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Learn more about how we’re helping plan sponsors identify and address disparities in their workforce.

The impact of SDoH accelerated in times of crisis


Published May 5, 2020


Andy Hiles


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


Data reveal the emerging care gap in severe COVID-19 cases (hospitalizations, ICU and ventilator needs) and mortality rates when considering social determinants of health (SDoH). Ten pilot SDoH analytics studies, executed by Aetna in partnership with large employers over longer periods of time, show parallel disparities. It’s not hard to see the pandemic as a high-speed version of what our SDoH pilot studies demonstrate is already happening with underinsured workers every day. How can we analytically harness this “amplifier” to highlight the everyday struggles we are trying to solve for?


In a recent article, we shared some insights from Aetna SDoH pilot studies. We see the significant social and financial barriers some employees experience and how those barriers limit good health and efficient interactions with the health care system. These employees and their families, covered under an employer plan but in many cases with health coverage they really cannot afford to use, display behavior patterns and health outcomes more like the uninsured than their higher-wage coworkers.


In our work to address these health inequities, we developed new analytics for our customers that show low-wage workers often falling behind in numerous areas. As COVID-19 claims data come in and flow through these analytics, employers will have facts about how COVID-19 affected their workforce when analyzed by SDoH. Hopefully, one aspect of this “amplification effect” is that it will help us recognize and strive to improve disparities. Our goal is to use analytics to involve a broader set of stakeholders, including health plans, community resources, and providers, and create more engagement points within the employer. Together, we can create commercial solutions for employers with greater health equity for all working Americans.


By always keeping in mind the four categories of health disparities, we can make sure that our solutions are specific and action oriented. The four categories are:


  • Navigation — underinvestment in basic/preventive care, lack of a medical home and underuse of outpatient behavioral health services
  • Outcomes — higher incidence of certain underlying conditions like hypertension, obesity and diabetes as well as higher inpatient readmission rates
  • Engagement — lower participation rates in care management and other support programs
  • Lifestyle — higher incidence of certain problematic health behaviors, like smoking


We expect to see that COVID-19 has acted as an accelerant, bringing what would normally be the longer-term consequences of health inequities into stark reality as a near-term result. Part of the reason for this is that chronic conditions create a higher risk for severe COVID-19 symptoms.


We will share our findings as we dig deeper into the impact of COVID-19 on working Americans. We are exploring short-term findings like disease incidence, costs and outcomes, and then the impact of the “second wave” of behavioral health challenges likely to continue for some time. Because low-wage workers have less job flexibility and face a higher likelihood of being laid off, this second wave will surely be right around the corner.


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