These disparities in health conditions and outcomes are exacerbated by inequities in access to care and care delivery as well as a lack of diversity in medical professions. People of color are more likely to be uninsured and to lack a regular source of care.[4] Additionally, evidence indicates that implicit bias in health care can influence the interactions between a provider and patient, the type of treatment a patient receives, whether a patient adheres to the medication they are prescribed, and, ultimately, their health outcomes.[5],[6]

Over half the non-elderly population of the United States is covered by employer-sponsored insurance.[7] This means that employers play an important role in ensuring that much of the nation has access to health care coverage and services that help reduce, not enlarge, racial disparities in health care.

In addition to being an important source of health insurance coverage, employers have opportunities to help address racial disparities in health conditions through the design and structure of their benefits and other employee services. For example, benefits can be structured to encourage relationships with primary care providers to help address the fact that people of color who have health coverage often lack a reliable source of care. As some of the nation’s largest employers, Business Roundtable companies can play an important role in identifying these opportunities and strategies to address them. Participating Business Roundtable companies will engage in a Health Equity Benefit Evaluation Initiative to identify employee health benefit practices that may reduce racial health disparities for employees.

Implicit bias in health care can adversely influence care and outcomes for people of color. When organizations prioritize diversity, equity and inclusivity and implement strategies to reduce implicit bias, they are taking important steps to ensure that people of color receive equitable, safe and appropriate care. Participating Business Roundtable companies will work with health plans and other health care partners to understand diversity, equity and inclusion (D,E &I) practices of the organizations that provide health care services to their employees and promote D,E & I practices to address implicit bias.

Especially during the COVID-19 public health emergency, expansion of telehealth services has provided crucial access to health care, particularly for communities of color that have traditionally lacked access to reliable sources of primary care. Medicare and Medicaid programs, as well as many companies, have provided additional coverage flexibilities during the pandemic to allow broader access to telehealth services. Business Roundtable supports efforts to expand telehealth coverage to employees of color and others during the pandemic and beyond. 

Business Roundtable will convene members to share insights and develop strategies in several areas:

• Accurate and complete race and ethnicity data is needed to identify where racial disparities in key health conditions and health care utilization exist. This data provides health care organizations the opportunity to improve access and utilization of care for people of color, and to understand when interventions are successful in reducing disparities. Business Roundtable will work with members to develop strategies to help address barriers that inhibit the appropriate collection and use of race and ethnicity data to improve health outcomes.
• Racial disparities in health outcomes are the product of more than just traditional health care provided in clinical settings. Social determinants of health (SDOH) are the economic and social factors, such as economic stability, education, safe housing and access to nutritious food, that significantly affect health. Black Americans are more likely to experience disadvantages in these factors.[8] Business Roundtable will convene members to discuss business’ role in addressing SDOH and develop a SDOH Roadmap that businesses can use to engage in community partnerships to address SDOH. This initiative will provide companies with actionable steps they can take to partner with local communities to address SDOH in the communities in which they do business.
• Since people of color are more likely to be impacted by adverse SDOHs, some are also likely to experience immediate, non-medical or “social” needs, which impact their health and ability to participate fully in the economy. Companies can provide invaluable support to their employees by identifying and taking steps to meet these non-medical needs. Business Roundtable will convene member companies to develop strategies to identify and address aggregate, anonymized social needs for their employees.

A more diverse health care workforce can help reduce implicit bias in health care and improve culturally competent care. While diversity among health professionals has increased over past decades, these gains are not reflected across the spectrum of health care professions or in educational programs. A 2020 study found that diversity gains are concentrated in lower-paying or entry-level positions.[11] And a 2018-2019 report from the Association of Medical Colleges found that increases in Black or African American applicants, matriculants and graduates lagged other groups, and that medical school faculty and active physicians continue to be predominantly White.[12] Business Roundtable supports legislation designed to expand scholarship and loan repayment programs for minorities to address health care workforce shortages and bolster workforce diversity.

Increasingly, states and communities seek to address SDOH as part of strategies to improve health outcomes and decrease costs. Funding and technical support from the federal government will accelerate efforts to support the development and deployment of effective SDOH interventions. Business Roundtable supports legislation to establish grant programs that help states and communities determine, implement and measure the most effective SDOH interventions for their needs.

The U.S. Department of Health and Humans Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) increasingly recognize that SDOH impact health outcomes and health care costs. HHS has taken steps to integrate health-related social needs into several innovative payment models.[13] HHS should continue these efforts and expand the testing of payment models, which include reimbursement for social needs. Additionally, HHS should create opportunities for the private sector to partner with public programs and community organizations to financially support community SDOH efforts. Business Roundtable supports continuation and expansion of innovative payment models that allow SDOH to be addressed.