Elevance Health : Health Equity Assessment

Advancing Health Equity

at Elevance Health

A Review of Approach and Capabilities

March 2024

This report was authored by Carolina Dominguez, Meghan Grever and Aude Ucla. BSR and Elevance Health wish to thank all Elevance Health employees and stakeholders who participated in this assessment.

Disclaimer

The conclusions presented in this document represent BSR's best professional judgment based upon the information available and conditions existing as of the date of the review. In performing this assignment, BSR relied upon publicly available information, information provided by Elevance Health, and information provided by third parties.

Accordingly, the conclusions in this document are valid only to the extent that the information provided or available to BSR was accurate and complete, and the strength and accuracy of the conclusions may be impacted by facts, data, and context to which BSR was not privy. As such, the facts or conclusions referenced in this document should not be considered an audit, certification, or any form of qualification. This document does not constitute and cannot be relied upon as legal or investment advice of any sort and cannot be considered an exhaustive review of legal, investment, or regulatory compliance. BSR makes no representations or warranties, express or implied, about the business or its operations. BSR maintains a policy of not acting as a representative of its membership, nor does it endorse specific policies or standards. The views expressed in this document do not reflect those of BSR member companies.

Executive Summary

Elevance Health, Inc. ("Elevance Health") is committed to improving the health of humanity. To that end, it has made an organization-wide commitment to health equity, which means making sure that all people have "a fair and just opportunity" to be as healthy as they can, regardless of race or ethnicity, sexual orientation, gender identity, disability, and geographic or financial access.

The diversified health services company, which changed its name from Anthem, Inc. in 2022, offers health insurance plans and care solutions to its approximately 47 million members. To understand if Elevance Health is living up to its commitment to health equity, company leaders asked BSRto evaluate the organization's efforts through a health equity assessment.

Health equity is an emerging and increasingly visible field, especially for the for-profit healthcare sector. BSR's team began this report by grounding itself in understanding the drivers of health equity, including its emerging trends. We surveyed the health equity landscape, seeking to understand how Elevance Health's peers were approaching health equity. BSR assessed 12 aspects of such peer companies: strategy, governance, leadership and organizational structure, remuneration, operations, public policy, metrics, services and offerings, data, collaborations, advocacy efforts, and philanthropy. Additionally, BSR conferred with external experts from organizations such as the Robert Wood Johnson Foundation and the Commonwealth Fund to deepen our understanding of external stakeholders' expectations for business.

Elevance Health's Approach to Health Equity

BSR then examined Elevance Health's ecosystem using this same framework, from its products and leadership to its staff and community partners, to see if the company's current reality lives up to its health equity goal.

Advancing health equity is core to the company achieving its purpose of improving the health of humanity. BSR found that the company lives that out in several ways, from its leadership and structure, including having a dedicated health equity team, to taking a value-based care approach which incentivizes health equity for its networks of care providers. The organization has intentionally brought a health equity lens to its main businesses and plans: Medicaid, Medicare, Carelon, and its commercial insurance

plans. Elevance Health integrates clinical, social, and demographics data to support whole health analytics to meaningfully drive improvement and reduce health disparities, including along its four priority areas: maternal health, food as medicine, behavioral health, and pharmacoequity.

This resulting report shows how Elevance Health stands by its commitment to health equity from the top down and is an example of how the health services industry can better align its initiatives and make better use of its resources, technology, and influence to create a healthier U.S. population.

The report provides a detailed and nuanced description of the many ways that Elevance Health works toward its goal of health equity, and how it can continue to improve upon each. This includes how Elevance Health embeds health equity into its health plans and business offerings, how the public affairs team engages with public policy and advocacy work to increase health equity in the U.S., and how the Elevance Health Foundation provides grant money to programs whose mission aligns with the organization's values. Additionally, there is information on Elevance Health's work at the intersection of climate and health equity.

Throughout this report BSR provides recommendations on how Elevance Health can continue to strengthen its health equity approach and capabilities. Actionable areas include opportunities such as pursuing the National Committee for Quality Assurance Health Equity accreditation for all health plans and continuing to mature its Whole Health Index.

Overall, Elevance Health has an integrated and mature health equity strategy, and advanced practices among its peers. Its dedicated health equity team and the board's commitment provide a solid foundation and structure for the organization's health equity commitment. Right now, the U.S. population is increasingly aware that a person's and a community's health lies at the intersection of many personal, historical, and societal factors. Elevance Health's values and approach reflect this reality.

1. Introduction

1.1 About Elevance Health

Elevance Health is an American diversified health services company. It was formerly known as Anthem, Inc., but changed its name to Elevance Health in 2022. Elevance Health is one of the largest for-profit managed health care companies in the U.S., with approximately 47 million members. It offers a variety of health insurance plans, including commercial, Medicare, and Medicaid plans. Elevance Health also offers a variety of clinical, behavioral, pharmacy, and complex-care solutions. The name Elevance Health brings together the ideas "elevate" and "advance," underscoring the organization's commitment to elevating whole health and advancing health beyond healthcare for consumers, their families, and their communities.

Elevance Health's purpose is to improve the health of humanity. The company focuses on helping people live healthier lives by providing them with access to care and the resources they need to do so. Elevance Health is also committed to addressing the social drivers of health, such as poverty, food insecurity, and housing instability, which can have a significant impact on people's health.

Elevance Health consists of a family of companiesto support and reach different segments of the market and to offer a variety of products and services. Its main health plans consist of: Anthem Blue Cross and Blue Shield, which offers a variety of plans in 14 Blue states; and Wellpoint, which offers select Medicaid, Medicare and commercial plans in non-Blue states. Carelon, a healthcare services business, consolidates Elevance Health's broad portfolio of capabilities and services businesses under one brand. In all, Elevance Health serves more than 115 million people, including the approximately 47 million members within its family of health plans.

1.2 Why a Health Equity Assessment?

To reinforce the company's commitment to advancing health equity, Elevance Health engaged BSR, a global nonprofit that works with businesses to create a just and sustainable world, to conduct a healthequity assessment. The assessment reviewed Elevance Health's services to discern whether their offerings create equitable outcomes that improve health for all regardless of age, race, ethnicity, sexual orientation, gender identity, disability, place of residence, and/or financial status. The assessment included a review of Elevance Health's thought leadership, the company's advocacy efforts, responsible artificial intelligence (AI) practices intended to help advance health equity, and engagement with internal and external stakeholders. The assessment aims to enable Elevance Health to further strengthen its commitment to health equity by identifying opportunities to integrate inclusive and equitable policies and practices into its service offerings.

1.3 Assessment Methodology

BSR gathered and reviewed a wide range of information to understand Elevance Health's current approach to health equity and to identify areas for improvement.

Initial research looked for trends in health equity and identified emerging issues. BSR reviewed public documentation such as website content, annual reports, impact reports, news stories, press releases, videos, and interviews with leadership to understand Elevance Health's health equity approach more deeply and to assess its progress against selected peers. BSR also reviewed internal materials such as the Health Equity Playbook for associates, board meeting presentations, and training calendars.

To assess progress made on enhancing health equity in the U.S., BSR also evaluated the comprehensiveness of several health services and health insurance providers' efforts-including Elevance Health-using publicly available information.

Finally, BSR engaged internal and external stakeholders, including staff, community partners, and other experts to gain a holistic perspective on Elevance Health's successes and challenges, and to identify

industry-wide opportunities. BSR included a wide range of stakeholders in this assessment by interviewing 18 individuals within Elevance Health and six external health equity experts and organizations. Internal interviewees' functions and departments included Health Equity, Medicaid, Medicare Advantage, Quality, Strategy, Communications, Public Policy, Marketing, Consumer Experience, Digital and Data Analytics. External organizations were selected on previous knowledge and experience working with Elevance Health and expertise of health equity in the U.S. Some of the external stakeholders interviewed were:

• Katherine Hempstead, Senior Policy Adviser, Robert Wood Johnson Foundation
• Hyewon Han, Director of Shareholder Advocacy, Trillium Asset Management
• Mary E Fleming, MD, MPH President, Reede Scholars, Co-Founder, CMO, Cayaba Care
• Joseph R. Betancourt, MD, MPH, President, The Commonwealth Fund
• Dr. Astrid Williams, Director, Programs & Initiatives, California Black Health Network

2. Elevance Health's Approach to Health Equity

2.1 Definitions

Elevance Health uses the Robert Wood Johnson Foundation (RWJF) definition of health equity,defined as everyone having a fair and just opportunity to be as healthy as possible. This includes removing obstacles to health such as poverty and discrimination. It also includes acknowledging those obstacles' consequences including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.

Additionally, Elevance Health uses the following terms in the context of health equity:

• Health disparities are differences in health outcomes between groups of people.
• Health inequities are differences in health outcomes that are avoidable, unnecessary, unfair, and unjust.
• Social drivers of health include how and where a person lives and how they react to and interact with their community and physical environment. Notably, Elevance Health does not use the term "social determinants of health," as the organization believes this suggests that health is pre- determined-that nothing can be done to change a person's health situation. The term "drivers" demonstrates that people and communities can overcome or change such factors. Health-related social needs (HRSN) are an individual's unmet, adverse social conditions (e.g., housing instability, homelessness, nutrition insecurity) that contribute to poor health and are a result of underlying social drivers of health. Additionally, Elevance Health recognizes that climate change is a driver of health and can worsen existing health disparities.
• Healthcare equity more narrowly describes equity in the experience of assessing and interacting with the healthcare system and its organizations. Healthcare equity more directly examines whether patients have equitable access, receive equitable care, and have equitable experiences.

Health Equity by Design

Elevance Health has committed to "health equity by design," an internal operational approach that allows for personalized, intentional interventions to ensure that all people can receive individualized care. "Health equity by design" strives to enable a comprehensive understanding of all members' needs by examining member data, analyzed within a community context; expanding and standardizing member data collection, analysis, and reporting; enhancing provider capacity, incentives, and accountability to advance health equity; identifying and scaling best practices for health outcome improvement; and cultivating and sustaining an enterprise culture of health equity.

2.2 Governance

At Elevance Health, a dedicated health equity team executes this mission and implements "health equity by design". The Chief Health Equity Officer leads the team, along with the Staff Vice President of Social Impact and Equity, and the Food as Medicine Director. They work in collaboration with the board of directors, which is actively involved in overseeing the organization's health equity strategy.

Elevance Health emphasizes health equity as being core to achieving its purpose and strategy and, accordingly, integrates it into their performance metrics. Elevance Health'sAnnual IncentivePlanincludes environmental, social, and governance (ESG) metrics (specifically, improving Black maternity outcomes), Medicare Star Ratings, and provider collaboration, all of which relate to health equity. This is further strengthened by integrating health equity into program management objectives and

• With community partners: Elevance Health maintains communication through conferences, roundtable discussions, participation on boards and advisory councils, attendance at annual meetings, by volunteering, and through research and data sharing.
• With suppliers and healthcare providers: Elevance Health connects through briefings and meetings, conferences and industry events, trainings and workshops, and the Ethics and Compliance HelpLine.
• With health plan members: Elevance Health has in-person interactions, conducts focus groups, has a 24/7 customer relations hotline, conducts surveys, and stays active through social media and the Sydney Health mobile app.
• With academic institutions: Elevance Health collaborates to sponsor research on high-cost, high- need individuals enrolled in Medicare Advantage plans through institutions like the Perelman School of Medicine at the University of Pennsylvania. The organization also partners with academic institutions for associate development, such as through the Leadership Development to Advance Equity in Health Course, developed with the Harvard T.H. Chan School of Public Health.

2.4 Priority Areas

Elevance Health prioritizes several areas for immediate health equity progress: maternal health, behavioral health, access to evidence-based medical therapy, and food as medicine.

Maternal Health

Elevance Health works with providers to enhance the care received by pregnant individuals. Improvement in black maternity outcomes-specifically prenatal and postpartum care rates and reduction in preterm births are tied to executive compensation. The organization has also joined the Blue Cross Blue Shield Association (BCBSA) with a shared goal of reducing racial disparities in maternal health by 50 percent in five years. This goal is a part of BCBSA's National Health Equity Strategy to take on the U.S.' racial health disparities and envision a more equitable healthcare system.

Elevance Health has done extensive research in the maternal care space-for example, on the importance of doula care in improving maternal health outcomes and hypertensive disorders in pregnancies. Research is a vital part of understanding members' needs and creating necessary interventions and programs to address those needs.

The organization created an obstetrics practice consultant (OBPC)role, which consists of maternal care clinicians who work closely with obstetrical practices and staff to provide high-quality care. OBPCs provide data to support care providers, deliver evidence-based care, and improve patient experience. Elevance Health offers OBPCs the ability to participate in value-based care agreements like the OB Quality Incentive Program to support pregnant people through their care experience.

The OB Healthcare Quality Incentive Programprovides financial incentives to care providers for achieving high-quality measures such as having a patient's first prenatal visit in the first trimester, a low rate of C- sections, having babies born at a healthy weight, full-term births, and cervical cancer screenings. The program's goal is improving health outcomes for people who are pregnant and their babies by rewarding points to a care provider every time they meet a metric.

In addition to the OB Healthcare Quality Incentive Program, Elevance Health collaborates with medical experts to address social drivers of maternal health disparities and embeds maternal health metrics into the company's annual incentive plan. The organization also analyzes data to identify disparities, design intentional interventions, and to identify the needs of Medicare recipients, such as food, transport, and housing.

Behavioral Health

Elevance Health uses data to address behavioral health needs such as mental health and substance abuse disorders. The company created multiple programs and tools to reach members across different

backgrounds, demographics, and geographies. Beginning in 2022, the Suicide Prevention Programexamines health insurance claims for hundreds of potential risk factors including substance use, certain behavioral health diagnoses, inpatient mental health stays, and prior suicide attempts. The program uses predictive modeling of data to identify members with at least a 10 percent risk of suicide events or attempts in the next 12 months and can alert a trained care management team to contact these members and provide support. As a result, in early 2022, there was a nearly 50 percent reduction in suicide attempts among the people enrolled in the program.The program has expanded to California, Georgia, and New York and with membership groups across commercial, Medicare and Medicaid business lines. The Changing Pathways program helps members admitted into an inpatient facility for behavioral health disorders receive educational material, medication, and ongoing treatment support from community providers and specialists once they leave the facility. The program has seen positive results in Connecticut, where members who engaged in the Changing Pathways program were 2.5 times morelikely to follow their treatment 90 days after being dischargedcompared to people who went through traditional withdrawal management.

Carelon Behavioral Health focuses on digital health tools to help members. Carelon Behavioral Health has partnered with Buoy Health, an AI-poweredcare-navigation system, to help people identify their symptoms and find appropriate providers in their area. These types of tools have helped Carelon Behavioral Health prioritize access to treatment, eliminate wait times, streamline care, measure member satisfaction and symptom reduction, increase patient choice, expand coverage of specialty care for adolescents, improve patient retention rates, and improve quality and affordability of care.

In July 2022, Carelon Behavioral Health launched the 988 Suicide and Crisis Lifeline. Working with the Substance Abuse and Mental Health Services Administration and Vibrant Emotional Health, in May 2022, Carelon Behavioral Health created a nationwide backup center capable of answering up to 20,000 texts and chats per month and now includes a Spanish-language line. In the year since the launch of the 988 Lifeline, text and chat answer rates have reached 96 percent or higherand Carelon Behavioral Health is working in some states to hold community meetings where stakeholders can share data, identify gaps in care, and find other ways to improve the Lifeline.

Elevance Health has seen a demand for behavioral health telehealth services increase by 80 times since 2019. To meet the demand, the company has trained about 7,000 providers in virtual care delivery and expanded their network of mental health and substance use disorder providers.

Food as Medicine

Elevance Health's Food as Medicine programs address the link between nutrition and health through strategies or interventions that improve access to nutritious food to prevent, manage, or even treat diseases. These strategies include tools such as tailored meals, produce prescription programs, and federal public health programs like the Special Supplemental Nutrition Program for Women, Infants, and Children. For Elevance Health, food as medicine is an important part of the Whole Health strategy. Given the organization's holistic view of health, Elevance Health believes it is critical to improve access to nutritious food for the people and communities it serves.

Elevance Health's programs and interventions recognize the important role food plays in managing health conditions and outcomes. To that end, the organization created and filled an official Food as Medicine director role at the end of 2023. The new Food as Medicine director will consolidate all Food as Medicine initiatives into a unified strategy, measured and analyzed for their impact on better health outcomes.

As an important partner in the Food as Medicine work, the Elevance Health Foundation has given $14 million to the largesthunger-relieforganization in the U.S., Feeding America, to combat food insecurity, a key social driver of health. This multiphase collaboration with Feeding America includes data collection and analysis between hospital systems and food banks to increase understanding of how food as medicine affects clinical outcomes among people with diet-related health conditions. The Elevance HealthFoundation has committed $30 million in food as medicine grants over athree-yearperiod.