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Addressing social determinants to create a more equitable worker health plan


Debunking 5 Myths that prevent plan sponsors from addressing social determinants and fully engaging in opportunities to improve health equity for all workers


Published February 7, 2020


Andy Hiles


Vice President, Plan Sponsor Insights & Health Equity Solutions, Aetna®

Many of us working with employer-sponsored health plans — myself included — might begin their journey for worker health equity with some preconceived ideas about social determinants of health. When we hear those words, it’s easy to think about certain types of situations that are usually outside of commercial plan sponsors day-to-day responsibilities. For instance, perhaps they only apply to public health issues and local solutions, with no real role for an employer providing for the health care of their workforce. This thinking is a barrier to real progress.


To jumpstart the marketplace into the health equity conversation, let’s begin with a straightforward debunking of those myths. Let’s look at these five (5) myths in detail. Getting past them is critical to engaging commercial plan sponsors in a meaningful way.


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.

Types of Disparities


At Aetna we that recognize there are many aspects of health where minority workers and those facing social determinants may fall behind. To make this information actionable we look across numerous dimensions of health and have categorize hundreds of health equity metrics that we capture in our plan sponsor reporting tools. The categories or types of health plan disparities are shown below:


  • Navigation: the efficiency of member’s health plan interactions.
  • Engagement: member’s participation and compliance with programs designed to support worker health.
  • Outcomes: the effectiveness of member’s health plan interactions.
  • Conditions: the health conditions members bring to the health plan.

Certainly, there is much for all of us in the plan sponsor community to learn in order to completely address social determinants and create health equity for all workers.


Some unlearning, like debunking the 5 myths discussed in this article, can be a helpful place to start.

Legal notices

Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).

Health benefits and health insurance plans contain exclusions and limitations.

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