Social Determinants of Health

Ben: When you think of health equity, what comes to mind? It’s a term that’s often used and sometimes misunderstood. But it’s also an opportunity for insurers to make a real difference in society. Aetna is a CVS Health company and it is committed to leveling the playing field. Today, we are diving into a conversation all about health equity.

I am Ben Levy and since I know almost nothing about health equity, I am pleased to inform you that today I am joined by Andy Hiles.

Andy: My name is Andy Hiles. I lead Aetna's plan sponsor insights team and I'm also responsible for the commercial side of Aetna's business in terms of how we address this topic of health equity.

Ben: How do you define health equity?

Andy: There's lots of definitions out there. Probably the best one is that everyone has a fair and just opportunity to achieve their best health outcome.

Ben: And, Andy, how is health equity influenced by society at large?

Andy: So there are two broad paths to health equity. One is structural inequities, that is the systemic disadvantage of one group relative to another. So you might see it manifest as racism, ageism, sexism, homophobia, algorithmic bias.

The other path to health equity, again, complimentary both should be pursued, is social determinants of health. That's where we live, work and play and how that has influence and impact on our health and how we utilize the health care system.

Ben: What about underinsured individuals? 26% of people with employer coverage are still underinsured.

And, I am curious, if that is something that is known in the industry at large, or if this is a statistic that has been shocking to employers when you have talked about it?

Andy: I think there has been a general recognition across the employer community that low wage workers have been falling behind from a health standpoint.

Andy: According to the Commonwealth Fund, you said 26% of people with employer sponsored coverage, more than one in four have insurance they can't afford to use, so their $2,000 deductible might as well be a $2 million deductible. And then when you go and you look at the health outcomes of people who are underinsured, they match those quite closely of people who have no insurance coverage at all.

Ben: What is it that makes this so important not only for healthcare in general but for Aetna?

Andy: Aetna has been involved in health equity really for decades. If you go back twenty or thirty years Aetna thought about health equity and made investments in health equity, largely though in the form of investments in community programs or investments in affordable housing or on the Medicaid side of the business.

Andy: We were really the first to take this from an idea and a good conversation to we have a data driven approach to building very targeted solutions that can help a plan sponsor or a group of plan sponsors solve disparities that exist within their workforce. It's good for workers, it's good for the plan sponsor.

Ben: What's the business side of things where this isn't just about equality for everyone, which is important, but there's also something good in it for the business.

Andy: We believed from the outset that if we couldn't demonstrate both a social good and a business good for our customers and for Aetna, we weren't going to get very far.

We built out a data modeling, we now have an analytic tool that was deployed first in 2019 so that companies for the first time can see the impact of social determinants have on the health of their workers.

Ben: I am really curious about that tool, how does that actually work in practice?

Andy: Our primary tool is ART, A-R-T, that is our business intelligence platform that has social risk, data included. If the employer is big enough, if their data is credible enough, they can use ART or their broker can use it on their behalf to determine where social determinants are getting in the way and preventing employees from achieving their best health.

Andy: So I would go back to the data as a plan sponsor and say, look, there's lots of potential problems that could be out there, but my data tells me that workers impacted by social determinants, as an example, in three zip codes in our Dallas location they are significantly overusing ER for non-urgent care. Bad for them, expensive for them, bad for us.

Okay. Let's target a solution to that, it could be an access challenge, or maybe it's an awareness challenge. So we would do some qualitative research to figure out what the root cause of that disparity is and then build, say a communication program or some sort of access program.

Ben: What would you say to the broker in terms of why they should bring this up, how it improves client relationship, and how it builds trust?

Andy: Having been in that broker consultant role for a long time, I would argue that a plan sponsor cannot achieve the highest level of performance in their health plan, unless they understand the disproportionate impact that social determinants are having on some workers.

Building solutions that work for the average worker, that average person that theoretically comes to work every day, that will not get you to the highest level of plan performance.

We need to be more nuanced, more granular in our analytics and our solutions.

Ben: Thanks, Andy. It's been a pleasure.

Andy: Thanks for having me. I've really enjoyed our time together.

Ben: Thank you for listening to my conversation with Andy. Health equity is such an exciting thing to examine, there is so much it can do to transform the business and society at large and it’s definitely something that goes hand in hand with Aetna and CVS Health’s values.

Thanks for taking the time to hear a little more about it.