Provider directory plans to promote LGBTQ-affirming care

LGBTQ+ patient experience marred by discrimination

"Unfortunately, we see that a lot of LGBTQ+ patients and people do experience discrimination often on a daily basis," Nowaskie explained. "Specifically for the healthcare context, we do see high rates of biases and assumptions from providers. But we also see the same type of scenarios played out with all staff across the entire healthcare journey."

A separate 2024 KFF report showed that a third of LGBTQ+ people have experienced discrimination in the healthcare setting. That's nearly double the rate of non-LGBTQ+ adults who said the same.

LGBTQ+ adults were also more likely than their counterparts to report that their provider assumed something about them without asking (40% versus 17%), suggested they were personally to blame for a healthcare problem (32% versus 15%), or ignored a direct request or question they asked (32% versus 14%).

Discrimination is not just happening with the clinician providing direct care, Nowaskie pointed out. LGBTQ+ patients have also reported explicit and implicit bias when interacting with greeters, the front desk, care coordinators and other support staff. Stigma is perpetuated across the entire care continuum, Nowaskie noted.

"And because of that stigma and marginalization, a lot of people will delay care," they stated. "They'll delay initiating care, they'll delay following up in care and there's a high dropout rate. We also see that there is a high rate of emergency service utilization because people often will not engage in care for 5, 10 or even 20 years."

"We do see that there are higher rates of physical and mental health conditions as well, because they're not being addressed," Nowaskie added. "They're not being treated, and they're getting worse over time."

What is LGBTQ-affirming care?

The queer patient experience could be different if patients had a guarantee that they could meet with a clinician who can provide LGBTQ-affirming care, Nowaskie said.

That is not to say queer patients can only meet with queer providers. But the assurance that a clinician is not only welcoming of LGBTQ+ patients, but also knowledgeable and engaged in providing care for this population, could improve patient access to care.

To get there, it's important to know what LGBTQ-affirming care truly means.

"When we were talking about affirming care, it was very common vernacular for people to say LGBTQ-friendly," Nowaskie explained. "We do not use that language. We never have used that language because we have a very high bar."

"In general, a lot of providers will say they're LGBTQ-friendly, but they may not be LGBTQ-affirming," they said.

OutCare looks for someone who has the training and education to fully understand and acknowledge the lived experience of an LGBTQ+ patient. This doesn't mean the clinician must be queer themselves, but they do need to be steeped enough in education and training to fully acknowledge how they need to deliver care to an LGBTQ+ patient.

An LGBTQ-affirming provider interacts with the queer community, serves as a voice or an advocate in social or political situations and stays on top of their medical education to provide quality healthcare to this population.

"It is a dynamic, comprehensive type of understanding of an LGBTQ+ person and the stigma and the discrimination as well as the goals and the values that they have that they're bringing into their care," Nowaskie explained.

Having access to LGBTQ-affirming providers could be a game-changer for patients who have previously experienced discrimination in healthcare settings.

And that's where OutCare comes in.

The provider directory identifying LGBTQ-affirming care

OutCare started in 2015 with its OutList, the largest worldwide provider directory guiding patient access to LGBTQ+-affirming care.

"There are a lot of people across this country, especially rural America, that have really no idea how to find an affirming provider," Nowaskie explained. "Some communities don't even have affirming providers, but some don't know how to find an affirming provider. They don't know where to turn, where to look, who to ask."

Historically, queer patients have relied on word-of-mouth and peer referrals to find a clinician who can meet their needs. The OutList helps connect those dots, especially for individuals who do not have anyone to ask about LGBTQ-affirming care.

"Now, with our directory in the amplification with our clients and partners, we are reaching many, many more millions of people than we were before," Nowaskie stated.

Still, OutCare knows its limits with the OutList and has reached across the healthcare industry to increase visibility into LGBTQ-affirming providers.

"No matter how fast or big we grow, there will be a lot of LGBTQ+ people and communities that we just cannot reach for a variety of reasons," Nowaskie said.

In 2023, OutCare partnered with Healthgrades, a popular website for online provider reviews and provider searches. Through the partnership, Healthgrades has access to OutCare's affirming provider data and ingests that into its directory. That means queer patients looking at Healthgrades can see an LGBTQ-affirming provider badge on relevant profiles.

"We actually have seen very positive rates of engagement with that filter," Nowaskie said. "The data that we have suggests that 90% or more of LGBTQ+ people will tell you that finding an affirming provider is one of the most important things for their care. And they often will overlook other traditional forms of importance for care."

Factors like transportation or cost might come in second or third to having an affirming provider, Nowaskie added, often because patients have never had access to that affirming care.

OutCare has also forged similar partnerships with healthcare payers to enrich their own provider directories. This helps queer patients find LGBTQ+-affirming care that is also guaranteed to be covered by insurance.

Pursuing LGBTQ-affirming care

While the OutList can serve as a provider directory from the patient perspective, it also serves a key function for the providers who join it, Nowaskie said. For the clinician, the OutList is more of a provider network.

"We don't data mine or data source, and we don't create profiles," Nowaskie emphasized. "We actually require that these profiles are made by the provider themselves, and that's very important to us. We want to make sure that the information is accurate, that it's updated, that it's timely, but we also want to connect and network with these providers so that we are letting them know about our training and our education."

In addition to the OutList, training and continuing education are OutCare's other central efforts. The organization offers education, panels, and different panels to help clinicians continue to provide LGBTQ+-affirming care. This means not just increasing knowledge about providing LGBTQ+ healthcare but also how to put that knowledge into practice.

Sometimes that means increasing comfort with treating queer patients, Nowaskie said, and in others, it means learning how to correct a mistake during a patient interaction.

"By no means do we want this to be a one-and-done type of organization where we come in, we'll do a panel, or we'll do a one-on-one, and we'll send you on your way. That's not near enough," Nowaskie asserted.

"We've built the OutList on trust," they concluded. "We want our network of providers to let us know what kind of affirming care they are providing, what education and what training they have received. But we also want them to have their recognition that LGBTQ+ cultures, LGBTQ+ topics and health and equity in general are very quickly changing at times. We want to grow with them."

Sara Heath has been covering news related to patient engagement and health equity since 2015.