Health Net report outlines evidence-based strategies for improving health equity in California


Eli Kirshbaum


Health Net recently released a report providing recommendations on how to improve health equity in California. The report is based on successful initiatives implemented by Health Net, which serves many Medi-Cal-eligible individuals.

The report outlines four overall recommendations to improve health equity: 

  • “Implement multi-faceted interventions 
  • Recognize that community-based resources drive the greatest impact
  • Understand that cultural competency is key and use opportunities to educate and support our providers in this area 
  • Leverage both qualitative and quantitative data to advance health equity work and drive meaningful outcomes, intentionally grounding approaches in lived experiences”

The report also provides recommendations based on specific initiatives Health Net conducted in the past. The recommendations are separated into three categories: programmatic recommendations, investment-centered recommendations, and education-focused recommendations.

Programmatic recommendations

Implement tailored solutions that are unique to each patient population

Health Net became aware of a disparity at a Central Valley Clinic that serves primarily Salvadoran patients. Only around half of women attended postpartum visits. A nearby clinic serving a different demographic of clients had much higher rates. An investigation revealed a Salvadorian custom in which women quarantine and cover themselves for 40 days after delivery.

To ameliorate this disparity, Health Net convened a community advisory workgroup to create an educational campaign for providers to inform them of this custom. It also added a question on an individual’s beliefs to the facility’s obstetric history form. As a result, postpartum visits in the clinic increased from 50% to 82% from early 2017 to mid-2019.

Utilize a multi-faceted approach and include the voices of members, providers, and the community

In response to the observed benefits of doula services (lower C-section rates, greater comfort during childbirth, increased postpartum visits), Health Net became the first Medicaid contracted health plan in California to provide free doula services to members. The program supported both African American doulas and African American mothers.

The report says preliminary data showed member C-section rates to be 50% lower among women who had doulas compared to those who didn’t.

Investment-centered recommendations

Where community support structures don’t exist, invest in institutions that know their communities best and allow them to build that support structure

Medi-Cal enrollment presents a barrier for many underserved individuals due to language, culture, and other factors. In order to reduce the consequential decrease in preventive care and worsened health outcomes for these communities, Health Net provided a grant to Fresno’s Centro La Familia Advocacy Services to support their Asegure su Bienestar program.

The program assists underserved individuals — especially farmworkers — with Medi-Cal enrollment. The report says the grant led to the enrollment of 408 new members in Centro La Familia’s services — individuals who had never had health insurance coverage before.

Work with local partners to identify safety net gaps, then invest in filling these gaps

Seniors who rely on community organizations to access basic needs were significantly impacted by COVID-19, and have a harder time accessing these services now. To address this issue, Health Net awarded a grant to WISE & Healthy Aging to buy a wheelchair accessible van to distribute food to seniors in key Los Angeles communities during the pandemic. The organization was also able to use the van to transport seniors to medical appointments.

Through the grant, WISE & Healthy Aging was able to provide transport assistance to at least 50 disabled seniors. The program also provided nutritious meals to at least 300 low-income seniors and delivered at least 5,000 meals to seniors’ homes.

Education-focused recommendations

Ensure cultural competency training and education at every level

African American children die at twice the rate of any other ethnicity in Sacramento County. The county’s four leading causes of pediatric death are perinatal conditions, infant sleep-related deaths, child abuse and neglect, and third-party homicide.

In partnership with the Sierra Health Foundation and the Black Child Legacy Campaign (BCLC), Health Net established the Cultural Broker Program to reduce deaths among African American children. The partnership involved BCLC partners and community stakeholders with the capacity to provide culturally relevant health care to mothers and children. As a result, African American child deaths in the county decreased by 25% between 2014 and 2017.

Build teams that reflect the communities they serve

In response to high rates of health disparities among Medi-Cal enrollees, Health Net developed “the largest cultural and linguistic team in the industry.” This team ensures that different cultures and languages among employees and enrollees are understood and appreciated.

Health Net’s use of this team has closed traditional gaps to care and promotes an understanding of equity among individuals involved. The creation of the team led to Health Net being awarded the National Committee for Health Quality Insurance’s distinction in multicultural care.

Design health care roles focused on multi-cultural care

California is experiencing health care workforce shortage that disproportionately impacts underserved communities. For instance, an uneven distribution of providers across the state worsens structural inequities.

To address the issue, Health Net invested nearly $4 million into workforce development to ensure providers across the state better reflect the communities they serve, and to help providers reach new patients. This includes investments into community programs that promote cultural acceptance and diversifying the representation of vendors.