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The following interview has been condensed for clarity and brevity.
Pleasant Radford Jr. is the Health Equity Officer at UCare, an independent, nonprofit health plan providing care to members throughout Minnesota and parts of western Wisconsin. As the inaugural Health Equity Officer, Radford uses his experience in business management, public health, and community engagement to align clinical, community, and provider health equity initiatives across the organization.
UCare and Violet recently joined forces to advance health equity in Minnesota by providing clinicians and a subset of UCare staff with the knowledge and tools necessary to deliver culturally competent care, as well as making it easier for diverse patients to access inclusive in-network providers. We spoke with Radford about his role at UCare and how he got his start working in health equity.
Violet: What does your role at UCare entail?
Radford: My role is to lead the organization of about 1,800 employees to think differently about how we provide equitable access to the 640,000 members we serve. My role is broad in the sense that when we think about health equity, we use Robert Wood Johnson's definition, that every individual in the nation has a fair and just opportunity for health and wellbeing.
Health equity means that everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.
– the Robert Wood Johnson Foundation
The idea is to make sure that we are providing the right care for the right person at the right time and the right place. And that is going to look different across the many members we serve.
There are four pillars that we ground our work in:
- Clinical outcomes. We’re focusing on how we can improve health outcomes particularly within maternal and mental health in our Black and Indigenous populations, where we see some of the most stark disparities.
- Operations, impact, and equity. Our health equity improvement plan tool is a way for department leaders to uncover opportunities within their work. This includes understanding our members, their background, where they are from, and what communities they represent. It’s looking at our data to understand how we can glean additional information that is not always in front of our face. Within that data, we are always looking at ways we can mitigate bias.
- Policy and procedures. We are working closely with our public affairs team to find out the state policies that might have a positive or negative impact on our members, and how we can help influence, lead or shape some of these policies, ultimately leading to more equitable outcomes for our members.
- Community engagement. Thankfully, we have a strong relationship with our community relations department and we understand the role that foundation funding can play in accelerating equity. We are working closely with them to understand the grant process, and learning more about the priorities within the community so we can design funding to make an impact in those areas.
Violet: What inspired you to get into health equity work?
Radford: It's personal for me. I grew up in Chicago, and my mom was a nurse at a hospital called Ingalls Memorial hospital in Harvey, Illinois. She served a predominantly low-income Black community. Through her experience, I got a chance to see what true health care could look like when you add compassion and humanity while you are touching people in their most vulnerable states. She loved it and was great at it. That led me to think about a career in medicine, but I decided to pursue more community/public health work. Right after college at the University of Illinois, I went into the Peace Corps as a community health volunteer in Central America. Afterward, I continued that work with Chicago public schools and The University of Chicago more broadly to impact the health outcomes of the south side of Chicago. I decided I wanted to continue in this space of health care but through a lens of business—and get a better understanding of the role that business can play in enabling good health. I made the leap to Minneapolis and decided I wanted to move into the insurance space to understand the role that health insurance can play to positively impact health.
Through those experiences, there has always been an undercurrent of health equity, serving the most vulnerable populations, engaging with them in a way that is more asset based versus deficit based, and understanding that there are a lot of positives within the community that we can lift up in order to improve their health outcomes. That has continued throughout my career in insurance. As a Black man, I unfortunately still am faced with discrimination and microaggressions and racism too often. So I know that there is an opportunity for us to change and I want to be a part of that solution.
Violet: What do you think about the intersection of DEIB and health equity?
Radford: I know that they mutually reinforce each other. You can't do DEIB well without thinking about health equity, and vice versa. As you are thinking about this work internally—education, employee representation, supplier diversity and spend—that is going to show up externally. Whatever we are hearing from the community, we want to make sure that that is also being included in how we shape our policies, and then we are able to improve our work and health outcomes.
Violet: Knowing the variety of work you and your team are championing, how do you define success?
Radford: I define success as not needing to have a Health Equity Officer in the org. It just becomes a part of our business, our DNA, and our operations. The fact that I am in this position indicates that there is still an opportunity for us to do better in this space and we need to be very specific in how we think about that. Success is phasing out my position constantly reminding leaders about the equity impact. Success also is improving the health of our members and living up to that definition of health equity. Another success factor for me is that the community regains trust in what we do, and that people have positive experiences where they are seen and heard.
Violet: Between CDOs, insurance companies, and pharma, is there one part of the industry that has earned more distrust than others?
Radford: Pharma definitely does not have a lot of trust within the community. There's very little price transparency related to the drugs we purchase and if they are actually improving our health or not. With providers, there is a little more trust, but if you stratify that by SOGI and REAL data, that's when you see that trust is not consistent within different communities. There are positive examples, but they are eclipsed by the negative headlines. Collectively, we are not where we need to be.
Violet: What are some of the legislations or regulations either proposed or approved at the state or national level that you're excited about?
Radford: Maternal health is a priority within the org as well as within the state of Minnesota. Our council of health plans was part of developing a bill where we increased the reimbursement rates for doulas. That's significant. It's not where it needs to be, but it's better than before. It speaks to the collective power that organizations can have to impact change. Doulas are being reimbursed at a higher rate.
There is another bill that is going through session right now that is focused on how we can include racial equity impact notes in every single bill that is being passed through the legislation. UCare signed a letter of support saying that it is going to require additional research and an additional level of expertise to make sure that we are considering the racial equity impact as we are proposing bills.
The last one is we are starting to collect better SOGI data, which is exciting. We are working in community with local LGBTQIA orgs in Minneapolis to understand the questions we need to ask and how to include that in our data. More importantly, we’re figuring out how we can add those questions into our member enrollment files so we are also collecting key info at the individual level. It's exciting to know that at a community level we’re working with these orgs, at an org level we are collecting the data, and at a state level we’re having conversations about how we can get that data into our member enrollment files so that a population that continues to be invisible becomes visible.
Violet: What is a common misconception or myth when it comes to health equity teams or health equity in general?
Radford: Health equity has been racialized in a sense that whenever we talk about it it's always seen as “Well that's an issue for communities of color, that's not my issue. I don't have to worry about disparities or inequities, that doesn't impact me.” Yes, with health equity you have to look at the racial equity component, but there are so many other issues that are part of health equity that we need to take into account.
When you look at health care from a global perspective, you see that a lot of different countries have a higher life expectancy than Americans do, recognizing that of course every country's policy and government is different. When you look at other countries that have similar, if not more resources than we do, they are performing at a much better rate than we are from a health perspective and spending less. Spain, France, South Korea, and Japan all have higher life expectancies. In America, white women live the longest, maybe behind Asian women, but other countries are living to 87 and that in itself is a disparity. Even the most well resourced American is still living four to five years less than someone in a different country. That shows that racism and all the isms we face here at a national level have a negative impact on all of us, not just on communities of color. If you think of it that way, everyone needs to roll their sleeves up to say, “What can I do in order to live to 85-86?” That's a great goal. We would love to live as long as possible but how can we improve the quality of our life? Everyone is impacted and everyone has a stake in this and everyone has an opportunity to improve.
Violet: If you could wave a magic wand, and have every health plan operate in a certain way to build health equity, what are the things you would want to see every health plan doing?
Radford: I would probably go to the policy piece. Policy has a huge influence on our lives, and if we are able to impact policy in a positive way then we are able to address those other social determinants of health. When you think about food or housing or transportation, we as health plans can obviously do some work to impact that, and we are. Housing, for example, specifically the history of redlining—we’re still dealing with that years later. Sure, we can continue to build new housing in different areas, but if we don't change the redlining component of that, and we have banks that are convincing our buyers to move into different areas because they think it's a better fit or not just their income, or we have real estate agents who are leading us to certain properties in certain areas, nothing changes. All of it is tied back to policy. If we are able to affect the policy, that will help us accelerate health equity more than just this incremental approach of, “Let's focus on this, but the policy is still bad so it's not going to have the impact we want.”
Violet: One of the things we have been thinking a lot about is what is the role of technology and AI in health care as well?
Radford: It's become a part of our world now and we have to think critically about how to integrate AI into our work. We don't want to further exacerbate the disparities we see in our communities. One example is around prior authorizations and procedures that require additional authorization from a health insurance plan before you move forward. How can AI support that? We want to make sure that we are using it to improve those prior authorizations that have already been reviewed by a health care professional, but do we really want AI to reject those prior authorizations without that human judgment? As flawed as human judgment is, we still want that human element to supplement what we are hearing from within AIs. I don't think AI is mature enough to read the nuances of a patient and a rejection to say, “We need to overturn this decision.” That is going to require a lot more data points and learning for AI, and it’s just one of many examples of how we need to think critically about the use of AI and its impact on the health care system.
Learn how partnering with Violet can help your org build a culture of health equity. Request a demo today.
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