As a health equity champion for Blue Cross and Blue Shield of Minnesota and current Bush Fellow, Ani Koch is deeply focused on work that addresses inequities for marginalized communities. Ani’s work is steeped in the practice of public health—a body of work that focuses on the health of a population as a whole.

“Public health is one of those things that is everywhere and nowhere― from trash pickup and proper plumbing to raising the tobacco tax or building bike lane infrastructure―all can be considered public health,” Ani says.

In honor of National Public Health Week, Ani shares a look at their role as a principal sustainability design consultant on the population health team at Blue Cross and the company’s focus on racial and health equity.

A focus on population health to improve health outcomes

While Blue Cross has a strong history of doing work in population health, that work has been accelerated through the creation of a dedicated population health team.

“The need to accelerate our work in this area has become even more important for Blue Cross to grow and remain competitive, while working to improve the health of our members and reduce overall health care spend,” Ani explains.

Blue Cross defines population health as a strategic framework to improve the outcomes of a defined group of people [our members] and a model of care for addressing individuals’ comprehensive health needs. This work touches all points along the continuum of care— including in the community setting. It tackles the many factors that contribute to health, while addressing health inequities through proactive, cost-effective and tailored interventions.

Population health tackles the many factors that contribute to health, while addressing health inequities through proactive, cost-effective and tailored interventions.

“As a company we need to move upstream to make an impact and prevent the need for so many downstream interventions,” Ani says. “That means we must address social determinates of health factors [the conditions in the environments where people are live, work and play]. This will be key to our success.”

Looking at the health of a community or group using data to identify disparities is core to the work of the population health team. For Ani, this means looking at how specific business actions improve health outcomes of a particular group, while also meeting the goal of lowering health care costs.

“Health insurers have an important role because we have access to claims data,” Ani explains. “If we see a disparity in a larger population, we can then use this information to inform the design of an intervention.”

Improvement to health outcomes can come from assessing how claims are processed, benefit plans are designed and what policies are in place within the company. Each of these― and other core business functions― can be leveraged to directly address racial and health inequities.

Addressing racial inequities

Ani also notes that the population health team also plays a critical role in the company’s racial and health equity strategy.

“Population health will effectively be an arm to implement racial and health equity strategy,” says Ani. “Gone are the days where it will be a small group of practitioners to implement a racial equity plan. Population health will be a key component for people to take this seriously in a different way.”

Ani points out that this includes addressing business practices and policies immersed in systemic racism as a part of the company’s commitment to dismantle racism and make health equity our business.

“We must address racism as the public health crisis that it is,” Ani says. “Police brutality, the prison pipeline, these are all public health crises created by systems steeped in racism. To advance racial equity, and create a healthier future for all, we must address this reality head on.”

Addressing the needs of marginalized communities

Advancing equity for marginalized communities is a cornerstone of the work that Ani does every day as a public health practitioner. Notably, Ani guided the creation of the Gender Care and Service initiative, which was established to provide inclusive and equitable care for transgender and non-binary communities.

“We need to continue to look at our process and policies to address how they support the communities we serve,” Ani says. “When systems are not built and designed for those most impacted, the frustrations that people feel are going to be ten-fold.”

"When systems are not built and designed for those most impacted, the frustrations that people feel are going to be ten-fold."

Guided by research of current policies, claims data and member experiences, the Gender Care and Service initiative has effectively begun to make significant steps to improve the experience for a group all too frequently left marginalized.

“As a company we have worked on improving care and service for the transgender population for several years, but it wasn’t until last year that we truly took that work external by providing a gender services consultant to our members,” Ani says.

“That role and work has been informed by health disparities data, community need and member input. It is a great example of a population health project:  improving the health care system for a marginalized population to improve health outcomes. Those improvements don’t take anything away from cis gender members; in fact, we often make improvements that better serve everyone.”

Public health practitioners focus to close the gaps

Ani points out that using public health data is key to guide work focused on reducing disparities in the structure of current systems.

“There’s a wealth of public health data that shows where disparities exist in health care,” Ani says. “Black, Indigenous and communities of color and the LGBTQ community continue to face significant barriers to care. Business must implement a practice of listening to learning from members of these communities— and then act to advance work meant to address them.”

And, Ani points out, it’s business critical to do this well.

“It is simply in our business interest to serve the health of all Minnesotans. Public health has been and will continue to be a cornerstone of our business. But how we do it― and why― will need to continue to evolve to have the greatest impact and allow us to stay ahead of the curve,” Ani says. “By creating programs and changing our practices to improve the health of all Minnesotans, we will improve the health of our members. It’s really an ‘all boats rise’ approach.”