Verizon's health care management team identified 4 recommendations (out of 21 total) from the IOM report that seemed most appropriate for employers, and adopted them as part of a revised health benefits strategy. The four adopted recommendations are outlined below:
- Increase awareness of racial and ethnic disparities in health care among key stakeholders.
- Collect and report data on health care access and use by race, ethnicity, socioeconomic status, and, where possible, primary language.
- Report racial and ethnic data, using federally defined categories wherever possible.
- Implement education programs to increase employee knowledge on how to obtain care and participate in treatment decisions.
- Drafting questions for RFPs: In 2003 and 2004, the team developed a series of questions to incorporate into the vendor selection process. As part of this process, team members attended conferences and talked with colleagues at other companies to see how they approached this issue. Verizon began using the questions as part of its health plan renewal process in 2005, as described earlier.
Resources Used and Skills Needed
- Staffing: Staffing varies by the type of program and service. In many cases, revamping programs to identify and address disparities does not require more staff at Verizon or its vendors, since these services are already provided to all employees, and need only be adapted or targeted to racial and ethnic minorities.
- Costs: Program-related costs are difficult to calculate since, as noted, many vendors that identify and address disparities provide a range of services that benefit all employees.
Getting Started with This Innovation
- Evaluate current policies: Before seeking vendors capable of identifying and addressing disparities, employers should first evaluate existing internal policies and practices related to diversity, such as whether recruitment efforts include minorities and whether workplace antidiscrimination regulations are enforced. If the company is lacking in this area, the appropriate first step may be to strengthen these policies and practices.
- Establish measurement systems: A company needs rigorous data on the scope of health disparities in its workforce before implementing programs and services aimed at reducing them. Consequently, contracting with an insurer or vendor skilled at generating such data is a logical first step.
- Prioritize problems to be addressed: Once an employer has a solid understanding of existing disparities, prioritize them according to the magnitude of the problem (based on health claim costs) and the ability to address it. With limits on available resources, companies may be better off targeting broad areas (such as preventable or manageable conditions) that affect a range of health issues.
- Educate employees: An employer can set the stage for new programs by using frequent, established communication vehicles (mailings to the home, targeted e-mails, lunchtime seminars) to raise awareness of health disparities. These efforts increase the likelihood that employees will discuss the issue with family members and subsequently participate in relevant programs.
- Stress confidentiality: Some employees and dependents may be reluctant to share personal information when filling out forms and questionnaires, including their medical history, race, and ethnicity. To address such concerns, make it clear that person-specific information is voluntary; information is provided confidentially only to the vendor (not the employer); that the vendor will use such information only to improve programs and services for employees and dependents; that the employer receives only aggregate data intended to track progress and identify problem areas to be addressed; and that an individual's responses will not affect their benefits or premium contribution.
Sustaining This Innovation
- Leverage technology: Technology can make it easier for employees and health vendors to communicate with employees, and many of these technologies can be leveraged to reduce disparities.
- Elicit and act on employee feedback: Employers should establish ongoing mechanisms to gather feedback from employees on health benefits, including disparities-related issues and programs. For example, Verizon regularly asks employees to give their views on specific programs as part of voluntary webinars targeted to different employee groups, including racial and ethnic minorities. This information is used to improve program services on a regular basis.
Contact the InnovatorAudrietta Izlar
1 Verizon Way
Basking Ridge, NJ 07920-1025
Telephone: (908) 559-3616
Innovator DisclosuresMs. Izlar reported having no financial interests or business/professional affiliations relevant to the work described in this profile.
References/Related ArticlesIzlar AC. The corporate role in reducing disparities: initiatives under way at Verizon. Health Aff (Millwood). 2011 Oct;30(10):1992-6. [PubMed]
Wojcik J. Diversity affects costs. Business Insurance. Feb. 14, 2010. Available at: http://www.businessinsurance.com/article/20100214/ISSUE0505/100219975.
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Original publication: September 26, 2012.
Original publication indicates the date the profile was first posted to the Innovations Exchange.
Last updated: September 11, 2013.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.