Q&A – June Newsletter

Here at NEBGH we are acknowledging and celebrating Pride month by featuring some of the good work our members are doing to improve the healthcare and benefits experience for members of the LGBTQ+ community.

Read on for a special Q&A with NEBGH’s Medical Director, Dr. Mark Cunningham-Hill, and Included Health’s Medical Director of Behavioral Health, Dr. Nikole Benders-Hadi.

Dr. Mark Cunningham-Hill: There is a lot of stigma associated with being LGBTQ+  —being addressed appropriately with the correct pronouns can increase trust and respect between patient and healthcare provider. How can someone who is LGBTQ+ find a provider who understands their needs and addresses them correctly without bias?

Dr. Nikole Benders-Hadi: Finding quality and affordable healthcare is a challenge for many, regardless of gender identity or sexual orientation. For the LGBTQ+ community it’s even harder—45% report difficulty finding a Primary Care Provider while 60% report difficulty finding a mental health provider.

First, it’s important to identify what kind of support you’re looking for and what is most important to you—Are you looking to work with a therapist with a certain gender identity? Do you need to find a primary care provider who is an LGBTQ+ ally and well-versed in the correct language to describe your sexuality?

For Included Health members, they can connect with their dedicated LGBTQ+ care concierge for guidance and support in locating a vetted, affirming, clinically-competent provider to align with your needs. One of our members shared their experience with finding an affirming provider here.

If care concierge is not available through your employer, there are a variety of ways to go about locating an affirming provider that include: contacting your health plan, taking a look at the Gay and Lesbian Medical Association provider directory and looking specifically for those who have had training and are allies or identify as part of the community.

And I’d be remiss not to mention, if you or someone you know is LGBTQ+ and having a mental health emergency, organizations like The Trevor Project offer crisis intervention and suicide prevention specifically for LGBTQ+ identifying people.

MCH: We know there are challenges for people from the LGBTQ+ community, but I also know that parents can struggle with coming to terms with a child saying they are gay. What support services are out there and how could a parent access these resources?

NBH: A great first step for parents and caregivers of LGBTQ+ adolescents is a therapist or family counselor who specializes in LGBTQ+ needs. At Included Health, our care coordinators can help caretakers find a therapist who has experience in affirming care and schedule an initial visit within days.

Other resources that may be helpful for parents include PFLAG and Supporting and Caring for Transgender Children from the Human Rights Campaign.

This is especially important since research shows that LGBTQ+ youth with strong support at home attempted self harm at less than half the rate as those who had less support.

MCH: Even though Pre-Exposure Prophylaxis (PrEP) came on the market 10 years ago I am sure not all providers are fully up to speed on this life changing medicine – how can someone find a provider who knows about PrEP?

NBH: It’s unfortunate, but for many they’ll spend countless hours scanning the internet for providers that are LGBTQ+ affirming and also within their insurance network; making call after call to healthcare offices to find that the provider they were interested in isn’t accepting new patients. With Included Health virtual care services, we provide access to medical and behavioral health clinicians who are experienced and affirming of all members we treat, regardless of gender or sexual orientation.

Included Health members can also find providers who are able to prescribe PrEP through our dedicated care concierge services. We can match you with one of our vetted providers in your area who is knowledgeable in LGBTQ+-affirming care, that is in-network and taking new patients. Learn more about PrEP coverage in 2022 here.

For anyone interested in PrEP, there’s a handful of resources, like PrEP Locator and Greater Than Aids, that can help individuals find a PrEP provider. Your local health department and your doctor’s office may be able to write you a prescription.

MCH: Navigating gender affirming surgery – how to see the right specialist, how to get insurance coverage is a challenge – how can someone get help navigating this journey?

NBH: At Included Health our highly-specialized care coordinators support trans and non-binary members with transition, gender affirming surgery and benefits navigation. This helps them appropriately leverage clinical case management services and other benefits available to them through their employer-sponsored health plan.

Support from care coordinators includes assisting members with coverage requirements, researching gender-affirming providers and surgeons, and preparing for pre- and post-surgical care. Care coordinators also help members get and send prior authorization letters for gender-affirming care, ensure forms are accurately filled out by the member, follow up with providers to ensure they’ve submitted to the health plan and more.

MCH: Being lesbian, gay or bisexual is possibly better understood by society than being queer, questioning, and transgender and as such may lead to disparities in access to care and support – what needs to be done to address this?

NBH: I think it all starts with a better understanding. Gender identity goes beyond the way that someone outwardly presents themself. It is the core sense of oneself. Gender identity often aligns with our sex assigned at birth, but for transgender and gender fluid people, their sense of self may not fully conform to their biology. A transgender person may identify as a man, a woman, both, or neither regardless of their sex assigned at birth because of their internal concept of themself.

It is important that medical professionals understand gender identity as a societal construct and continue education on gender identity so that those who are queer, questioning, and transgender continue to return to care and not be discouraged.

MCH: We know that there are racial disparities in access to healthcare, are there unique challenges for people of color who are also LGBTQ+?

NBH: Yes, absolutely. It’s pretty clear that a one-size-fits-all approach to healthcare doesn’t work and ends up excluding many people from getting the care they need.

Both the LGBTQ+ and Black community face healthcare inequities—especially in mental health. Additionally, there is difficulty in both these populations when finding affirming providers and experiences are often discriminatory with medical professionals, leading to care avoidance.

It’s at these intersections of underrepresented communities (for example, a transgender Black woman) that can make finding a culturally-affirming healthcare provider that much more difficult, especially if it’s important that the member have access to a provide who identifies and/or looks like them. That’s why Included Health has focused efforts on working with communities to build healthcare offerings that work for them, on their own terms.

MCH: What have you seen as employer best practices in engaging with their LGBTQ+ employees?

NBH: Many of our clients have leaned into working closely with Employee Resource Groups (ERGs) and Diversity, Equity, Inclusivity and Belonging (DEIB) Teams to build out comprehensive communication plans for these underrepresented communities.

There is also value in offering services that are anonymous for employees, since not all LGBTQ+ individuals within a workplace are part of an ERG or out in the workplace. That way individuals—out or not in the workplace—can access the tools needed to get and stay well.