The devastating COVID-19 pandemic has yet again brought to the fore racial, social, and financial disparities in our healthcare system. The clarion call to address the long-pending issue has gained momentum over the last year. Social determinants of health (SDoH) have been instrumental in putting black, indigenous, and people of color (BIPOC) at a higher risk of contracting, hospitalization, and death from coronavirus infection.
Sensing the need of the hour, payers have increased the focus on addressing disparities in the healthcare system. Budgets have been widened, new schemes and awareness programs launched and organizational restructuring in leading health plans are underway to fight the underlying problem.
In the first part of a blog series, DistilINFO is focussing on how the pandemic has exposed the healthcare faultlines. This part will be followed by details on measures taken by major payers to fight health inequity.
Black Americans are infected with COVID-19 at nearly three times the rate of white Americans and are twice as likely to die from the virus. The infection rate for Blacks is 62 per 10,000, compared with 23 per 10,000 for whites, according to The Physicians Foundation 2020 Survey of America’s Physicians.
Government Report
The Centers for Disease Control and Prevention has maintained that race and ethnicity are risk markers for other underlying conditions that affect health, including socioeconomic status, access to health care, and exposure to the virus related to occupation, like frontline, essential, and critical infrastructure workers.
Studies have revealed that nearly 50% of health outcomes depend on the social, economic, and physical environments of individuals. The rest of it is controlled by lifestyle components (30%) like physical activity and food habits, and medical care (20%).
To rid the society of health disparities, which have existed for ages, a massive systemic change is required where all stakeholders of the US healthcare system will have a key role to play in close coordination with each other.
Role of Payers
Health insurance providers will have to lead from the front of the findings of The Physician’s Foundation 2020 Survey is anything to go by.
A majority (63 percent) of those surveyed supported reimbursing physicians for addressing SDoH such as poverty, homelessness, poor nutrition, and others. They rated this as an important or extremely important policy step. A considerably high number of physicians (70 percent) are of the view that social determinants of health should be included in patient risk scoring as a future means of ensuring access to high-quality, cost-effective care for all.
Another study led by clinician-researchers at the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology at Beth Israel Deaconess Medical Center (BIDMC) characterized heart disease and cerebrovascular deaths by race and ethnicity during the pandemic. Their evaluation found that the year-over-year increase in deaths due to heart disease and cerebrovascular disease was significantly more pronounced among Black, Hispanic, and Asian populations in the US than in the non-Hispanic white population.
The researchers suggest several factors may have played a role in the disproportionate rise in cardiac and cerebrovascular deaths among racial and ethnic minorities, including disruptions in healthcare delivery in minority communities especially hard-hit by COVID-19. Although the use of telemedicine increased during the early phase of the COVID-19 pandemic to bridge gaps in care, Black, Hispanic, and Asian patients have also experienced unequal access to video telemedicine. In addition, avoidance of health care systems may have also played a role. According to the American Heart Association, Hispanics and Black Americans were most likely to stay home if experiencing a heart attack or a stroke, to avoid the risk of contracting COVID-19 at the hospital.
Conclusion : Insurers, healthcare providers, policymakers, and others are becoming more aware that addressing the underlying social determinants of health is critical to improving overall health and reducing costs. They believe it is these factors, more than access to care or even quality of care, that largely determine health outcomes.
Patient-centered measures are now at the fore to ensure delivery of the unmet SDoH requirements. The next part of the article will cover the initiatives taken by health insurance providers in this direction.