Human Resources: Employers play an important role in promoting health equity.

More than 181 million Americans receive health coverage through employers, the largest source of health coverage for the nonelderly, covering 58% of the U.S. population. As there is increasing focus on health equity, how can employer-based insurance plans, and the HR professionals that select and administer benefits, encourage more equitable systems and structures of care? To explore this question, and many more, Bill Finerfrock discusses with Sean Sullivan, Chief Human Resource Officer at the Society for Human Resource Management, or SHRM.

Episode Transcription

94: Human Resources: Employers play an important role in promoting health equity.
Published: April 14, 2021

More than 181 million Americans receive health coverage through employers, the largest source of health coverage for the nonelderly, covering 58% of the U.S. population. As there is increasing focus on health equity, how can employer-based insurance plans, and the HR professionals that select and administer benefits, encourage more equitable systems and structures of care? To explore this question, and many more, Bill Finerfrock discusses with Sean Sullivan, Chief Human Resource Officer at the Society for Human Resource Management, or SHRM.

Bill Finerfrock: Welcome to the Health Disparities Podcast, the program of Movement Is Life. My name is Bill Finerfrock, and I serve on the Movement Is Life caucus steering committee, and I’m President of Capital Associates. We work on the legislative arena on things such as public health policy, health care financing, health systems reform, health workforce and rural health. I want to state at the outset that all the views and opinions expressed today on this podcast are the participants own views. They do not necessarily represent our respective organizations, or that of Movement Is Life. More than half of all Americans receive their healthcare through employer-based insurance coverage, which makes it the largest source of health coverage for the non-elderly, covering 58% of the population or roughly 156 million people. As we, as a nation, increasingly focus on health equity, a question comes up of how can employer-based insurance plans and the HR managers that choose them, encourage more equitable systems and structures of care? To explore that question and others, it’s my pleasure to welcome Sean Sullivan, who is the Chief Human Resource Officer at the Society for Human Resource Management, or SHRM. Sean has broad experience developing and delivering on operational HR strategies across complex, multinational organizations. Prior to joining the executive leadership team at SHRM, he served as vice president of human resources at Tufts Medical Center in Boston, where he was responsible for all aspects of human capital practices and labor relations for 5,500 employee academic medical center. And before that, he served as vice president of human resources at Science Applications International Corporation. A $4 billion, publicly traded Technology Company with 15,000 employees worldwide. Sean, welcome, and we appreciate you joining us today to help our listeners understand that very important role played by stakeholders in the human resource management space, then improving our healthcare.

Sean: Bill, thanks so much for inviting me to join you for this conversation. I’m really pleased to offer SHRM’s HR professional’s point of view on the employer based health care system, and our role in promoting health equity in the workplace. The issue of health equity is important to me personally and at SHRM, we believe healthcare should be affordable and accessible for all Americans. So, very much looking forward to the conversation.

Bill Finerfrock: I think the term Human Resource Manager meant it’s something we’ve all heard of, but I’m not sure that a lot of us really understand who that is or what the role and responsibility is. So, who are your members and what are their roles and responsibilities in the workplace?

Sean: Yeah, outstanding, Bill. So, the Society for Human Resources Management is a professional membership association. We’ve represented the interests of our nation’s HR professionals for over 70 years. Today, we’ve got more than 300,000 HR professionals and we impact the lives of over 115 million employees. So, each day, we use our voice to elevate issues that are squarely at the intersection of work, workers and the workplace. Workplace healthcare is one of those issues, ensure members design and administer benefits, the benefit offerings, and especially including healthcare and workplaces across the United States. So, Bill, our members range from HR managers who are generalists, they might wear many hats in an organization, to very specialized benefits experts who may be domain experts in administering some of those benefits programs.

Bill Finerfrock: Now, you individually, in addition, we had mentioned in your intro that you were at Tufts prior to coming to SHRM, but you’re the chief human resource officer for your association. So, you’re actually the inside guy who handles human resources for all the employees of SHRM who then also serves as the Association for human resource managers. Have I got that, right?

Sean: You’ve got that right, Bill. So, I look both internal and external and it’s one of the real privileges of this position. So, internally, what I do is work very closely as the CHRO with the rest of the executive team to really build out the strategy for SHRM and how do we fulfill our purpose of elevating human resources? And in setting that strategy, then it’s my responsibility to say, okay, what do we need for the talent and the culture that is required to be able to execute to that strategy? So, how do we recruit, retain and develop people and then, how do we create a workplace, a culture that supports the kind of strategy we’re trying to put in place to achieve better workplaces better world.

Bill Finerfrock: Within the human resource managers, and in this whole issue of health equity, we as a society have really been seeing the effect of health disparities and health inequity as a consequence of the COVID 19 pandemic, where individuals of color, communities of color, certain geographic areas have been harder hit by the COVID than others and our human resource managers is health equity, something that they have been thinking about? I know at SHRM, I know you guys have put together some materials to help people look at that kind of stuff. Can you talk about some of the things that you as an organization and human resource managers are doing in this space of health equity?

Sean: Yeah, absolutely. So, I’ll start broadly Bill and just share with you that at SHRM, we’ve long been a champion of policies that promote equality across every area of society. Most recently, last year, we launched the Together Forward at Work Initiatives and that’s really a call to action to bring racial equity to the workplace. That’s the place we know best, and we have served the longest, and so, we really look to that and to the business community, to stand together against all forms of social inequities. But specifically in the area of healthcare equity, HR professionals have a very important role. And here’s where we try to provide resources and best practices to our HR managers. Because HR professionals do have a very specific role in designing healthcare benefit offerings and to meet the needs of their particular workforce, there is a very intentional effort to make sure that the benefits that are offered are accessible by all employees across that particular workforce. This comes to both access to networks, Bill, as well as the fee structures and the copays that might be built out and also the communication around those, that whole benefit package, so, people understand what benefits are in there. So, broadly speaking, very concerned about equity in the workplace, specifically because healthcare is such a large investment for any business in their employees and a commitment to employees, HR shoulders a very special responsibility to make sure that there is equity in terms of how that benefit is accessed.

Bill Finerfrock: And I would imagine it’s a huge piece of employee recruitment and retention, that that’s something that individuals have come to expect when they you know, seek out employment that do you offer healthcare and what kind of healthcare is it that you’re offering?

Sean: Absolutely, and HR professionals get feedback on this all the time, Bill. During the recruiting process, it’s something that as an HR manager, you’ve got to be able to communicate well to candidates, so they find your offer to be compelling and they understand what it is. We also when employees leave the organization, typically, HR folks are doing an exit interview and during that process, you also get feedback frequently, it’s on some aspect of the healthcare plan. And they’ll tell you when they have found another employer who has some differentiation in their benefits plan that they find more attractive and more appealing. So, it is something that we’re constantly looking at, and always getting feedback from employees on.

Bill Finerfrock: And how deep, I guess, do HR managers get into the selection of a health plan, the details of a health plan, and I would imagine it varies, but certainly for larger employees, and many of the larger employers are what we call self-insured. Do the HR managers in those companies play an even bigger role in trying to do benefit design, network design, geographic, how extensive a network is looking, in conjunction with the employee population of that employer?

Sean: Absolutely, Bill, and what I would say, you know, going back to some of your earlier, introductory comments around the employer provided health care plans, we know that 67% of those employees who are covered by those kinds of plans are in self-funded plans and that covers both large employers and small employers. The large employers, to your point, have more complexities to address because they’re typically working across a number of different regional areas. And in that case, they’re looking to make sure that their employees have similar kinds of access to health care across those several regions. Smaller employees may be able to work within a much more regional or local network and that simplifies the task to some degree. But having said that, because it is such a large investment, and because it is such an expected part of the competitive offering from a company, HR professionals do spend a lot of time trying to think through what the design of a program should be. And with the self-funded health care programs, you really do have some latitude as the benefit provider to really make sure that you are putting things in place that make sense for your workforce. And I’ll give you a very small example, Bill. You know, we’re looking here within SHRM at the kind of healthcare offering that we have that we provide to our over 400 employees. One of the small things that we noticed, though it was not insignificant to some of our employees, we got feedback that hey, this seems strange that hearing disabilities max out at the age of 59. Why would that be? And it was just something that had been in our healthcare benefit for a long period of time, and once it, you know, people raise that to our attention we said, yeah, that seems a little bit odd to us, as well. And because you know, we are self-funded, we’re able to make that decision to restructure that benefit and eliminate that barrier to care. A small example, but, again, not an insignificant one of paying attention to who’s able to access your benefit, and what span of their career and life experience.

Bill Finerfrock: So, you as SHRM, you’re headquartered here in Alexandria, Virginia, where we’re both located, and we’re in what’s called the DMV, you have the District, Maryland and Virginia. And I suspect you have employees that live in each one of those jurisdictions. And so, you’re trying to provide health insurance for individuals, but you have potentially three different legal jurisdictions that you might have to comply with. And also, trying to look at your network of what kind of providers is available in Washington, DC, Maryland, Virginia. Is that a really, difficult undertaking or do you rely on the health plans to ensure if you have employees who live in areas where it may be a lower income area or may not have, even in in our urbanized areas, we have communities that have more challenges trying to access healthcare? How do you at SHRM or how would an HR manager kind of go about looking at some of those things?

Sean: Yeah, it’s a great question Bill, because it is such a complex area to your point, not only using our example, not only do we have employees in the DMV and the Maryland, DC, Virginia area, but we also have employees spread out across the nation. A smaller number of employees, but still, you know, we are compelled and committed to providing the same kind of healthcare to them. So, in that case, employers really need to work with third-party administrators if you’re self-funded, so, you do work with large insurance, healthcare insurance providers and so you need to understand what kinds of networks they have in place. A resource that can be very tremendous, if well utilized are benefit brokers whose specialty is understanding what different health insurance providers have, how they negotiate and what their offerings look like. But I do want to circle back to your question about access, because it is very, very important. One of the things that HR professionals are able to do is to look at where the workforce lives, and understanding where they live and where they work. Then also doing some sensitivity analysis to when you overlay the healthcare network, and understanding, you know, is that a good match or are there significant gaps for significant parts of the population?

Bill Finerfrock: One of the things that we’ve been looking at, at Movement Is Life is how providers are paid, and how that can influence decisions they make on what cases they choose to take, or what individuals they choose to take, and it’s primarily related to risk. You know, historically, the insurance company or the employer, if it was a self-funded plan, would be the risk bearing entity and a lot of the new payment models are moving more towards trying to get the provider to undertake some risk. Are those conversations that even occur within HR managers or is that something that occurs outside your space and is you just leaves that up to policymakers or is that something that even comes up in your environment?

Sean: You know where it especially starts to come up Bill is, when you start working with individuals, with the employees who all of a sudden may have a barrier to access, and they, you know, their primary doctor might say, you know, you need this kind of treatment, and then that employee encounters some kind of difficulty, either in terms of getting our insurance provider to work with the available care provider or some element of the insurance that is creating a barrier to them being able to get access to that. That particular example tends to present through individual circumstances and then as the employer and HR specifically, then become the translator between the insurance provider, sometimes the care provider and the employee, or in this case, the actual patient, trying to make these several different components of care come together assuming that that is possible. So, it tends to arise through very individualized circumstances, but absolutely something that we encounter and not on an infrequent basis.

Bill Finerfrock: And I guess that was one of the questions, if someone in your audience is having difficulty finding someone who can provide the care that they need, they’ve gotten a recommendation from their primary care provider that you need this particular surgery or something and they’re having difficulty, one avenue would be to go to the HR manager within their company, and ask them and explain the situation and that would be someplace where they could get help?

Sean: Absolutely. And because the HR team typically has the relationship through the insurance account, and we typically have the relationship with the insurance provider that could be a case where if it’s the third or fourth time that we’ve heard of a similar kind of issue, then that gives us leverage to work with the provider to say, you know, if there’s a gray area in the coverage, let’s work through that. And if it’s something that is a true barrier during a particular year, it might be something that an organization believes strongly should be changed, and they might do that for the next benefit enrollment year. So that’s always a consideration too. It may be the case that the employee doesn’t receive the answer that they are hoping for, it can also be the case that some progress can be made, or it sets the stage for your changes, in which case I think it’s very valuable.

Bill Finerfrock: I had that situation. You reminded me personally years ago when my wife was pregnant with our first child, and I was working for a healthcare association and suddenly they realized no one at the association had ever had a baby, and it wasn’t something that I looked at or considered when I was hired. I looked at the health plan, and yeah, it seemed fine. Now, this was a long time ago, there were no maternity benefits. I ended up having to pay out-of-pocket for the cost of the birth of my daughter and they were able to go back, and they changed the policy, to your point, for the future but I was out a couple $1,000 because it was just something that nobody now the laws have changed. And they’re required to do that now and things but I was the test case and they were like, ‘oh, my gosh,’ it had never come up before.

Sean: Yeah, I think that’s a really powerful example because it does also remind us Bill that people’s circumstances change throughout their careers, right and the nature of your workforce could change dramatically, if you’re a startup kind of organization and you’ve got, you know, a small group of people starting at the same time, they might not have encountered some of these other life events. And there could be some surprises and a constant need, then, to evaluate how is your workforce evolving and how do you help ensure that your healthcare benefits are evolving at the same pace as well?

Bill Finerfrock: Have you seen an increase in desire to address health equity within the last year or so? We certainly, and I don’t know if it’s because we’re in that space, but we certainly hear a lot more people talking about health equity today than we did three, four, five years ago. And as I mentioned, I mean, I think there are certain events that have shined a light on that. But are you seeing that in your world as well, that that’s an issue where employers are really looking at are we doing as much as we can to ensure equitable access to health care for our employees?

Sean: I think about it in two ways, Bill, because for me, it’s been something that has always been a prominent concern. But I will say among our members, to your point, I think the past year has put a spotlight on those kinds of issues, both in terms of the impact of the pandemic, the economic downturn, and then a number of issues that came forward in terms of all of the equity and equality and systemic racism issues that surfaced even larger last year have caused people to start looking at many aspects of gosh, to your point, are we doing everything that we can to make sure people have access to the care that they need? Are we providing health care plans that are not just meeting the basic needs, but also truly providing access to equitable and vital care for our employee?

Bill Finerfrock: Are there any kind of observations or comments that you’d like to make from your perspective as an HR manager or from SHRM’s perspective on this whole area of health equity and health disparities and what you’d like to see done?

Sean: Yeah, so I start Bill with some very basic things that I think HR managers are doing and should continue to do. And by that, what I mean is a focus on communication, a focus on education for employees. And some of that starts with the open enrollment materials that HR teams provide to employees each year. Those should be accessible in a range of ways to help communicate with employees that might, depending on the workforce, also, require a range of languages as well to make sure that all employees can process the information on similar terms. Even how we represent in those materials, the pictures that are used, are they representing different family situations? Are they representing the full nature of the workforce so that you’re sending messages, affirming messages that healthcare is important, it’s important for all employees, and even by what’s reflected in those materials, it suggests that all employees then therefore have access to that care? The education part is so critical, because there’s so much information, and there’s so much access to information. By helping employees understand where to start and where to begin becoming better healthcare, consumers, is, I think, a vital part of the HR mission. So, it’s not just enough to say, hey, we’ve got great benefits, helping people understand how to maximize those benefits, and how to really be the best consumers they can be really advances overall healthcare and wellness for all employees.

Bill Finerfrock: Yeah, as you were talking about that, the imagery, the advertisements that are used, who are the people that are pictured, what are the activities that they’re engaged in and how are they sending messages and how are they received by the audience in terms of, “Okay, is this someplace that seems to understand me, or are they talking about somebody else?” So, I really appreciate your pointing that out. I want to thank you for taking the time to chat with us today on the Health Disparities Podcast. Certainly, I’ve learned a lot. I hope our audience has learned a lot. I think this is a new pathway for us. A lot of our work on health disparities and social determinants of health have really been focused on government. Government policies, government programs, and what can or should be done, but I think the data that we talked about the number of people who are covered by employer sponsored health insurance. Whether it’s a self-funded plan, where the employer is very directly engaged in that, or they’ve simply identified a health insurance plan, that the employees, the huge role that employers play in this space and that if we really are going to get a handle on addressing health disparities and health equity. We really have to engage the employer community in that conversation, because they have such a huge impact on healthcare, healthcare, cost, health care, access, availability and equity.

Sean: Absolutely, Bill, and thank you so much for inviting me to this conversation. It’s been great to speak with you about this. It’s a complex area and we at SHRM are absolutely committed to working this within the workplace and also advocating for policies that increase equity of care. And making sure that this critical and fundamental benefit remains something that people have access to the quality care that they and their families absolutely deserve. So, we’re grateful that we’ve had the opportunity to kind of share some thoughts here on how we approach it and I’ve really enjoyed the conversation.

Bill Finerfrock: I have as well. And thank you on behalf of Movement Is Life and I hope that there are opportunities for us to work together moving forward to achieve the common goal of addressing social determinants of health, eliminating health disparities and improving health equity.

Sean: Thank you very much, Bill.

Bill Finerfrock: When you said this is complex, I don’t know if I told you this before years ago, I had a cartoon made and it was generated by the thought of what do rocket scientists say when they get stuck with a problem, right? We always when we’re struggling, I will come on, we ought to be able to figure this out, it’s not like its rocket science. So, a friend of mine knew a cartoonist and I had him do this cartoon, and it’s two people standing in a lab and it says, Rocket Science Lab, on the door, and the one says the other, “We ought to be able to figure this out.” and the other scientists says, “Yeah, it’s not like it’s health policy.”

Sean: I love that.

Bill Finerfrock: Thank you again, Sean. And thanks to everyone who has joined us for this episode of our weekly podcast series. We hope you’ll subscribe and join us again soon and you can also find us on Twitter. We are @milcaucus, where we are sending our reminders of new episodes along with lots of other health equity related information. Be safe, be well and goodbye for now.

(End of recording)

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