Diversity Inside Out
How do we support diversity in our thoughts to support diversity in our actions?
The confluence of a major health crisis such as Covid-19 and a “shouldn’t humanity equate to equality” crisis with Black Lives Matter (BLM) has forced a fundamental revisiting of healthcare in the U.S. The social, heath and economic storms will forever change the way we live and work. The individuals and organizations best suited for reinvention will be those who look for, seek to understand and embrace the opportunities of doing things differently. It requires seeing the world from new vantage points.
While the virus has not distinguished between traditional demarcations, such as map-based boundaries (county, state, country, etc.), financial inequality or religion, it does seem to have a keen sense for race, age, gender, and comorbidities. Socioeconomic and a multitude of underlying clinical considerations have created more precise targets for the virus, thereby driving a clinical risk pool that — to date — has not been evidenced by modern healthcare and more specifically health insurance practices.
Condition-oriented care management has been the modus operandi for health insurers (medical and pharmacy benefits players, or PBMs) because it is easy to stratify and it is congruent with the condition-based orientation of pharmaceutical companies. The Covid-19 crisis should render a crushing blow to population stratification based purely on evident health conditions.
In addition to the virus challenging status quo across the healthcare industry at large, the BLM movement and jingoistic talk about the coronavirus drove deeper reflection about workplace biases. Companies and leaders that simply checked the box in terms of valuing diversity are now being forced to take a step back and ensure that there are deliberate strategies in place to address biases, diversity, and inclusion in the workplace. This means a fundamental rethinking of everything across employer branding, recruitment, internal company values, people strategies, etc., to ensure a true 360-degree focus on doing the right thing.
This heightened focus on diversity-related strategies both internally and externally creates a critical imperative for health insurance leaders to embrace the need to change both internally and externally, or be condemned to running a tone-deaf business.
What is needed to meet the moment?
- Health insurers (including PBMs) will have to be willing to disrupt themselves and their now-tired thinking, to be able to come up with new solutions for a completely new set of challenges.
- Pivoting away from purely condition-oriented clinical strategies, while antithetical to everything they have done since they came to exist, need to evolve… now.
- Showcasing a different kind of leadership in general, but more specifically focusing on the need to drive a very high level of organizational resilience and innovation.
- Organizational resilience that allows employees to not just survive, but thrive professionally, while deliberately ensuring a bias-free company culture of inclusiveness.
Breaking the molds
EmpiRx Health bet that treating patients and clients in a manner similar to how they wanted to be treated would be a game changer in an antiquated PBM industry–traditionally more focused on an arbitrage-based financial model (buy for X and sell for Y), with minimal clinical innovation and suboptimal service. This focus on individual needs enabled a company in the conservative and consolidated PBM space to thrive when a couple of years ago its leaders decided to look differently at how to segment populations for effective management of pharmacy benefit utilization.
The clinical strategy evolved into the PBM industry’s first Rx-driven population health management model, one that is tailored to an employer’s population. Put another way, it is based on the clinical and financial risks shown by the patients in that particular employee base. This has ensured that EmpiRx Health patients are cared for based on their individual risk profile, including socioeconomic considerations, versus being cared for on the basis of condition-oriented boxes that can be checked at face value. A special advocacy program supports complex patient care, to ensure the most-challenged patients are provided with a proactive clinical concierge experience.
Additionally, company leaders believed that a company’s culture built on transparency, diversity, inclusiveness, and empathy drove business innovation–and in turn, helps support it. An extremely diverse workforce led by a leadership team with 60% women has propelled EmpiRx Health to a different strata of innovation in a PBM industry that continues to recreate variations of status quo. In the midst of the pandemic shutdown, the firm earned a Great Place To Work certification.
Taking a different cut at the data required imagination and the willingness to break from the past. How can companies such as EmpiRx Health help us learn about how to rethink decade-long patterns?
July 25, 2020
Authors: Karthik Ganesh (EmpiRx Health CEO) and Carin-Isabel Knoop (Harvard Business School and co-author of Compassionate Management of Mental Health in the Modern Workplace, 2018). We welcome feedback and input as we all learn together. Please reach out to us at kganesh@empirxhealth.com and cknoop@hbs.edu feel free to share widely.
