Elevance Health – Civil Rights Audit (2023)

Outcome: Successfully withdrawn following Elevance Health’s agreement to conduct a third-party health equity assessment using a civil rights lens focusing on products, services, artificial intelligence practices, and political activities.

Resolved: Shareholders urge the board of directors to oversee a third-party audit (within a reasonable time and at a reasonable cost, and consistent with the law) which assesses and produces recommendations for improving the civil rights impact of its policies, practices, products, and services. Input from stakeholders, including civil rights organizations, employees, and customers, should be considered in determining the specific matters to be assessed. A report on the audit, prepared at reasonable cost and omitting confidential/proprietary information, should be published on the company’s website.

Whereas: Black and Native Americans have higher death rates than white people across a variety of illnesses.[1] Black and Latina women, even in higher income brackets, also face higher preconception and maternal health risks than other groups.[2] One study found “a potential economic gain of $135 billion per year if racial disparities in health are eliminated, including $93 billion in excess medical care costs and $42 billion in untapped productivity.”[3] Elevance committed $50 million to “combat racial injustice, strengthen communities, and address health inequities” among other initiatives, but it has not conducted an outside assessment of its current and potential civil rights impacts.[4]

Although algorithms increase efficiencies, they should be vetted to prevent algorithmic bias. Optum, a UnitedHealth Group subsidiary, used an algorithm that reportedly referred equally sick Black people to care less frequently than white people.[5] We believe an analysis of Elevance’s algorithms and proxy factors is necessary as similar biases may exist. Opaque data collection practices by health insurance companies raise the possibility of discrimination and pose reputational and legal risk.[6] New York’s Financial Services and Health departments launched an investigation of Optum after the results of the study were published.[7]

Elevance’s executive committee also appears to lack racial diversity and its reporting demonstrates a decrease since 2019. Moreover, managerial racial diversity has stayed flat since 2019. The 2021 EEO-1 report shows just 3.2 percent Hispanic and 4.6 percent Black executives compared to 79.7 percent white executives. Elevance’s strategy to address the lacking diversity remains unclear to shareholders without public targets.

Beyond race, Elevance should examine its approach to transgender-inclusive care to avoid future legal risk. In September 2022, Elevance’s Anthem Blue Cross in California was reportedly found out of compliance by the California Department of Managed Health Care after a transgender patient submitted a complaint.[8] Insurers such as Elevance are requiring manual overrides for transgender patients seeking care, causing additional stress and burden on a marginalized population.

Lastly, Elevance has supported political candidates such as Young Kim of California who voted against HR 8296 Women’s Health Protection Act of 2022 and HR 8373 Right to Contraception Act.[9] Bills such as these address health disparities for women.

We urge the company to conduct a civil rights audit to examine its total impact and help dismantle systemic injustices.

[1] https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=61, https://www.kff.org/racial-equity-and-health-policy/issue-brief/disparities-in-health-and-health-care-5-key-question-and-answers/

[2] https://www.nytimes.com/2020/08/06/nyregion/childbirth-Covid-Black-mothers.html .

[3] https://altarum.org/RacialEquity2018

[4] https://philanthropynewsdigest.org/news/anthem-commits-50-million-for-racial-justice-health-equity

[5] https://www.nature.com/articles/d41586-019-03228-6

[6] https://www.propublica.org/article/health-insurers-are-vacuuming-up-details-about-you-and-it-could-raise-your-rates , https://www.nejm.org/doi/10.1056/NEJMms2004740

[7] https://www.fiercehealthcare.com/payer/new-york-to-probe-algorithm-used-by-optum-for-racial-bias

[8] https://khn.org/news/article/medical-coding-creates-barriers-to-care-for-transgender-patients/

[9] https://justfacts.votesmart.org/candidate/key-votes/151787/young-kim/?p=2, https://www.antheminc.com/cs/groups/wellpoint/@wp_about_government/documents/wlp_assets/d19n/mzk3/~edisp/2021%20Anthem%20Political%20Giving%20and%20Related%20Activity%20Report%20FINAL.pdf