How Employers Can Combat Anti-LGBTQ Bias in Healthcare Using Digital Health Programs

In case you’re wondering what’s up with the sudden rise in rainbow-colored logos on LinkedIn, June is LGBTQ Pride Month. Across the country and around the world, members and allies of the LGBTQ community are celebrating the impact that lesbian, gay, bisexual, transgender, and queer individuals have had throughout history — such as the 1969 Stonewall Uprising in Manhattan, which is considered the tipping point for (what was then known as) the Gay Liberation Movement in the United States. Pride Month is also an opportunity to champion the ongoing efforts to create a more equal and inclusive society. It’s a time to shed our outdated taboos and embrace the colorful and unique identities that make us all different. After all, the world is beautiful because it's colorful.

Yet while significant strides have been made in recent years towards LGBTQ equality and acceptance, we must acknowledge that many barriers remain for members of the LGBTQ community. And one of the most harmful, painful, and insidious examples exists in the healthcare industry.

LGBTQ People Face Explicit and Systemic Discrimination in U.S. Healthcare

A study by the American Heart Association (AHA) revealed that 56 percent of LGBTQ adults, and 70 percent of adults who are transgender or gender non-conforming, report experiencing some form of discrimination — including the use of harsh or abusive language — from a healthcare professional. Research by the Center for American Progress has found that 48 percent of transgender adults and 29 percent of lesbian, gay, or bisexual adults have delayed or avoided medical care.1 Stated the AHA: “Trust toward health care professionals is still lacking among many members of the LGBTQ community, and health care professionals need more education on how to provide appropriate care for LGBTQ patients.”

Closing the Trust Gap in HealthCare

On a positive note, some good work is being done to ensure that healthcare professionals provide inclusive services and care for the LGBTQ community. A key resource is a document called the Community Standards of Practice for the Provision of Quality Health Care Services to LGBT Clients. Created by the LGBT Health Access Project, which is part of the Massachusetts Department of Public Health, these standards address agency administrative practices and service delivery components across six core areas: 

  • Personnel
  • Client's Rights
  • Intake and Assessment
  • Service Planning and Delivery
  • Confidentiality
  • Community Outreach and Health Promotion

The American Medical Association (AMA) has also assembled a list of best practices for making practices LGBTQ-friendly, which includes utilizing the Healthcare Equality Index (HEI) — a national LGBTQ+ benchmarking tool that evaluates healthcare facilities' policies and practices related to the equity and inclusion of their LGBTQ+ patients and employees.  

Employers Have a Big Role to Play in Countering Anti-LGBTQ Bias and Discrimination

Speaking of equity and inclusion for employees… employers across all sectors — not just within healthcare — have a pivotal role to play in ensuring that LGBTQ employees feel safe bringing their full selves to work. To that end, McKinsey advises employers to eliminate explicit and systemic discrimination by: 

  • Creating structural support for trans employees
  • Stamping out inappropriate behavior
  • Broadening the recruiting pool to make the “only” experience rare from the outset (i.e. when an individual is the only one on a team or in a meeting with their given gender identity or sexual orientation)
  • Improving sponsorship of LGBTQ employees to support career progression
  • Promoting inclusivity in remote-working environments

At the same time, employers need to focus on ways that help their LGBTQ employees overcome the above-noted discrimination barriers that prevent them from getting the healthcare they need — especially with respect to heart health. Hypertension, or high blood pressure, puts individuals at greater risk for heart disease and stroke, which are the first and fifth leading causes of death in the U.S.2

Digital Health: Homophobia and Transphobia Not Included

In certain contexts, cutting humans (and our biases) out of the picture can be beneficial. For example, Hello Heart’s self-paced digital coaching app provides nutrition and wellness tips that encourage healthier behavior that can reduce the risk of heart disease and stroke. 

Given the pervasive “trust gap” in healthcare that so many LGTBQ individuals continue to face, the Hello Heart app lets employees conveniently and privately access personalized wellness tips and biometric data directly on their mobile device. There’s no human involvement required — and therefore no risk of discrimination, abuse, or judgement.

Instead, the app is powered by artificial intelligence and behavioral psychology, and in a peer-reviewed study published in a JAMA Network Open, Hello Heart’s hypertension self-management program was clinically shown to reduce blood pressure.3 Plus, it led to a 2X improvement in reducing blood pressure compared to other digital heart health options on the market.4 So not only can cutting humans out of the equation help to eliminate biases and trust issues, but it can lead to more effective outcomes as well.

In addition to improved health outcomes, Hello Heart’s coaching app may lead to a significant reduction in claims costs for self-funded employers. According to a Hello Heart-commissioned analysis of 2017-2020 employer claims data, Hello Heart’s coaching app saved an average of $1,865 in total year one medical costs per participant compared to matched non-participants.5 And a separate 2021 analysis of Hello Heart’s book of business found that employers who offer Hello Heart saw a minimum 2:1 return-on-investment.6 Empowering your people to take control of their heart health is not only a great way to address hypertension and its related conditions, it can also pay for itself.

Celebrate Pride by Taking Meaningful Steps Towards Health Equity

Employers and healthcare professionals alike must make it a priority to eliminate ALL of the barriers that prevent LGBTQ individuals from accessing the care and support they need. And employers must continuously demonstrate in tangible and meaningful ways that they are “walking the talk” when it comes to supporting and empowering their LGBTQ employees.

To organizations that are leading the way towards a more inclusive and equitable society: keep it up and look for ways to raise the bar! And to organizations that are doing less than they could and should: now is your time to step up and be part of the solution. Will you answer the call?

Footnotes

1  Krehely, J. (2009) How to close the LGBT health disparities gap. Center for American Progress. Accessed June 8, 2022. 

2  Ahmed FB, Anderson RN. The Leading Causes of Death in the US for 2020. JAMA. 2021;325(18):1829-1830. https://jamanetwork.com/journals/jama/fullarticle/2778234. Accessed 6/8/2022.

3  Gazit T, Gutman M, Beatty AL. Assessment of Hypertension Control Among Adults Participating in a Mobile Technology Blood Pressure Self-management Program. JAMA Netw Open. 2021;4(10):e2127008, https://doi.org/10.1001/jamanetworkopen.2021.27008. Accessed 6/8/2022. (Some study authors are employed by Hello Heart. Because of the observational nature of the study, causal conclusions cannot be made. There were 108 participants with baseline blood pressure over 140/90 who had been enrolled in the program for 3 years and had application activity during weeks 148-163. See additional important study limitations in the publication.)

4  Sources: (1) Gazit T, Gutman M, Beatty AL. Assessment of Hypertension Control Among Adults Participating in a Mobile Technology Blood Pressure Self-management Program. JAMA Netw Open. 2021;4(10):e2127008, https://doi.org/10.1001/jamanetworkopen.2021.27008. Accessed 6/8/2022. (Some study authors are employed by Hello Heart. Because of the observational nature of the study, causal conclusions cannot be made. See additional important study limitations in the publication. This study showed that 108 participants with baseline blood pressure over 140/90 who had been enrolled in the program for 3 years and had application activity during weeks 148-163 were able to reduce their blood pressure by 21 mmHg using the Hello Heart program.) (2) Livongo Health, Inc. Form S-1 Registration Statement. https://www.sec.gov/Archives/edgar/data/1639225/000119312519185159/d731249ds1.htm. Published June 28, 2019. Accessed 6/8/2022. (In a pilot study that lasted six weeks, individuals starting with a blood pressure of greater than 140/90 mmHg, on average, had a 10 mmHG reduction.) NOTE: This comparison is not based on a head-to-head study, and the difference in results may be due in part to different study protocols.

5  Validation Institute. 2021 Validation Report (Valid Through October 2022). https://validationinstitute.com/wp-content/uploads/2021/10/Hello_Heart-Savings-2021-Final.pdf. Published October 2021. Accessed 6/8/2022. (This analysis was commissioned by Hello Heart, which provided a summary report of self-funded employer client medical claims data for 203 Hello Heart users and 200 non-users from 2017-2020. Findings have not been subjected to peer review.)

6 Depends on employer size. Based on data on file at Hello Heart.