Helping employers get started

When Aetna started talking about social determinants of health in the commercial segment a few years ago, it was not uncommon for us to hear benefit and human resources managers say, “I just can’t give all my workers a pay raise to solve this.” It’s undeniable that cost matters in health care. This is true for every worker and plan sponsor. However, we have learned that the barriers to good health outcomes and efficient medical care presented by social determinants are both broader and more nuanced than just cost. Social and financial drivers of disparities can be summarized as The Four A’s – Awareness, Access, Affordability and Assumptions. Trying to eliminate a health disparity facing lower wage workers without understanding this “root cause” is a recipe for frustration and failure.

Many of us whose work is focused on employer-sponsored health plans, when we hear the words “social determinants” we immediately think that a community program is needed to address whatever the issue may be. Let’s be clear, community programs can play a role in helping low wage workers covered by employer plans achieve better health outcomes, but there are many other levers available to a commercial plan sponsor. In fact, looking across the universe of levers available to a plan sponsor, depending on the nature of the disparity, greater impact may be possible through employer actions (like plan design, leveraging non-benefit communication channels, adjusting work hours, etc.), health plan or PBM adjustments (improving the cultural competency of clinical outreach, etc.), or network/provider adjustments (working with local provider groups to adjust hours of operation, adding mental health professionals to the network in places where low wage workers are receiving care out-of-network, etc.).

The words “social determinants” may also conjure up a focus on longer-term health issues, like prevalence of conditions like diabetes and hypertension. Certainly, those conditions and comorbidities matter in employer-sponsored plans, but there are also many health disparities that can be addressed right away, rather than years down the road. For example, a Navigation Disparity, where the efficiency of health plan interactions by those impacted by social determinants is a concern (e.g. high use of emergency room care for non-urgent situations). These types of disparities can be addressed over a shorter time horizon, and as such are good candidates for plan sponsors looking to engage their company finance partners by demonstrating a positive and meaningful return on investment as they begin their journey to more fully address the health equity of the workforce.

Public health programs sometimes struggle to deliver hard metrics that demonstrate a return on the investment in community health. This has been true in the commercial side of the market as well. However, health equity metrics and reporting are no longer barriers to action for commercial plan sponsors—at Aetna our plan sponsor reporting tool (ART) is available today to deliver health equity metrics to plan sponsors. ART helps plan sponsors identify where low wage workers impacted by social determinants are falling behind, and it allows the plan sponsor to precisely quantify the impact that each disparity has on plan costs and worker health.

Improved plan performance and higher levels of health equity are not in conflict. In fact, our customer pilot studies show that employers cannot reach their highest level of health plan performance without addressing social determinants and health equity. We ask that you internalize this critical point, and act as the spokesperson in your organization for helping others understand that peak health plan performance—whether your company’s interest is total health plan cost or worker productivity—cannot be achieved without directly addressing social determinants. And, as you tackle the barriers to good health presented by social determinants, greater health equity will result. It’s a win-win-win for workers, plan sponsors and ultimately the communities where we all live, work and play.