A survey of more than 1,500 benefit managers by the Washington Business Group on Health found that nearly half believe that ethnic health care disparities "weren't a problem" for their employees, although 80% had never asked minority employees if their race affected their health care.

However, they could not be more wrong, and their lack of awareness is costing them both people and money. According to research from various sources:

• Minorities are less likely than whites to get proper heart medication, heart bypass surgery, kidney dialysis and transplants.
• Black patients receive cardiac catheterization, a life-saving heart treatment, at a much lower rate than do white patients, regardless of the race of their doctors.
• White doctors perceived black patients as more likely than white patients to abuse drugs and alcohol, to be unintelligent and uneducated, and to fail to comply with medical advice.
• Minorities have more communication problems with doctors and tend to feel, more so than whites, those physicians treat them with disrespect.

Adding to the weight of such differences in care and access to care is the fact that minorities are among the more vulnerable groups in terms of potential health risks. For example, African-Americans are four times more likely to get diabetes than non-Hispanic whites and should have a colonoscopy at 45, five years earlier than the general population, cites Corliss Hill, national director of business development for UnitedHealthcare's Generations of Wellness campaign. (See Minority report to read more detailed statistics on health risks specific to minorities.)

Further, ethnic minorities' health risks may become more acute without meaningful intervention. Research from the Centers for Disease Control and Prevention shows:

• Black adults had an average of five bed days per person due to illness or injury in the past 12 months, compared with an average of four bed-days per person for white adults.
• 44% of American Indian or Alaska Native adults and 53% of black adults had excellent or very good health, compared with 63% of white adults. Conversely, 23% of American Indian or Alaska Native adults and 19% of black adults had fair or poor health compared with 11% of white adults.

"When you look at the demographics and the sheer numbers of growth that are projected for the years to come, employers realize that they have to stay ahead of the curve in meeting the needs of their employees," says Hill.

Different approaches

Several insurers are strengthening ties and outreach to minority communities in an effort to combat disparities in care and access.

Regence Blue Cross Blue Shield has developed a Latino concierge program that provides bilingual and bicultural “consejeros” to aid its Hispanic members in Idaho, Oregon, Utah and Washington. These advisers help members navigate the insurance and health care process, which many Hispanic immigrants do not fully understand, as they come from a country with a nationalized health care system. In fact, many believe they can purchase insurance once they become ill.

"The key thing is that [the consejero program] is not a translation service, but a transcreation service," explains Francisco Garbayo, the emerging markets manager for Regence BCBS. "You have to explain what health care is before you can begin to translate terms like coinsurance, copayment and maximum out-of-pocket, you must help them understand the concept of health care."

While Hispanics often respond to outreach by creating bonds through their native language and culture, experts say, African-Americans tend to prefer communication via social networks, according to focus groups conducted by UnitedHealthcare. Therefore, Hill says, UHC communicates health care and benefit information to African-Americans through partnerships with churches, African-American community businesses and black Chambers of Commerce.

UHC also targets Asians who, despite generally being well-educated and on a high socio-economic level, are 5.7% more likely than whites to be uninsured. The gap may be due to superstitions concerning health, according to Amber Jia, the carrier's director of Asian-American markets.

To help offset these suspicions, Jia was meticulous in crafting UHC's communications to this group, even down to how she designed the multilingual Web site. She selected colors like red and yellow — which inspire strength and confidence in Asian culture — as opposed to black, white and gray, which would inspire thoughts of funerals.

Leveraging media

In addition to online resources, benefit service providers also are using other technology to reach a wider swath of minority workers.

The Segal Company, an actuarial and consulting firm based in New York City, sponsors a Latino education program that features podcasts and an electronic signboard in the parking lot containing wellness messages.

Regence also is using media to engage Hispanics. They created mini-telenovelas (soap operas popular in the Hispanic community) that show Hispanics in family settings discussing health care. In addition to telenovelas for its Web site, the outreach campaign features television ads and a radio show that transforms typical Hispanic recipes into healthy alternatives, such as replacing lard with oil in refried beans.

However, garbayo cautions, even with such targeted efforts, employers must realize that subsets exist within minority demographics as well. According to garbayo, 'latino' is more a culture than a race, and although 80% of the latino community he works with is mexican, he is careful to use language appropriate for all groups. He recommends that employers have a workplace latino council or club to review the material before it is sent out.