INSURING EQUITY: AN EXPLORATION OF HEALTH INSURER ORGANIZATION PRACTICES THAT PROMOTE EQUITY IN HEALTHCARE UTILIZATION AND QUALITY

The Center for Medicare and Medicaid Services (CMS), the largest US payer, has shifted policies to improve care quality for millions of Medicare beneficiaries. Health insurers, integral to these programs, can drive health equity as they influence all healthcare aspects (1). Despite persistent inequities in healthcare quality and use among groups, effective strategies for advancing equity remain unclear. A literature review identified 11 studies on health insurers' organizational practices aimed at health equity, revealing that without a validated framework, strategies are not aligned with evidence for addressing inequities (1). This provided an opportunity to examine how insurer practices affect health equity. The research question for this dissertation was: What are the organizational practices of health insurers that promote equity in healthcare quality and use among social risk-factor (SRF) and non-SRF populations, while achieving high Star ratings? • Aim 1: Identify health insurers that have maintained high Star ratings among SRF and non-SRF contracts from 2017-2025. • Aim 2: Understand the key organizational practices of health insurers that contribute to high Star quality ratings for both SRF and non-SRF populations, how they support equity, and the barriers and facilitators to implementing the practices. This study used an explanatory sequential mixed methods approach. Quantitatively, it identified organizations with high (4.5+) Star ratings for Medicare contracts with high SRF and non-SRF populations from 2017-2025. Qualitatively, it explored characteristics and themes in practices supporting equity. Twenty-five insurers were identified with mixed performance over nine years. Leadership buy-in, accountability, strategy, and culture emerged as critical practices. The cascading effect highlighted a dynamic system from well-ordered practices promoting equity. I will develop a thought leadership product portfolio and disseminate using the Waters of Systems Change model to promote systemic change.