Research: How social determinants of health impact vitality of individuals, communities, and businesses

Unmet social needs impact the vitality of working adults and to improve vitality, employers must leverage data and interventions to address health inequities in their workforce.
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Social determinants of health (SDOH) impact the health, well-being, and overall vitality of individuals, communities, and businesses. A new analysis by Evernorth suggests strategies that employers can take to boost health, well-being and vitality among their workforce. 

According to the study, unmet social needs impact the vitality of working adults and to improve vitality, employers must leverage data and interventions to address health inequities in their workforce. 

Key findings of the research: 

  • People living in under-resourced communities have lower vitality scores and more unmet social needs than those living in areas with more resources. 

  • Those with lower vitality rated their health lower and reported a higher prevalence of chronic conditions than those with higher vitality. 

  • Rural residents are among the most vulnerable to SDOH, as they face more barriers to accessing health care and achieving optimal health. 

  • The research identified a segment of people with high vitality living in areas with high social needs. Social support and connection, healthy behaviors, health literacy, and employer engagement help keep them resilient.

“Employers play a critical role in promoting and protecting the health and well-being of their workforce and the communities where they operate,” said Urvashi Patel, Ph.D., vice president of the Evernorth Research Institute. “Our research suggests that employers must take a data-driven approach to designing a workforce health strategy that provides access to tailored benefits and programs that address the specific needs of their employees.” 

Helping improve health care access in rural communities 

According to the research, rural residents are more likely to face cost barriers when obtaining health care, more likely to live with chronic conditions, and less likely to have a health care provider they know and trust. Rural residents are also more likely to struggle financially – a significant driver of health and vitality. As a result, rural residents were also more likely to skip a prescription or other care due to cost.

To expand access to health care in rural communities, Express Scripts, the pharmacy benefits management business of Evernorth, launched the IndependentRx Initiative. The initiative aims to drive new business growth opportunities for independent pharmacy owners by empowering them to provide certain routine, preventative and chronic care services that increase their local community’s access to care traditionally only available through a primary care provider. Additionally, Express Scripts will increase reimbursements to pharmacies that are independently owned and unaffiliated with a drug wholesaler in areas with only one pharmacy within 10 or more miles from an Express Scripts customer. To support this initiative, Express Scripts founded the industry’s first Independent Pharmacy Advisory Committee to convene a diverse group of pharmacy leaders across rural, urban and suburban areas to inform new solutions that work to address the fragmented health care system. 

Based on guidance from the Independent Pharmacy Advisory Committee, Express Scripts recently announced it will collaborate with CPESN®USA. Initially, efforts with CPESN USA will focus on enhanced care services for Medicare beneficiaries living with hypertension and diabetes, with plans to expand to additional capabilities and offerings. CPESN pharmacies will provide enhanced care, including coordination with other health providers to address care gaps, identification of at-risk people paired with pharmacist-led interventions, and informed medication management and optimization. CPESN USA’s network of over 3,500 pharmacies in 44 states will also add new options for care delivery within the Express Scripts retail pharmacy network.

Expanding access to care for patients with complex cancers

Research shows that individuals living in areas with higher social needs are less likely to be screened for cancer. Factors that may limit screening include lack of knowledge of the importance of screenings, barriers to access and limited provider availability. Research also shows that those living in areas of high social need have higher mortality and incidence rates for cancers, including liver, stomach and lung.

At Evernorth, we are piloting new programs to help close the screening gap for at-risk patients. By leveraging medical and pharmacy data, we identify at-risk patients and proactively outreach to their providers to prompt a screening, ultimately resulting in earlier detection, treatment and better outcomes. 

A key area of focus for Evernorth is expanding access to care for people living with complex cancers. Our Cancer Consult Service uses data to identify patients with complex cancers who may benefit from a consultative review with a cancer subspecialist at a National Cancer Institute-designated cancer center at no cost to the patient or the oncologist. These peer-to-peer consultations give community oncologists information they may not otherwise be aware of, helping patients gain access to treatment recommendations based on the latest evidence-based guidelines. 

Today, more than 6 million people with health benefits from more than 50 large national employers have access to this service. To date, approximately 15% of cancer cases have been flagged as eligible for expert review, and more than 30% of these reviews resulted in a material change to the patient’s diagnosis or treatment plan. Of those cases that saw a change in diagnosis or treatment, medical oncology savings averaged $17,800 per case. 

Additionally, Evernorth’s Concierge Cancer Support program employs a team of nurses who specialize in oncology. They serve as the patient’s single point of contact while coordinating an individualized care experience. The result? $13,000 in savings per engaged patient. 

As part of their efforts, these nurses: 

  • Help patients navigate the care delivery system and their health plan benefits 

  • Build individualized care plans for patients and their caregivers 

  • Coordinate care to align treatment plans across various settings and resources 

  • Identify resources within the community that can help provide financial support, childcare, transportation, meal delivery, and other needs 

“Targeted interventions based on social determinants of health and vitality measures can increase benefit utilization, lower costs, and enable better health outcomes for all,” said Dr. Bhuvana Sagar, an oncologist and senior medical principal at Evernorth. "Additionally, screening efforts among the rural population can increase detection of cancers in an earlier stage, lower cost and improve outcomes." 

This article was created with the assistance of AI tools. It was reviewed, edited, and fact-checked by Evernorth's editorial team.