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Putting analytics to work for health equity
Published April 13, 2021
Executive Vice President, CVS Health and President, Aetna
Businesses want their employees to be at their healthiest and to enjoy full lives at home and in their communities. Healthy and fulfilled employees are more creative and productive at work. That’s also what employees want — and deserve. Yet, we know that life circumstances significantly impact each person’s opportunity to achieve their best health. The term we use for life circumstances that create barriers to health, such as poverty, race, ethnicity, social isolation and community environment, is social determinants of health (SDoH).
At Aetna®, we’ve been working to address SDoH, and recently, we’ve taken a significant step forward by providing new health equity analytics for employers who sponsor Aetna plans. In 2019, we produced the first social risk scores for Aetna members using Analyze Rethink Transform, or ART, our Aetna-developed plan sponsor analytics toolkit. ART assigns a social risk score to every plan member, and their employer can then review health plan performance through this new lens, gaining insight into which employees are falling behind in health status and in what ways.
In April 2020, we went further and deployed a user friendly, point-and-click pathway that leads employers through their health plan metrics step by step so they can understand how social risk factors are affecting their employees. We also began providing patient-privacy-preserving, cohort-level analytics (such as hospital inpatient readmission rates, diabetes incidence and cancer screening rates) and paired them with health actions recommended by our clinical and informatics experts. That information allows plan sponsors to see beyond previous “groupings” and “averages” that treated all employees as if they faced the same life circumstances.
How important are social determinants of health to the success of employer-sponsored health plans? They’re crucial. For over a decade, we’ve seen employers increasing point-of-care costs to employees through consumer-driven health plans (CDHP) and relying on transparency tools, such as data on health care cost and quality, to support cost management. We’ve also seen stagnant wage growth, particularly among low-wage workers. Most significantly, minorities are disproportionately represented among low-wage workers, who often have difficulty affording and accessing health care. Since most companies and employees share the cost of health insurance, both want to achieve health goals at the lowest total spend. This is especially important going forward, as the cost of providing health insurance through employer-sponsored group plans rose 4% in 2020 to $7,400 per year for one employee and over $21,000 per year for family coverage.
According to the Commonwealth Fund, one quarter of employees covered by employer-sponsored health plans are “underinsured” — meaning they have coverage, but their point-of-care costs are so high that they cannot really afford to use their plans. With approximately 160 million Americans covered under employer-sponsored plans, this means some 40 million people are effectively underinsured, with the highest rates seen among vulnerable populations in Latino and Black communities. The data show that the underinsured often do not use their health plans, sometimes skip or postpone screenings and basic or preventive services, or delay getting care, all of which can put them on a path toward chronic health conditions and expensive inpatient care.
By using Aetna tools and techniques, employers can now identify the important health areas, including patient outcomes, cost of care, utilization rates and engagement with diabetes programs or medication compliance, in which employees affected by social determinants are falling behind. They can also quickly quantify the real costs associated with care gaps and develop interventions that produce the best company ROI on their health plan. These interventions can be employer actions, such as using nonbenefits communications channels to inform employees of the advantages of getting treatment for nonurgent health issues at a CVS® HealthHUB™ location, for example, instead of at an expensive emergency room. They can also come from the Aetna plan pharmacy benefits managers taking actions like adding greater cultural competence to scripted dialogues used by health coaches; from provider networks taking actions like expanding clinic hours or adding specialists in ZIP codes where expensive, out-of-network care is common; or through community programs taking actions like connecting first-time mothers with local maternal health programs.
This a prime time to raise awareness about the health disparities that affect racial and ethnic minority populations and to encourage actions to address them. I’m proud that Aetna is developing tools for employers that engage and empower organizations to address social determinants in targeted, concrete ways. We will continue to advance our analytics capabilities and help employers develop innovative solutions for eliminating health disparities. Doing so is a both a business and moral imperative.
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