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Understanding the unique health needs of LGBTQIA+ employees

By FOLX Health, an Accolade Trusted Partner | June 21, 2023 | 8 min read

For the LGBTQIA+ community, including people who identify as lesbian, gay, bisexual, transgender, queer, intersex, asexual, or other gender-diverse identities, healthcare barriers are profound. Inclusive and culturally-competent care is essential. Good healthcare is not just about considering medical history or prescribing the right medications. It’s also about having a safe and trusted relationship with your provider.

People who belong to marginalized communities are frequently underserved by traditional medicine. Fortunately, an inclusive, proactive and compassionate approach to healthcare can help. The concept of concordant care, or a shared identity between a patient and healthcare provider, enhances this approach. Studies show that patients feel more comfortable when their provider is similar to them. For more than  9 million LGBTQ Americans, having a provider who understands their experience increases access and trust via concordant healthcare.

The LGBTQIA+ patient experience

LGBTQIA+ individuals have historically experienced mistreatment in healthcare settings. In 2020, over a third of LGBTQIA+ folks experienced discrimination from a healthcare provider. For these individuals, concordant care reduces stigma and discrimination in healthcare settings. Concordant care is one way to ensure patients receive culturally competent care. Concordant health care highlights the patient's identity as key to better healthcare experiences. 

Three out of ten trans people had a negative experience with a healthcare provider about being trans, according to the 2015 National Transgender Survey. Negative experiences ranged from having to educate their provider about what being trans meant; to being refused care and verbal or physical assault. These experiences make focusing on patient experience vital for LGBTQIA+ people. 

Queer and transgender people face several health risk factors. LGBTQIA+ people are susceptible to cardiovascular disease from minority stress. Mental health disorders, suicide, homelessness, HIV, and lack of preventative screenings are more common among gender and sexual minorities. Transgender-specific treatments like gender-affirming hormone therapy must be with a competent, affirming provider.

Challenges unique to LGBTQ concordant care 

  • A lack of available diverse providers 

  • Long wait times to be seen at regional Centers of Excellence or LGBTQIA+ focused clinics (average six-plus months) 

  • A lack of education among healthcare professionals on LGBT health

  • The stigma associated with being out, for both patients and providers 

  • Bills that target LGBTQIA+ healthcare, and in some cases, ban access. 

  • Challenges with insurance coverage because of gender identity (For example, gynecological care for transgender men) 

  • Inequitable insurance policies that challenge access for LGBTQIA+ people (e.g., requirements to have had “unprotected sexual intercourse” for six months for fertility treatments)

Solutions

The LGBTQIA+ community benefits from providers who understand their issues and their needs. One way to make it easier for LGBTQIA+ people to find healthcare providers who understand their needs is to use telehealth platforms like FOLX Health. Telehealth provides outreach to rural, distant, or underserved areas and populations in the larger US. Having increased diversity on healthcare teams and LGBTQIA+ knowledgeable care improves healthcare interactions. When LGBTQIA+ patients have healthcare providers who also identify as LGBTQIA+, it can make their healthcare experience better and lead to better health outcomes. 

What is concordant care?

The definition of concordance means "agreement." Concordant care is based on a shared cultural identity. For example, racial concordance in healthcare is when a Black doctor treats a Black patient.

Feeling seen and heard by a clinician can lead to better health outcomes for patients. Experiencing isolation or bias can lead to minority stress, which is linked to poorer health outcomes. When are people more likely to engage with their provider and follow through on their care plans? When the care is collaborative and aligns closely with their goals as a patient.

The benefits of concordant care 

When clinicians share an identity with their patients, are there better health outcomes? Research points to yes. When patients feel that their healthcare provider really understands them, they are more likely to be proactive in their care. This builds trust between the patient and the provider. It also makes it more likely that patients follow through with their health care plan.

When people from different racial or ethnic groups feel uncomfortable or experience tension in healthcare settings, it's called a "racially-discordant encounter." A study in 2021 showed that Black men who didn't trust the healthcare system before benefited from having a healthcare provider of the same race. In fact, preventative care for heart disease could reduce the gap in death rates between Black and white individuals by 19%.

Though these studies center on racial concordance, the same concept can be applied to LGBTQIA+ communities. In a study with lesbian and bisexual women, researchers found their healthcare was negatively affected by providers who made incorrect assumptions about their sexual orientation and practices. Although participants supported LGBTQ health education programs for healthcare providers, they were skeptical if these programs would be effective.

For LGBTQIA+ people, tension frequently arises in healthcare settings. Discrimination from in-person visits or overcomplicated health insurance claims put minority stress on LGBTQI+ individuals. For example, a person who does not engage in sexual activities that can create a pregnancy may not need a pregnancy test. In another case, someone who engages only in receiving anal sex may not benefit from a urine STI screen. Many healthcare professionals who are not LGBTQIA+ don’t understand the stigma and cultural nuances that impact care. When there is a lack of cultural competence, receiving care can create more risk for ongoing health disparities.

Better health outcomes reduce costs 

For marginalized populations, concordant care is one way to promote optimal health outcomes.

Hesitancy to see a provider in person because of discrimination is a concerning barrier to care for LGBTQIA patients. Preventative care, such as finding an affirming primary care physician, is challenging. Without concordant care, LGBTQ folks may be less motivated to seek preventative health care. Lack of preventative care can be costly for health organizations.

Concordant care creates safer spaces that allow providers to address health disparities head-on. It often results in more specific and accurate approaches to care. In turn, more tailored approaches can lead to more cost-effective healthcare.

Our LGBTQIA+ community often has more specialized health needs. Specialized preventive care, like PReP, immunizations, and more STI screenings, can help LGBTQIA+ patients stay healthy.

This calls attention to the risks of conditions that are higher in our community. For example, substance abuse or mental health issues are higher in the LGBTQIA+ community. Understanding this can increase providers' screening efforts to identify concerns early on. 

Another example might be when a medical provider is sensitive to not just name and pronoun, but alert to body and/or gender dysphoria. This is especially important when it comes to touching a patient or the physical exam.

Concordant care helps LGBTQIA+ folks feel safer and more comfortable. This can improve not just the patient-provider relationship but also lead to improved health outcomes. Access to an EMO or Expert Medical Opinion in LGBTQIA+ health can help eliminate misdiagnoses. Expertise combats costly diagnostic tests and errors. Virtual access to EMOs allows high-quality personalized care to be accessible to more LGBTQIA+ people.

Virtual healthcare with FOLX

Virtual healthcare from our experts in LGBTQIA+ health can help reduce discrimination and make care more accessible. This is especially true for gender and sexual minorities who live in underserved local or regional areas of the US. It allows LGBTQ providers to connect with LGBTQ patients who are farther away. Many might have difficulty accessing transportation or cannot take a lot of time off from work to travel to their appointments. From apps to LGBTQIA+-friendly telehealth, technology will help increase concordant care.

The FOLX model of healthcare, a telehealth-based platform for the LGBTQIA community by LGBTQIA healthcare providers, takes concordant care to a new level of shared identity. From virtual health care to gender-affirming hormone therapy, the needs of a specific population are addressed by experts who are culturally similar to the patients they serve. The dedication of a provider deeply integrated into a community surpasses the kind of care from someone who is not.

At FOLX, we understand how vital it may be that gay, queer, and trans patients feel validated and heard by their healthcare providers. A clinician who is current on emerging studies and best practices, and who understands the importance of body autonomy and shared decision-making, is important for all people seeking quality health care.  Our FOLX healthcare professionals listen carefully to each patient and understand the importance of being:

  • Supportive of LGBTQIA+ specific health issues, including pronouns and gender expression. 

  • Informative and well-informed, especially of gender-affirming medical care options and in the context of a rapidly changing legislative landscape. 

  • Able to promote LGBTQIA+ specialized healthcare services and referral to LGBTQIA+ competent providers. 

Improving access to patient-centered care for all employees, including our LGBTQIA+ employees, is crucial to creating inclusive workspaces where employees feel valued and safe. Offering proactive, preventive, LGBTQIA+ specialized healthcare services sends an important message. It's not just for LGBTQIA+ employees, but for family members and allies who understand the importance of health equity. FOLX Health and its unique telehealth provision of LGBTQIA+ expert care create health equity and care access in all parts of the US.

For a host of employers who want to improve patient outcomes and reduce costs for both patients and themselves, adopting concordant care is a compelling solution.

FOLX is part of Accolade's Trusted Partner Ecosystem which exists to simplify benefits selection for our customers and drive a more integrated experience for our members.

To learn more about concordant care and how to support your LGBTQIA+ employees, catch a replay of a webinar presented by FOLX.

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