Investing in health equity

Health plan designs for 2021 can help achieve health equity

Published July 14, 2020

There’s no end to conversations around how COVID-19 and the pandemic are reshaping our economy and health care system. As companies manage costs as part of their economic recovery — and aim to retain employees to avoid the negative impacts of adding to the unemployment surge — the cost of health plans is naturally a big focus. Deft Research shared measured insights on the continued consideration to shift costs to employees in its most recent Employer/Employee Group Insurance Study. Why is this worrisome? Let’s remember a few things we have recently learned (and quantified) about social determinants of health in recent SDoH pilot studies. Continue reading, and you’ll see that there are other ways to manage company health care costs.

Aetna is conducting pilots around social determinants of health in partnership with 10 innovative and progressive large employers. This is significant because we are looking at populations that are employed with access to health insurance through their employer, and yet we have identified and quantified the impact of significant disparities affecting low-wage workers. In these pilots, we are measuring SDoH-influenced member behaviors and outcomes, and then the resulting costs to plan sponsors (employers) in terms of medical spend and lost productivity. We use advanced analytics and proprietary algorithms built from Aetna data science work. This lets us segment a population by the degree to which SDoH are likely creating barriers to good health and efficient use of health care resources. When we look across these groupings, we see statistically significant differences and patterns emerge in places like use of emergency room and primary care office visits or prevalence rates of chronic conditions like diabetes and hypertension, all in employed, insured populations. When we look across the pilots, we can identify, on average, at least 5% of increased total costs driven by unaddressed SDoH within employed populations.

Using our Health Equity framework, we quantify disparities, creating transparency around root causes. Using quantified results, we engage a broader set of stakeholders to make targeted, effective changes. We design solutions working across our own Aetna resources, our network of providers and our specialized and localized community resources.

So now what? By identifying and quantifying the impact of the real issues, we can design better, more suitable solutions that provide direct business results to employers without shifting costs to low-wage workers. In a post-COVID-19 world, this will amplify cost impacts (see The impact of Social Determinants of Health accelerated in time of crisis). We know that for some employees, when the deductibles are too high, the health care disparities affecting low-wage workers are increased (almost to the point of seeing health care consumption behaviors and outcomes more like those that are uninsured). We know that low-wage employees who have deductible amounts that are too high will be disproportionately affected by health care disparities to the point that these employees will statistically resemble those who are uninsured. What does that mean for an employer? It means that the care avoidance now will lead to higher unexpected costs tomorrow. In the next few years, proactive health care, chronic condition management and mental health care will be essential to ensuring productivity in the workforce and lower health care costs overall.

We can solve all this, but to do so will require a commitment to really understanding how social determinants affect worker health. Aetna is on this journey, using new analytics that take us beyond speculation and “general trends” discussions. We use real data to understand what’s actually happening in order to prevent low-wage workers from achieving their best health, and we partner with employers to build solutions that yield concrete results — better health for workers and lower costs for everyone.

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