Colorado recently launched an initiative asking insurers that offer certain health plans to collect demographic information from providers and enrollees—a move that some health care workers say could threaten their safety, Markian Hawryluk reports for Kaiser Health News.
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Colorado asks insurers to collect demographic information
Under the new law, which is set to take effect later this year, health insurers will be required to offer the "Colorado Option," a state-run Affordable Care Act marketplace plan that offers standardized benefits. The state will require those plans to create "culturally responsive provider networks" that offer "a diverse set of health practitioners who can meet the needs of a diverse population," Hawryluk writes.
According to state officials, the "Colorado Option" will be the first health plan in the country specifically designed to further health equity. It will include improved coverage for services that combat health disparities. In addition, all providers, staff members, and customer service representatives will be required to undergo anti-bias training, and plans will be required to boost the number of community health centers and certified nurse-midwives in their networks.
The health plan directories will also be required to list the languages spoken by providers and their office staff, specify whether they are accessible for those with disabilities, and disclose whether the provider offers evening or weekend hours.
Ultimately, state officials and consumer advocates anticipate that the demographic data will help patients make more informed decisions when selecting a provider. Further, the state plans to use the data to narrow any gaps between patient and provider diversity.
"Nobody knows how many particular racial or ethnic identities they might have among their providers, what the percentages are, and how they correspond with the communities that they serve," said Kyle Brown, Colorado's deputy commissioner for affordability programs. "Traditionally, data like this isn't collected."
Previously, the state considered including demographic data in directories patients could use to choose their doctors, but it decided to make the reporting of demographic data voluntary and confidential after physician groups voiced privacy concerns. "That means insurers must ask, but the providers can decline to answer," Hawryluk writes. "And the data collected will be reported to the state only in aggregate."
Health care professionals voice privacy, safety concerns
While research suggests that patients often have better outcomes when they see health providers with similar backgrounds, some health care professionals have voiced concern that the initiative could ultimately pose a threat to their safety and privacy.
In particular, physician groups and other stakeholders worry that publishing public demographic data could subject some providers to harm, especially those in the LGBTQ+ community.
"There are a lot of really conservative parts of Colorado," said Steven Haden, a mental health therapist and CEO of Envision:You, a nonprofit that focuses on LGBTQ+ behavioral health services. "In lots of communities outside of our metropolitan areas, it's not safe to be out."
As a result of these concerns, state officials are trying to determine how to use demographic data to help patients select practitioners who have similar backgrounds while avoiding unintended negative consequences, especially those surrounding sexual orientation and gender identity.
According to Mark Johnson, president of the Colorado Medical Society, more doctors than ever now feel comfortable disclosing their sexual orientation and gender identity. However, there are still incidents in which disgruntled patients lash out because of a physician's personal characteristics.
"Even though we're a purple state, there's still a lot of bias here and there," Johnson said. "There could be some real problems that come out of this, so I am hoping they will be very, very sensitive to what they're doing."
Despite these concerns, however, "Colorado's approach has caught the eyes of other states," Hawryluk writes.
Notably, CMS recently announced it would increase its collection of demographic data across all programs—which cover around 150 million people—as part of a new federal health equity initiative.
"We have learned from bits and pieces of what other states have been doing and what the national leading experts have been talking about in terms of health equity and cultural competence, and we have synthesized that into something that we think is really leading the nation," said Brown. "People are going to look at Colorado as an example." (Hawryluk, Kaiser Health News, 4/25)