Our Position on Health Equity
Health inequity is when avoidable differences in health status exist and are unduly influenced by unjust reasons such as race and ethnicity, income or geography. The overall level of health inequity in the U.S. is staggering. Across the United States one’s life expectancy can vary as much as three decades depending on where one lives and this is heavily influenced by race, ethnicity, and socioeconomic status. According to a Journal of American Medical Association (JAMA) publication, a total of $35 billion in federal funds was allocated from 2000 to 2019 to execute over 16,000 research projects that attempt to address racial/ethnic disparities. And, as of June 2020, there were more than 200,000 PubMed articles relevant to racial/ethnic health disparities. Despite all this work, clear disparity remains. Many payors have acknowledged their responsibility to address health disparities amid the increasing number of initiatives in this space. This naturally raises the question – what is an effective strategy for payors to address health inequity?
At NextHealth, we have been partnering with health plans providing insight to influence behaviors since our inception. And, we are well-positioned to enable payors to address disparities in health status across the care continuum with a focus on three determinant factors:
- Access to Care and Services. Ensuring members can readily visit with high-quality providers including primary and specialty care, as well as other services like case management, behavioral health, and community-based organizations.
- Activation, Engagement, and Education. Helping members address unmet social and healthcare needs to bolster self-management skills.
- Patient-centered Outcomes. Keeping members healthy and happy while avoiding unnecessary high-cost utilization like emergency department and inpatient care
Our Projects and Capabilities
Almost all of NextHealth Technologies’ clients have initiatives targeting health equity. And we’re helping them evaluate the impact of Social Determinants of Health (SDOH) factors (e.g. food access, household composite index, minority status, social isolation/vulnerability index, technology access) on access and cost of care. We’re supporting clients to improve health equity by enabling better visibility into the role of SDOH factors on key outcomes and displaying this in a quantitative, actionable format.
For example, access to healthy food drives members whole health, so payors are being strategic about helping more individuals get better access to nutrition. Studies have shown that food insecurity leads to an increased risk of chronic health conditions. People with less money, less education and poor living conditions are more likely to experience food insecurity and have a less healthful eating pattern and higher levels of diet-related diseases. Payors have sought to address the challenge of food insecurity by coordinating the home delivery of medically tailored meals and groceries during the pandemic, with a focus on reaching both high-risk and COVID-19 positive patients. With our experience and expertise, NextHealth is partnering with payor clients to study the impact of multiple food security and nutrition management programs (e.g. Mom’s Meals) on local communities.
Even more, our platform capabilities can also be leveraged to study the racial and ethnic disparities related to COVID and identify ways to improve vaccine adoption rates among marginalized populations.
NextHealth is committed to playing a role in promoting health equity. Leveraging Social Determinants of Health (SDOH) and Social Vulnerability Index (SVI) data from our clients as well as multiple public and private sources, NextHealth is increasing engagement of vulnerable populations more effectively to transform healthcare for everyone.
NextHealth believes promoting virtual behavioral healthcare using data driven means is one of the foundational health equity imperatives. Our work with health plan clients has proven this out – especially during the pandemic. We recently examined some important client challenges related to health equity.
Opportunities to overcome unmet social needs that serve as barriers to telehealth adoption.
In a recent assignment, NextHealth was asked by a payor to determine whether SDOH variables were an impediment to telehealth adoption. To do so, NextHealth first segmented the plan’s members with challenging rankings in seven different SDOH categories including Food Access, Household Composition, Minority Status, Transportation, Technology Access, Socioeconomic and overall Social Vulnerability. We broke members into two groups: members in the top quartile of low SDOH ratings vs. those outside the top quartile of low SDOH ratings. NextHealth then analyzed changes in these two groups’ use of telehealth pre- and post- Covid as measured by per member per month (PMPM) cost for telehealth by group.
In six of the seven SDOH categories, the increase in the rate of telehealth adoption was nearly identical. In fact, for several SDOH categories, telehealth adoption was even greater during the pandemic for members with SDOH challenges compared to those without. For example, members in the top quartiles of low SDOH ratings increased their telehealth costs from $0.04 PMPM pre-pandemic to $14.79 post; while members without SDOH challenges increased from $0.08 to $13.65. The one exception was members living in areas rated as low in Technology Access, who showed a lower increase in telehealth adoption. It is important to note that this payor client had decided early in the pandemic to eliminate telehealth co-pays and reimburse telehealth at parity to in person visits.
The result: Aside from Technology Access, the remaining SDOH variables are not an impediment to telehealth adoption. Rather, telehealth can be a valuable tool in addressing health inequity provided co-pays and reimbursement are structured properly. This critical insight contrasts what both we and our client partner expected at the outset.
Increasing the rate of activating members into virtual behavioral healthcare.
In the same client engagement where we examined SDOH barriers to telehealth adoption, NextHealth was asked to isolate which disease states comprised most of the incremental telehealth adoption since the start of the COVID-19 pandemic.
The result: For all members, the clear answer was behavioral health. Specifically, Medicaid members averaged about 30% higher utilization compared to Commercial and Medicare members.
- Medicaid: Between 87-91% of incremental visits were for behavioral health
- Commercial and Medicare: 44-77% of incremental visits were for behavioral health.
As part of another engagement with a large national health plan, NextHealth was tasked to increase the activation rate to get members into care with two virtual behavioral health vendors. Our team first replaced the four marketing-based cohorts the plan had been using with sixteen clinically-based cohorts. We then developed tailored messaging and outreach strategies for each cohort.
The result: 63% increase in the rate at which the plan activated members into virtual behavioral health care.
The data driven conclusions from these client engagements offer important insights for payors seeking to address health inequity and challenge some commonly accepted beliefs that may currently be an impediment to developing effective health equity strategies.
We can act now.
We all have a responsibility to address health inequity. From where we sit, NextHealth has identified a few insights we can use immediately:
- SDOH Factors are not an insurmountable challenge to Telehealth Adoption. Members with high needs desire to engage via telehealth and those with unmet social needs stand to benefit in an outsized manner if barriers to these digital visits can be addressed. Aside from access to technology, consideration of SDOH status is not a requirement to improve outcomes for this population.
- Amplifying Telehealth Adoption Should be Concentrated on Behavioral Health Initially. For effective activation, plans can waive copays and reimburse for telehealth visits at parity to in-person visits.
- Care Coordination with Primary Care Physicians is Create effective care coordination strategies with PCPs who are serving members with SDOH challenges to ensure familiarity of referring members to virtual providers as appropriate.
Are you looking for a partner to help you amp up your impact on health inequity? Let’s talk about how we can tackle this big problem together, for our members and their families.
Dr. Michael Poku, Chief Medical Officer
Nasir Ali, Chief Product Officer
Interested in learning more about what leading health plans are doing to address health equity?