The pandemic has touched all of us, but some have felt its effects more than others. COVID-19 has exposed longstanding inequities that have harmed the physical, social, economic, and emotional health of communities of color and other vulnerable populations.
Payers understand that eliminating these health disparities is not only an ethical imperative, but also a necessary step to ultimately achieving lower-cost, higher-quality care. That’s because health disparities result in vulnerable populations delaying important care and visiting the emergency room to treat chronic illnesses that are better managed in non-acute, lower-cost settings. In fact, the Robert Wood Johnson Foundation estimated that racial health disparities cost health insurers $337 billion between 2009 and 2018.
Here are some of the ways that payers are working to reduce disparities to create healthier individuals, healthier communities, and lower health care costs.
Increasing transparency to reduce complexity and boost health literacy
Health care is notoriously confusing. In fact, most Americans have difficulty understanding health information, according to the Centers for Disease Control and Prevention. But some groups tend to be disproportionately affected by low health literacy, including people with low levels of education or income, and racial and ethnic minorities, according to researchers.
Patients who have particularly low health literacy are more likely to smoke, be sedentary, be overweight, and have worse physical and mental health, according to some research. Moreover, financial stress is a major reason lower-income patients don’t seek preventive care or treat chronic diseases before symptoms become emergent.
Payers are addressing health literacy issues with tailored, straightforward communications and decision-support tools — whether that means education campaigns, digital pricing tools, or financial counseling support — to alleviate some of the confusion and anxiety patients have about seeking care. Offering tools and providing cost information creates a better experience that allows patients to move through the health care system while avoiding the shock, anger, disappointment and distrust that lead so many to check out of the system altogether.
Reducing risk factors with personalized programs and incentives
Lifestyle risk factors, including tobacco and alcohol use, poor nutrition, and inactivity, disproportionately affect lower-income and vulnerable populations, as well as communities of color. At the same time, research shows that a whopping 70% to 90% of the most common and deadly chronic diseases that are prevalent among these groups, including diabetes and coronary artery disease, could be prevented by stopping smoking, increasing physical activity, and losing even a relatively small amount of weight. Obesity-related issues alone create nearly $150 billion in health care spending every year, according to research.
Insurers are increasingly embracing digital therapeutic programs as one way to help the huge swaths of patients who suffer from one or more of these conditions. To be effective, these offerings must be based on rock-solid clinical research, and include the engagement trifecta of personalization, incentives, and online communities for support.
Taking aim at social determinants of health
Social determinants of health — including access to affordable and adequate housing, employment, education, transportation, proper nutrition, and safe communities — account for 80% of health outcomes, so insurers are more urgently making these issues a top priority.
A 2019 article in the American Journal of Accountable Care outlines a potential payer approach to managing Type 2 diabetes that accounts for social determinants of health. Through this lens, an insurer would not just approve and pay for medications to manage blood sugar levels, but might also connect patients with nutritionists to build healthy eating habits. Some are also working with local grocery stores and food banks to improve access to fruits and vegetables.
Along the same lines, several major payers have recently invested heavily in improving housing in response to the lack of affordable, adequate shelter in underserved communities that presents a major obstacle to better health. And they’re going even further, funding community partners that offer social services, transportation to and from health appointments, and financial literacy programs.
Beyond partnering to create innovative programs for patients, payers are also factoring social determinants of health into their risk calculations. Doing so helps them offer more holistic care while helping them attain quality measure goals and improve benefit utilization.
Payers understand that excellent care requires more than just medication and clinical intervention. Tackling social determinants of health, investing in programs that support a healthy lifestyle and increasing transparency will improve the overall health of members and start to reduce health disparities while also lowering the overall cost of care. And that’s good for everyone.