Shonti Meyer, a registered nurse midwife and medical director of the STRIDE Public Health Center in Colorado, does not routinely disclose her sexual orientation to patients. But sometimes it seems appropriate.
After telling a transgender patient that she was a lesbian, Meyer learned that the woman had recently taken four other transgender women, estranged from their birth families, under her wing. They lived together like a family, and each one came to see Meyer at the Aurora Clinic, where she practices. According to her, some of them were just starting out as transgender women and felt comfortable with her as a provider, believing that she understood their needs and could communicate well with them.
“They feel more connected because I’m part of the community,” Meyer said.
Research shows that when patients visit healthcare professionals who share their culture, speak the same language, or reflect their experiences, their treatment outcomes improve. Now Colorado is trying to help patients find these providers. As part of this effort, the state is asking insurers offering certain health insurance plans to collect demographic information such as race, ethnicity, disability status, sexual orientation, and gender identity from both health care providers and members — a move that they say some medical workers. may threaten their safety.
Later this year, a new state law goes into effect that requires insurers to offer a “Colorado Option” plan to the state market of the Affordable Care Act with state-standardized benefits. Colorado requires these plans to create culturally sensitive provider networks with a diverse mix of practitioners who can meet the needs of a diverse population.
Some other states, including California and Washington, D.C., require plans sold in their health insurance markets to collect demographic data from patients, though not from providers, and patients are usually only asked about their race and ethnicity, not about their sexual orientation or gender identity. .
“No one knows how many specific racial or ethnic identities they may have among their providers, what the percentages are, and how they relate to the communities they serve,” said Kyle Brown, Colorado Deputy Commissioner for Accessibility Programs. “Traditionally, this kind of data is not collected.”
The state and insurers will be able to see how similar groups of patients and providers are, and then work on ways to close the gap if necessary. For example, a plan may find that 30% of its members are black, but only 20% of its suppliers.
Colorado has considered including health care provider demographics in the directories so that patients can use them to select their doctors. But after groups of doctors raised the issue of privacy, the state decided to make the provision of demographic data by service providers voluntary and confidential. This means insurers have to ask, but service providers may refuse to answer. And the collected data will be reported to the state only in aggregate.
Government officials and consumer advocates hope demographic data will eventually help inform patients. But for now, physician groups and other stakeholders fear that making the data public could harm some providers, especially LGBTQ+ people.
“There are a lot of really conservative neighborhoods in Colorado,” said Stephen Hayden, psychiatrist and CEO of Envision: You, a Denver-based nonprofit specializing in LGBTQ+ mental health services. “In many communities outside of our metropolitan areas, it’s not safe to be outside.”
State officials say the Colorado Option will be the first health plan in the nation created specifically for health equity, a term used to describe everyone has an equal opportunity to be healthy. This framework includes broader coverage of services that address health inequalities. This requires anti-bias training for providers, their front office staff, and health plan customer service representatives. Plans are to increase the number of community health centers that treat more patients from underserved communities than other clinics in their networks, as well as certified nurse midwives, to help reduce maternal mortality.
Health plan directories must list the languages spoken by health care providers and their front office staff, whether offices are accessible to people with disabilities, and whether the provider works evenings or weekends.
But officials are trying to figure out how they can use demographic data to refer patients to doctors with similar identities while avoiding unintended consequences, especially regarding sexual orientation or gender identity.
Dr. Mark Johnson, president of the Medical Society of Colorado, said more doctors than ever feel comfortable disclosing their sexual orientation or gender identity, but cases of disgruntled patients who lash out citing a doctor’s personal characteristics still occur. .
“Even though we’re a purple state, there’s still a lot of prejudice here and there,” he said. “There could be some serious problems because of this, so I hope they will be very, very sensitive to what they are doing.”
LGBTQ+ patients often face stigma in healthcare settings, which can lead to negative experiences that range from discomfort to outright abuse.
“There are many marginalized and disenfranchised people who, when they don’t have a good experience, refuse to be taken care of. They are not returning to this provider,” Hayden said. “Thus, needs remain unmet.”
As a result, according to Hayden, LGBTQ+ people have two to four times higher rates of depression, anxiety, overdoses, and suicide than heterosexual cisgender people.
Many people in the LGBTQ+ community share information about which doctors and clinics are friendly and competent, and which ones to avoid. Finding health professionals who are LGBTQ+ themselves is a way to increase the likelihood that the patient will feel comfortable. But many experts emphasize that LGBTQ+ health care education is more important for a health care provider than participation in this community.
“The best doctor you can go to is someone who has done the work to understand what it means to be a safe, positive practice,” said Jessica Fish, director of the Sexual Orientation, Gender Identity and Health Research Group at the University of Maryland.
Many health plans allow members to search for providers who have received such training, but do not indicate which providers are themselves part of the LGBTQ+ community. The decision to self-identify to patients or colleagues can be difficult and often depends on the circumstances of the provider.
“There are many variables that go into their comfort level and the decision of whether disclosure is safe for them,” said Nick Grant, clinical psychologist and president of GLMA: Health Professionals Advancing LGBTQ Equality, formerly the Gay and Lesbian Medical Association. “In different parts of the country it depends on the climate. National politics influenced these conversations.”
Grant said the debate over transgender laws in conservative states like Florida and Texas is having a chilling effect on doctors across the country, making them less willing to speak out. On the contrary, Colorado’s moves towards culture-sensitive networks are helping to signal that the state is much more protective of LGBTQ rights, he says.
“I have never seen anything like it in other states,” he said.
The new data collection requirement will only apply to Colorado Option plans, which become available in 2023 and are likely to cover only a subset of the more than 200,000 people who purchase plans in the state’s health insurance market. But government officials are hoping health plans will use some of the same network building strategies for their other plans.
Colorado’s approach caught the attention of other states. And as part of a new federal health equity initiative, the Centers for Medicare and Medicaid Services recently announced they will collect more demographic data, including race, ethnicity, language, sexual orientation, gender identity, disability, income, geographic location, and other factors. . in all CMS programs that reach 150 million people.
“We’ve learned bit by bit about what other states are doing and what the nation’s top experts have been talking about in terms of health equity and cultural competence, and we’ve synthesized that into what we think is truly leading the nation. Brown, spokesperson for accessibility programs in Colorado, said. “People will look to Colorado as an example.”
KN (Kaiser Health News) is a nationwide newsroom dedicated to in-depth health journalism. Together with Policy Analysis and Polling, KHN is one of the three major operational programs in KFF (Kaiser Family Foundation). KFF is a charitable non-profit organization providing health information to the nation.