PEBB Board Retreat Goals and Format Goals

welcome to brighter

• To develop a strategy that is centered on health equity, building on the Triple Aim, value based care strategies, core values and guiding principles

• To educate and inform Board members about health disparities, health equity and related concepts in order to define and address the issue of health equity

• To create a framework on how the Board will be proactive in pursuing health equity

• To develop an approach for the Board to consider policy and operational decisions from a health equity lens

Key Assumptions to Achieve these Goals

• The Board needs to fundamentally do business differently in order to evolve its strategy to embrace health equity

• As the Board changes and articulates its needs and requirements, the benefit partners will also need to change to become aligned with this evolving health equity strategy

• Building a strategy on health equity is NOT just about measuring health disparities and this is NOT about data analytics

• To Understand and address the Board composition through intentional diversity (NOTE: The new Board members are identified from the Governor’s office of appointments)

Format

• Virtual using Zoom (set up by Mercer)

• Interactive participation with robust conversation, not just lecture

• Break-out sessions to discuss specific topics

• Frequent breaks

Page 2 PEBB Board Retreat Goals and Format

Structure of the Retreat: Three major parts

• Phase 1: Introductions, Retreat Goals, Education

─ Background, history, and challenges face by marginalized populations

• Phase 2: Health Equity

─ Framework, including terms, concepts, assumptions, values, and guiding principles

• Phase 3: Identify Action Items

─ Board

─ Member committees and councils

─ Benefit partners

─ Consultants

─ Other stakeholders

Page 3 PEBB Board Retreat Goals and Format

Phase One: Education

Topic Format Estimated Time • Meeting kick-off • Mercer facilitated discussion 15 minutes ─ Introductions ─ Review of retreat goals ─ Meeting guidelines to foster robust and respectful dialogue • Education • Mercer facilitated discussion 30 minutes ─ Overview of health disparities, including Oregon-specific data ─ Impact on marginalized populations Break 5 minutes • Discussion about health disparities • Small group break-out 10 minutes in ─ Learnings sessions small groups ─ Surprises • Gather back to larger group to 10 minutes in ─ What does this mean for the PEBB share insights larger group membership? Break 5 minutes

Phase Two: Health Equity

Topic Format Estimated Time • Health equity framework • Mercer facilitated discussion 20 minutes ─ Overview of the OHA health equity framework, including vision, values, assumptions, and prioritized populations with Oregon specific data • Discussion on health equity • Small group break-out 15 minutes in ─ Strengths and alignment of OHA equity sessions small groups framework with PEBB • Large group facilitated by 10 minutes in ─ Identify what health equity does NOT Mercer large group look like Break 5 minutes • Review of the short term and long term • Mercer facilitates review of the 10 minutes for strategies through the lens of health equity long term and short term review strategies • Small group break-out 15 minutes for sessions small groups • Re-group for sharing 10 minutes for re- discussion from small groups group

Page 4 PEBB Board Retreat Goals and Format

Lunch Break: 30 minutes

Phase Three: Identify Action Items

Topic Format Estimated Time • Organizational change management (AGILE) • Mercer facilitated 20 minutes ─ Awareness of issues discussion ─ Goal setting ─ Identify improvements ─ Leverage resources ─ Evaluate results • Health equity visioning session from • Small group break-out 20 minutes for stakeholder perspectives sessions small groups ─ What is working well • Regroup into larger group 10 minutes for ─ What is not working well regroup ─ What does success look like Break • 5 minutes • Plan for implementation, including • Small group break-out 20 minutes in accountabilities, assignments, & timeframes sessions small groups ─ Board • Regroup into larger group 10 minutes in re- ─ OHA group ─ Benefit partners ─ Consultants ─ Other stakeholders ─ Resources ─ Timeframe ─ Vetting ─ Communication Break 5 minutes • Evaluation of retreat and wrap-up • Mercer facilitates large 15 minutes group discussion

u:\ehb\core\sea\pebbor\year\2020\board deliverables\11172020 - retreat\pebb board retreat agenda goals_nov2020_.docx

Phase 1, Section 1: Introductions

November 17, 2020

Michael Garrett, MS, CCM Principal, Total Health Management and Inclusive Benefits Practice

welcome to brighter Agenda

To develop a strategy that is centered on health equity, building on the Triple Aim, value based care strategies, core values, and guiding principles

To educate and inform Board members about health disparities, health equity, and related concepts in order to define and address the issue of health equity

To create a framework on how the Board will be proactive in pursuing health equity

To develop an approach for the Board to consider policy and operational decisions from a health equity lens

The Board needs to fundamentally do business differently in order to evolve its strategy to embrace health equity

As the Board changes and articulates its needs and requirements, the benefit partners will also need to change to become aligned with this evolving health equity strategy

Building a strategy on health equity is NOT just about measuring health disparities and this is NOT about data analytics

To understand and address the Board composition through intentional diversity (NOTE: The new Board members are identified from the Governor’s office of appointments)

Interactive Break-out participation Virtual format sessions to Frequent with robust using Zoom discuss specific breaks conversation, topics not just lecture

• Annotate 1 2 – Used for non-verbal feedback – Let’s practice!

• Chat Function – Thumbs up/down, yes/no, “coffee break”, etc. 1

• Polling (we’ll practice!) – Answer are anonymous

• Breakout Rooms 2 – Randomly assigned – Mercer facilitator in each room

What are you most excited about for this What are your concerns about this retreat? retreat? • Feeling overwhelmed • Learning about this important topic • Not achieving consensus on a clear action plan • Spending time and getting to know other board • Being uncomfortable members • Not getting to everything we need to address • Making progress towards health equity • Getting bogged down • Developing a strong collaborative consensus on what we need to do as a Board • Uncertainty over the future course of action

• Being able to demonstrate our commitments to • Needing to make significant changes to achieve our goals achieving health equity • Dealing with irritating meeting facilitators • Really making our strategies actionable

• Designing benefits and programs to better meet the needs of members

• Creating a whole new approach to benefit designs

Phase 1 Phase 2 Phase 3

Introductions, retreat Health equity Identify action items goals, education • Framework, including terms, • Action items and • Background, history, and concepts, assumptions, accountabilities for all challenges faced by values, and guiding stakeholders marginalized populations principles

1. Follow the agenda 2. Tackle issues, not people 3. Assume positive intent 4. Make sure you understand the topic/issue before giving an opinion 5. One speaker at a time 6. Let everyone have a chance to speak 7. Be present, so do not multi-task 8. Be willing to ask questions if you don’t understand 9. Stay on key topics and do not derail 10. Ask tough but respectful questions 11. Be brave enough to suggest radical ideas/solutions 12. Allow some humor

If you are comfortable, we are not making progress…

November 17, 2020

Michael Garrett, MS, CCM Principal, Total Health Management and Inclusive Benefits Practice

Madeleine Winslow Senior Associate, D&I Consulting

welcome to brighter Today’s speakers

Madeleine Winslow Michael Garrett, MS, CCM • Senior Associate • Principal • Diversity & Inclusion • Total Health Management and Inclusive Benefits Practice

Pronouns: she/her/hers Pronouns: he/him/his

Copyright © 2020 Mercer (US) Inc. All rights reserved. 12 Definition of racism Definition of anti-racism “a belief that race is a fundamental “the policy of challenging racism and determinant of human traits and promoting racial tolerance” capacities and that racial differences produce an inherent superiority of a particular race”

What you’re saying: You don’t hold the belief that one race is superior to another

Segregationist: Assimilationist: Anti-racist:

One who is expressing the One who is expressing the One who is expressing the racist idea that a racist idea that a racial group idea that racial groups are permanently inferior racial is culturally or behaviorally equals and none needs inferior and is supporting group can never be developing, and is cultural or behavioral developed and is supporting supporting policy that enrichment programs to policy that segregates away reduces racial inequity, and develop that racial group, and that racial group, and an anti-racist thinks nothing reduces racial minorities to believes that inferiorities and the level of children needing is behaviorally wrong or right superiorities of racial groups instruction on how to act by (inferior or superior) with any explain racial inequities adopting the dominant culture of the racial groups

Kendi, I.X. “How to be an antiracist.” New York, NY: One World, 2019.

Institutional Structural Interpersonal Internalized

Policies and practices Multiple institutions Racist acts and micro- Subtle and overt that reinforce racists collectively upholding aggressions carried out messages that reinforce standards within a racist policies and practice, from one person to negative beliefs and self- workplace or i.e., society another hatred in individuals organization

Source: Slow Factory Foundation

Diversity Equity Inclusion Evolving Designing to Fostering representation ensure access belonging

How well does our workforce How well do we ensure that How well do we create represent the communities we programs, policies and benefits a culture, environment, represent and serve? deliver equality of opportunity, and experience that instills How will current representation experience and pay? a sense of belonging, of underrepresented minorities authenticity, and trust? change over the next 5-10 years?

Objective lens Organization lens Member lens

Following the murder From the #MeToo Organizations are looking of George Floyd and movement to the to support the financial other Black Americans, disproportionate and physical well-being Organizations must the global outcry economic impact of of employees adapt to attract and regarding racial injustice COVID-19 on women, from disadvantaged retain a workforce has prompted it’s clear that maintaining backgrounds who are and customer-base There is increasing organizations to rethink an intersectional lens on disproportionately that expects them to external pressure on their approach to DEI gender will be more impacted by the become accountable corporations from critical than ever to global pandemic for equity and equality shareholders, customers, ensure DEI progress both internally and investors, and regulatory externally bodies to drive positive social outcomes (and minimize negative ones)

Copyright © 2020 Mercer (US) Inc. All rights reserved. 18 Understanding the Black experience in the US today How far we’ve come The current 116th 43% Congress is the From 2014 to 2019, the number of businesses owned by women of most racially color in the U.S. grew by 43% diverse yet

Traction for 45% protection against discrimination based on natural hair texture with HB 4107 Copyright © 2020 Mercer (US) Inc. All rights reserved. 20 Deeply-rooted history 1865. Juneteenth; Ku 1990. Exonerated Five wrongfully Klux Klan forms. convicted in Central Park case. th 1868. 15 Amendment 1954. Brown v. Board of 1992. Rodney King is viciously beaten by passed. Education 1619. A ship with 20 captives lands at Point Comfort in Virginia. 1844 - Oregon (as a territory) banned slavery but prohibitedpolice. Black LA Riots. 1641. Massachusetts is the first in North America to recognize people1870. from Sharecropping. living in Slavery the territory 1955.for more Emmitt than Till is three years 1991. Civil Rights Act. murdered. slavery as a legal institution. by another name. 1994. Hate Crime Enhancement Act. 1662. Virginia law determines that the status of the mother 1849 - Black people who were not already in the area were barred from 1955-1968. Civil Rights 1996. Affirmative Action is abolished by determined if a Black child would be enslaved. entering1870 or-1945 residing. Jim in the OR territory Crow Laws Movement California lawmakers through Proposition 1705. The Virginia Slave Code codified the status of slaves, 1855 - Mixed race men were forbidden from becoming citizens209. further limiting their freedom, and granting slave owners more 1882-1968. 4,743 1965. The Voting 1998. James Byrd Jr. dragged to death by rights. lynchings occur in the Rights Act prohibits 1859 - TheUnited 1849 States. exclusion measure made it into the state constitutionWhite supremacists in Texas. 1776. The Declaration of Independence is signed. All (White) racial discrimination and prohibited Black people from owningin voting. property and making2002. contracts Stop and frisk starts in NYC. men are created equal. Slavery persists. 1896. Plessy v. 1857. Dred vs. Sanford, Supreme Court case rules that Blacks 1862 - OregonFerguson adopted. a law requiring all1968 Blacks,-1979. Rise Chinese, of 2006Hawaiians,. Sean Bell killed on wedding day. are not citizens of the US and Congress is denied the ability to Black Power Unarmed. and “Mulattos”1932. residing Tuskegee in Oregon to pay an annual tax of $5. Interracial prohibit slavery in any federal territory. Movement marriages wereexperiments banned. begin. 2009. Oscar Grant killed on New Year’s 1860. Southern states secede to form the Confederacy and the 1971. War on Eve. Unarmed. Civil War begins. Census showed Black population in US about 1934. 1870-1885 - Anti-Chinese sentiments beganDrugs to rise 2012- . Unarmed Black men and women 4.5 million. Nearly 4 million are enslaved. Redlining 1978. continue to be killed by police and 1863. President Lincoln issues Emancipation Proclamation. 1948 - Vanport flood Affirmative vigilantes. BLM is born. 1865. Confederacy surrenders. The Civil War ends. Action passes. 2020. COVID-19. The Great Awakening. 2002 -The racist language in Oregon’s constitutionWhite womenwas removed Today - Portland remains the whitest big city inare the the Unitedmain States beneficiaries.

AMERICAN SLAVERY POST- CIVIL WAR CIVIL RIGHTS POST-CIVIL RIGHTS ACT

1619 1700 1800 1865 1900 1954 1960 1990 2000 TODAY

WEALTH GAP POLICE BRUTALITY DISINFRANCHISED White families own 90% of the Black Americans 3x more likely than 1 out of every 13 Black Americans national wealth in the U.S., while Whites to be killed by police has lost his or her voting rights Black families own only 2.6% because of a felony conviction

FOOD DESERTS MASS INCACERATION COVID-19 8% of Black Americans live in a In 2017, Blacks COVID-19 has disproportionately hit census tract with a supermarket, represented 12% of the U.S. adult people of color. In Oregon, 3.2% of compared to 31% of White population but 33% of the people with the virus are Black, Americans sentenced prison population according to OHA data. Nearly 37% of cases involve Hispanic people.

REDLINING EDUCATION CHILDBIRTH 3 of 4 Black neighborhoods Black high school students are still Black women have historically had “redlined” on government maps 80 twice as likely (12.8 percent) to be the highest maternal mortality rates. years ago continue to struggle suspended as White (6.1 percent) Black mothers died at a rate of 3.2 economically high school students times that of White mothers

Sims biography suggest slave women endured VVF experiments with amazing Medical Misconceptions Today Medical Misconceptions in the 1850’s patience and fortitude 2016 Medical Student Survey Black people experienced less pain than U.S. Public Health and scientist were white people presenting a series of pseudoscientific theories 25% agree blacks have thicker skin than Black people possessed thicker skin regarding the African-American population and whites* their sexual health Less sensitive nervous system 50% endorsed false beliefs about biological differences between black and Scientists also believed that African-American Lower lung capacity (forced labor was white patients* remedy to vitalize and correct the problem) men would not seek out or accept treatment for STIs even if they were available 1808: 12% agree nerve endings were less sensitive* U.S. Congress issued a Federal ban on importing Scientific and Public Health officials slaves America became dependent on domestic claimed that larger genitals and high sex Same 50% showed a racial bias in the slave births drive caused African-American to be prone accuracy of their treatment Journal of American to contracting sexually transmitted diseases, recommendations* Gynecological examination of black women Medical Association like syphilis influenced slavery, medicine, and medical announced J. Marion publishing forming synergistic partnership – Sims public statue for U.S. Public Health Service, launched an Trial Ends after 40 years. incentivizing inhumane practices his “brilliant experiment to study the course of Almost 40% of the black achievements carried untreated syphilis on Black men Tuskegee population had Dr. J. Marion Sims begins to conduct the fame of American syphilis City of New York repeatedly invasive experiments on women’s surgery throughout the genitalia without anesthesia (although anesthesia Recruitment was under the guise of removes sculpture civilized work” Congress holds hearings had been introduced) or consent offering “free medical treatment” or for of J Marion Sims treating “bad blood” and a class-action lawsuit stating to hail Sims American Medical is filed on behalf of the Sims experiments on 14 slaves with as a hero was Association dubbed study participants resulting vesicovaginal fistula VVF including 30 Penicillin treatment for syphilis became inappropriate and Sims the “father of in a $10M out of court experiments on a single woman named Anarcha available but study subjects were continued out of bounds modern gynecology” to be denied treatment settlement in 1974

AMERICAN SLAVERY POST- CIVIL WAR CIVIL RIGHTS POST-CIVIL RIGHTS ACT

Silent Gen Millennial Baby Boomers Gen X Generation

Systemic Racism Social Determinants Health & Equity Disparities • Segregation & Redlining • Economic Stability • Privilege Legacy & • 3X Pregnancy-related Death • Education Networks • 2X Infant Mortality Rates • Health & Healthcare • Public & Private Investment • Higher Rates of Hypertension, • Healthcare Access & Bias • Neighborhood & Built Diabetes, Asthma and Heart Environment Disease • Social Justice • 3X More Likely to Live in Poverty • Social & Community • Environmental Protections Context • 1/10th of Wealth Accumulation • Higher Rates of Unemployment

• In Oregon, 1.3% of physicians and 1.5% of nurse practitioners are Black, according to a 2019 Oregon Health Authority report. The state’s overall Black population is 1.8%. • Some specialties have even wider disparities • In Oregon, 3.2% of people with COVID-19 are Black, according to Oregon Health Authority data. Nearly 37% of cases involve Hispanic people.

(2020) National Alliance of Healthcare Purchaser Coalitions Copyright © 2020 Mercer (US) Inc. All rights reserved. 25 in·ter·sec·tion·al·i·ty • Multiple systems of oppression can exist at the same time, which helps to explore the frameworks between co-existing identities, such as black and woman, patriarchy and white supremacy

• This term has expanded to include age, ability, sexual orientation, gender identity, immigration status, religion, and national origin

* Crenshaw, K. “De-marginalizing the Intersection of Race and Sex: A black feminist critique of anti-discrimination doctrine, feminist theory and anti-racist politics.” University of Chicago Legal Forum, 1989, Issue 1, Article 8 Copyright © 2020 Mercer (US) Inc. All rights reserved. 26 Wheel of power

POWER

Adapted from ccrweb.ca @sylviaduckworth

Copyright © 2020 Mercer (US) Inc. All rights reserved. 27 How to be anti-racist “It is not our differences that divide us. It is our inability to recognize, accept, and celebrate those differences.” I identify how I unknowingly benefit from racism I promote & advocate for policies & leaders that are anti-racist I recognize racism is a present & current problem I sit with my discomfort I seek out questions that make me uncomfortable I deny racism is a problem I speak out when I see racism in I understand my own action – even when no one is watching I avoid hard questions privilege in ignoring racism

Becoming F E A R Z O N E LEARNING ZONE GROWTH ZONE Anti-Racist I educate myself about I strive to be comfortable I educate my peers on how race and structural racism racism harms our profession I talk to others who look & think like me I am vulnerable about my own biases and knowledge gaps I don’t let mistakes deter me from getting better

I listen to others who think and look different than me I yield positions of power to those otherwise marginalized

I surround myself with others who look, think, and experience the world differently than I do Copyright © 2020 Mercer (US) Inc. All rights reserved. 30 Continuum on becoming an anti-racist multicultural organization

Monocultural Multicultural Anti-Racist Anti-Racist Multicultural

Racial and Cultural Differences Seen as Deficits  Tolerant of Racial and Cultural Differences  Racial and Cultural Differences Seen as Assets

Exclusive Passive Symbolic Change Identity Change Structural Change Fully Inclusive

An Exclusionary A “Club” A Compliance An Affirming A Transforming Anti-Racist Multicultural Institution Institution Organization Institution Institution Organization

• Makes official policy • Institutionalization of • Continues to • Growing • Commits to process • Future vision of an institution pronouncements racism includes intentionally understanding of of intentional and wider community that has regarding multicultural formal policies and maintain white racism as barrier to institutional overcome systemic racism diversity practices, teachings, power and privilege effective diversity restructuring, based and all other forms of But… and decision making through its formal • Develops analysis of upon anti-racist oppression. • Little or no contextual on all levels policies and systemic racism analysis and identity • Institution's life reflects full change in culture, • Openly maintains the practices, But… • Audits and participation and shared policies, and decision dominant group’s teachings, and • Institutional structures restructures all power with diverse racial, making power and privilege decision making and culture that aspects of cultural and economic groups on all levels of maintain white power institutional life to in determining its mission, institutional life and privilege still ensure full structure, constituency, intact and relatively participation of policies and practices untouched People of Color

Anti-Racist Monocultural Multicultural Anti-Racist Multicultural

Adopt and lead with inclusive behaviors; avoid exclusive behaviors

Copyright © 2020 Mercer (US) Inc. All rights reserved. 33 Unconscious Biases Conscious Inclusion are social stereotypes about certain groups Building the desire, insight and capacity of people that individuals form outside their of people to make decisions do business own conscious awareness. Everyone holds and to think and act with the conscious unconscious beliefs about various social and intent of including diverse members identity groups, and these biases stem from one’s tendency to organize social worlds by categorizing.

Examples Small actions or words that demonstrate disagreement, superiority, lack of • Negative, impatient or questioning tone confidence and distrust • Forgetting name, incorrect name, and/or mispronouncing name • Interrupting or dismissing coworkers from a different ethnic, gender or social group • Not giving timely feedback to a direct report out of concerns of how it will be Cumulatively lead to exclusion, received because they are “different” undermine confidence, reduce • Discounting a person’s capability due to participation, and increase risk of failure dress, disability, some other difference • Making jokes at the expense of another

To a colleague with an To an Asian To a Black employee unfamiliar name: in the current colleague: To a new male environment Constantly forgetting “Wow… you colleague… name, using incorrect “I have a lot of speak English “You’re married! What name, and/or Black friends so I so well!” does your wife do?” mispronouncing / understand what misspelling name you’re going through”

To a female To a Black employee A manager When a new Hispanic / colleague… with braids to their team: Latinx employee joins “Are you planning the company, “Can I touch your “Let’s organize an to have kids “Hey Julio, can you hair? It’s so fun!” office softball league” anytime soon?” take Juanita to lunch?”

Four stages of the inclusive leader continuum

Phase One Phase Two Phase Three Phase Four Unaware Aware Active Advocate

You think diversity is You are aware that You have shifted your You are consistently compliance-related  you have a role to  priorities and are  leading to confront and simply tolerate it. play and are finding your voice as discrimination and It’s someone else’s educating yourself you begin to make bring about systemic job, not yours about how best to meaningful action in change move forward support of others

Private & Low Risk Evolving Awareness Public & High Risk

Brown, J. (2019). How to be an inclusive leader: Your role in creating cultures of belonging where everyone can thrive. Oakland, CA: Berrett-Koehler Publishers, Inc.

Cognizance

Courage Curiosity

Inclusive Leadership Traits

Cultural Commitment Intelligence

Collaboration

Dillon, B. & Bourke, J. (2016). The six signature traits of inclusive leadership: Thriving in a diverse world. Westlake, TX: Deloitte University Press.

•

“To be antiracist is to think nothing is behaviorally wrong or right — inferior or superior — with any of the racial groups. Whenever the antiracist sees individuals behaving positively or negatively, the antiracist sees exactly that: individuals behaving positively or negatively, not representatives of whole races. To be antiracist is to deracialize behavior, to remove the tattooed stereotype from every racialized body. Behavior is something humans do, not races do.” Ibram X. Kendi

True or false activity

I have never questioned whether my race or ethnicity was at play when told I TRUE FALSE was “articulate” I have never been perceived as a threat when taking public transportation TRUE FALSE The people who regularly visit my home socially tend to be of the same/ethnicity TRUE FALSE as me. In most team meetings, I am of the same racial/ethnic group as everyone else TRUE FALSE I have never altered my communication style (dialed up or down my natural TRUE FALSE style) to avoid playing into stereotypes I generally do not have to work to “fit in” in at the office TRUE FALSE I have never felt distracted at work because of external events related to TRUE FALSE race/ethnicity I am able to go to work with my natural hair without questions or comments FALSE TRUE from others I have never been mistaken for another team member of the same racial/ethnic TRUE FALSE group

Shortly, you will be randomly divided into breakout groups via Zoom

In your groups, please use the provided template to discuss the following:

1 What would you do if you heard a racist remark? We want to adopt an anti-racist strategy at our organization. How do we 2 include the voice of BIPOC members to contribute to the strategy?

3 How can I be a better anti-racist and ally in my organization?

4 What is one thing you will commit to do personally?

1. This will be an open discussion 2. After the breakout sessions, we will ask you to share insights back with the broader group

Time in your breakout session: 10 minutes

We want to adopt an anti-racist strategy What would you do if you at our organization. How do we include heard a racist remark? the voice of BIPOC members to contribute to the strategy?

How can I be a better anti-racist What is one thing you will and ally in my organization? commit to do personally?

Phase 2: Health Equity

November 17, 2020

Michael Garrett, MS, CCM Principal, Total Health Management and Inclusive Benefits Practice

welcome to brighter Agenda

• Terms & Overview of the OHA Health Equity Framework • Health Equity Stakeholders & Potential Challenges • Health Equity Measurement

Discussion & Break

• Bridge Strategies and Long Term Strategy

Discussion

Diversity evolving representation

Equity Inclusion designing to fostering ensure access belonging

Differences in health which are not only unnecessary and avoidable but, in addition, are considered unfair and unjust

The policy implication of this definition is not to eliminate all health differences, but to reduce or eliminate those resulting from factors both avoidable and unfair

Disparity implies an inequity or an injustice rather than a simple inequality

* Whitehead, M. “The concepts and principles of equity and health.” Health Promotion International. Vol. 6, No. 3 (1991): 217-228

• It is the physiological result of chronic toxic, environmental, and psychosocial stress exposure • Individuals, families, and communities of marginalized communities need improvements in physical and psychosocial environments to survive, if not prevail Copyright © 2020 Mercer (US) Inc. All rights reserved. 6 Targeted profile of PEBB population: Ethnicity/Race (employee only) Time period: April – March 2019

Executive Summary

White Non Hispanic population represents 75% of the total population with an average age of 47. The majority 1 of the employees are in the Providence and Statewide plans.

Hispanic Population has a younger population and along with the lowest percentage of high cost claimants 2 (>$100K). Hispanics have the lowest preventive screening rates and have the highest prevalence of obesity on a per 1000 basis.

Asian population have the lowest PEPY costs and lowest average illness burden score. Asians had the 3 highest percentage of preventive screening rates, along with the lowest utilization of Emergency Room Visits.

Black African American population has the highest prevalence of Cardiovascular/Metabolic chronic conditions, 4 particularly with Diabetes, Hypertension and Congestive Heart Failure

American White Non Black African No Primary Native Hawaiian Current Year Hispanic Unknown Asian Other Indian Alaska Hispanic American Race Pacific Islander Native Utilization IP Admissions (/1,000) 41.0 44.4 42.4 26.4 30.3 43.7 44.8 72.3 31.9 IP Days (/1,000) 143.4 140.9 171.5 96.9 94.9 171.1 182.5 372.0 145.2 ER Visits (/1,000) 173.2 184.5 190.1 102.9 217.1 247.5 192.8 236.0 180.1 • % Non-Emergent ER Visits 22% 26% 21% 23% 26% 22% 23% 24% 27% • % ER Users with 3+ 10% 8% 12% 10% 10% 8% 11% 10% 2% % Non-Claimants 6% 7% 7% 7% 6% 5% 6% 7% 7%

Avoidable Admits per 1000 Readmissions per 1000 Complications per 1000 50.0 7.0 10.0 43.9 5.8 8.6 6.0 8.0 40.0 5.0 25.9 30.4 29.0 6.0 30.0 26.7 25.0 4.0 23.0 21.0 19.4 21.0 3.0 3.4 20.0 2.0 4.0 1.7 2.0 2.1 1.6 1.8 0.9 2.0 1.4 1.7 10.0 0.8 0.5 1.1 1.0 1.0 0.3 0.9 0.0 0.0 0.0 0.0 0.0 0.0

Employee Preventive Visits Employee Mammogram Screening 54% 40% 60%

32% 56% 57% 36% 50% 54% 54% 54% 53% 30% 33% 49% 50% 30% 30% 31% 40% 45% 29% 29% 26% 20% 22% 30% 20% 10% 10% 0% 0%

Employee Cholesterol Screening Employee Colon Cancer Screening 60% 35%

30% 33% 50% 45% 48% 49% 25% 28% 21% 40% 46% 46% 44% 43% 43% 41% 25% 24% 38% 20% 23% 30% 21% 20% 20% 15% 19% 20% 10% 10% 5% 0% 0%

• Oregon will have established a health system that creates health equity when all people can reach their full health potential and well-being and are not disadvantaged by their race, ethnicity, language, disability, gender, gender identity, sexual orientation, social class, intersections among these communities or identities, or other socially determined circumstances • Achieving health equity requires the ongoing collaboration of all regions and sectors of the state, including tribal governments to address: – The equitable distribution or redistributing of resources and power – Recognizing, reconciling and rectifying historical and contemporary injustices

(2019) Oregon Health Authority: Health Equity Definition

(2019) Oregon Health Authority: Health Equity Committee

Rural racial/ethnic minority Inequities in population Addressing health 01 populations have 02 health outcomes are 03 inequities means substantial health, primarily the result of addressing access to care, and social and political differences that are social determinants of injustice, not lifestyles, not only unnecessary health challenges that behaviors, or genes and avoidable but can be overlooked when also, unjust and considering aggregated unfair population data

Equity must be Health is broadly Everyone has the 04 intentionally pursued 05 defined as a positive 06 right to a standard of as a strategy; it will state of physical, living adequate for not necessarily happen mental, and social well- health, including as a byproduct of other being and not merely nutrition, education, development efforts the absence of disease housing, medical care, and necessary social services

(2019) Oregon Health Authority: Health Equity Committee

Oregon will be a place where health and well-being are achieved across the lifespan for people of all races, ethnicities, disabilities, genders, sexual orientations, socioeconomic status, nationalities and geographic locations

 Black, Indigenous, People of Color, and American Indian/Alaska Native People (BIPOC-AI/AN)  People with low incomes  People who identify as LGBTQ+  People with disabilities  People living in rural areas

Healthier Together Oregon; 2020-2024 State Health Improvement Plan, September 2020

1. Institutional bias

2. Adversity, trauma and toxic stress

3. Behavioral health

4. Economic drivers of health

5. Access to equitable preventive health care

Healthier Together Oregon; 2020-2024 State Health Improvement Plan, September 2020

Board

Carriers & vendors

Community

• Accessible care • Understandable, meaningful, & accessible communication • Selecting providers & provider interactions based on personal needs & preferences • Quality care • Respectful of values • Having a meaningful voice at the table • Attending to physical, behavioral, and social determinants of health — whole person approach

• Listening to members on health equity • Setting strategic guidance & priorities • Setting the success metrics • Dedicate resources for health equity • Board composition alignment • Review performance of carriers/vendors & metrics • Communication with other stakeholders

• Diverse & culturally competent provider network • Member-centric care delivery • Holistic care addressing physical, behavioral, and social determinants of health • Communications that are meaningful & accessible to members • Coordination with community based organizations for human & social service needs of members • Report on health equity measures • Implement improvement plans to address health disparities

• Engagement and coordination with Community Based Organizations (CBOs) to address social needs • Accountable for reporting out to the CBOs on health equity metrics • Engage with CBOs to implement improvement plans to address health disparities • Communicate with CBOs regarding their goals for health equity • Integrate CBOs ideas and health equity frameworks into PEBB policy and implementation platforms

• Access to existing data fields or the creation of new data fields • Board and staff time and resources • Creating and maintaining diverse Board composition • Capabilities of the carriers/vendors and alignment with current scope of work • Creating and maintaining member communication channels

Members Providers/Coaches • Race • Demographics • Ethnicity • Race • Ethnicity • Language • Language • Sexual orientation • Gender • Gender identity • LGBTQ+ • Veteran • Disability status • Access • Veteran status • Digital channels • Socioeconomic status • Communication channels • Geographic location • Accessibility for people with disabilities for office visits • Geographic location • Competencies • Racial/ethnic minorities • Women’s health/men’s health • LGBTQ+ • Veterans • Specific cultures Copyright © 2020 Mercer (US) Inc. All rights reserved. 24 OHA: SB 889 charge for addressing quality and equity

The Implementation Committee has addressed the SB 889 charge by organizing its work in separate work streams, including “quality and equity” Despite this, it is important to remember that equity is fundamental to the cost growth target program and is broader than quality