UPMC Center for High-Value Health Care focus group reports on sexual and gender minority individuals’ health care and coverage experiences
More than 10 million Americans are part of sexual and gender minority (SGM) communities, including individuals who identify as lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ+). SGM communities often experience poorer behavioral and physical health, with disparities that include higher rates of depression, anxiety, substance use, cardiovascular disease, and limited access to health care. National research shows that, despite increased access to insurance resulting from the Affordable Care Act and the American Rescue Plan Act of 2021, SGM individuals’ satisfaction with their health care is significantly lower than that of their cisgender and heterosexual counterparts.
UPMC Health Plan is committed to ensuring that all our members are treated with dignity and respect and that we provide access to affordable, high-quality care that meets members’ health and health-related needs. With that in mind, the UPMC Center for High-Value Health Care (the Center) completed a series of seven focus groups with members of Pittsburgh’s SGM communities to identify ways we have improved—and can continue to improve—access and services for this community. More than 50 people of varying sexual orientations and gender identities participated. They were covered by a variety of health insurance plans and companies.
The results have helped us outline a roadmap that we can use to inform and improve key parts of UPMC and UPMC Health Plan’s clinical and outreach strategies.
Here’s what we learned:
SGM individuals experience barriers when seeking medical care.
Seeking medical care can be stressful—and sometimes traumatic—for SGM individuals. As such, physicians and other health care providers must be respectful, understand the unique care needs of SGM individuals, and be unafraid to ask appropriate questions that might inform their health care decisions. Focus group participants told us that quality care was less about “knowing every permutation of pronouns” than having the skill set and temperament to care for LGBTQ+ patients with comfort, humility, and respect.
Several SGM patients in the focus group expressed frustration in feeling that they know more than their providers about topics such as how drugs interact with hormone therapy, contraceptive needs, and means by which to recognize and respect the rights of SGM patients’ spouses and partners. While many focus group members understood that educating providers during a visit could inform better care outcomes, they also noted that the need to do so signaled that the provider might be ill-equipped to provide quality care to transgender and gender-diverse communities. These concerns extended beyond care delivery to how information is collected and listed on provider forms and misuse of appropriate pronouns (misgendering).
Trauma related to the health care system leads some to delay care.
Some participants indicated that negative experiences with the health care system led them to delay or avoid seeking care. This reluctance extended to health care needs at all levels, from routine preventive services to specialist care.
Participants reported weighing the danger of a delayed diagnosis against the stress of navigating the care system. Some participants indicated that they would be wary of “one-off” appointments because they had not built a relationship with the provider and were not out to them like they might be to their primary care provider. One respondent explained their thought process as follows:
“Is the emotional trauma of going and getting [the screening] worth it? … Maybe I would just rather take the risk … .”
The complexity of health insurance is frustrating.
Insurance policies and procedures can be exceptionally complicated for SGM individuals, and they may limit access to some types of gender-affirming services and procedures. As noted in the report:
“The ‘gatekeeping’ role insurers play in determining what gender-affirming treatment is available and affordable to gender-minority focus group participants can literally shape the trajectory of individuals’ lives.”
Participants shared their frustration with finding clear information on covered services but noted that resources like UPMC Health Plan’s “Transgender Concierge” hotline provided meaningful assistance and direction. The people who answer this hotline are trained to understand these benefits and the needs of transgender individuals. Their goal is to help our transgender members learn about their care options and UPMC Health Plan’s policies.
Transparency and empathy are required when choosing providers.
SGM patients want access to additional information when searching for in-network providers. They would like to know which providers offer SGM care or are otherwise SGM-friendly. Members of the focus group explained that many SGM individuals know which providers offer good care to the community largely through word of mouth. But those high-demand providers often have limited availability or go elsewhere to practice trans-care. While focus group participants supported the idea of identifying SGM-friendly providers more formally, they expressed skepticism about providers’ ability to self-identify. They suggested other, more structured ways to convey LGBTQ+-friendly health care providers’ credibly.
What comes next?
In many ways, UPMC and UPMC Health Plan are already working to address many of these concerns. Still, there is always room for improvement. The thoughtful, deeply personal input of the study participants has helped us identify additional areas of opportunity. We plan to put what we’ve learned to use by creating respectful, meaningful policies that address the needs of the LGBTQ+ community and demonstrate our commitment to ensuring all members have access to affordable, world-class health care that’s delivered with dignity, respect, and understanding.