L.A. Care Health Plan is the largest publicly operated health plan in the country. James Kyle, M.D., the organization’s medical director for quality, diversity, equity and inclusion, believes that health plans have an obligation to serve as more than just payers.
Kyle joined L.A. Care as medical director for quality improvement in April of 2019, leading quality improvement efforts in clinical quality, including health disparities, accreditation initiatives and member and provider surveys. He recently assumed his new title, but he has been leading the health plan’s enterprise-wide equity efforts since July 2020.
Speaking during WEDI’s “Quest for Health Equity” virtual program on March 24, Kyle described the features of what he called a “next-level health plan.” As well as meeting NCQA and state regulations and working on its star ratings, plans should focus on being a valued partner with vulnerable populations, communities, public health agencies, and community-based organizations. A health plan has a role to play that goes beyond just writing checks and contracting with doctors and hospitals, he added. “We have the opportunity, because of our size and because of our community position, to function as a community services agency ourselves.”
Next-level health plans need to focus on eliminating health disparities, and partnering for economic development in the communities where their members reside, being a trusted advocate of social change and a convener of community action, and being an advocate for equity and justice, Kyle said. “We've created what we call the Equity Council, a steering committee that has three subcommittees underneath it. One is the L.A. Care team, a committee, or council that focuses on our employees. The second one is our provider and vendor council. And the third is our member council of those who were enrolled in L.A. care. We believe that we have an obligation to improve equity, fairness and inclusion in all three of these areas. And the team council becomes the most urgent, because if we can't guarantee equity and inclusion in our own ranks, then we have little standing to advocate for that in the community,” he said. “We have established partnerships with the LA County Commission on Human Rights. And we've participated in the LA vs. Hate campaign. We've empowered L.A. Care’s internal councils to set and prioritize goals and metrics to measure their change efforts in the community.”
Of the constituent councils, one is the member equity council. “They ensure that the services we provide to our members promote equity, and are free of implicit bias and racism,” Kyle explained. “We implement programs that address the causes of inequity that our members and their communities experienced, including racism and poverty, and other social determinants of health. And we reduce health disparities among our members by implementing targeted quality improvement programs.”
The provider and vendor council prioritizes efforts to make sure members who speak languages other than English can find a provider who speaks their language and that African-Americans, if they choose, can find an African-American provider. It also looks at vendor diversity.
To address long-standing structural racism, L.A. Care is instituting policies to increase economic empowerment, fund community programs that enhance neighborhood stability, and offering interventions that address social risk factors. “For health plans to be involved in this kind of work, you have to have dedicated staff and you have to create an arm of the health plan that actually focuses on these issues, but also embeds these kinds of issues and thinking throughout the rest of the health plan,” Kyle said.
Kyle said health plans have to ask themselves this question: What is the impact of our policies on the populations that we serve? How do we improve access by what we do?
“If we build policies and procedures that serve our own needs but don't serve the needs of the people we're trying to serve and that we're obliged to care for it, then we've got the wrong policies,” he added. “So we have to look at structural racism in terms of what's going on in government, in terms what's going on in the community, in terms of the economy, in terms of access to care, access to food, access to clear and clean water,” he said. “We now are obligated here in California, probably across the country, to monitor the lead content in the blood of children. Well, it's one thing to monitor lead content, but when you look at the data, you're going to find hot spots where people are having elevated lead. Does a health plan really just report what we see? Or do we engage in community collaboratives to abate the lead in those communities and make sure those children are safe? I choose the latter. I think we have to engage those communities. Because we're going to be complicit if we have the information, if we know that there's a problem, and then we do nothing about it.”
Kyle closed his talk by noting that health plans are very data-focused. “We measure our success in small increments, but I will say that we cannot be comfortable with incrementalism. Disruptive change is the only way to rescue vulnerable communities and halt the intergenerational consequences of structural racism,” he said. “I believe we have to, therefore, dream large, and we have to act with boldness. I try to picture a 10-year-old boy or girl in an underserved community that we are tasked to bring care to. And if it takes us 10 or 15 years to make any sizable change in the social determinants that impact that girl or that young boy, then we'd miss their entire adolescence. Whatever has set them back at 10 will set them further back when they become 20. We don't have the luxury of just sitting around saying it will take us a couple of decades to fix this problem or to assume that certain issues can never be resolved. I think we have to be creative. We have to dream big dreams. And we have to push and push until we can see real changes that happen in communities.”