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Sep 1, 2022
Addressing Health Disparities and Social Determinants of Health for the Medicare Population
Addressing Health Disparities and Social Determinants of Health for the Medicare Population

Health equity can be achieved only when everyone has the same access to quality health care.

At Cigna, we are committed to addressing social determinants of health (SDOH) to make quality health care a reality for all, regardless of age, race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, geography, preferred language, and other factors – and we are putting the money and resources behind achieving this goal. Most recently, Cigna's Medicare business named its first national medical director for health equity.

In her new role, Dr. Alla Zilbering serves on Cigna's Enterprise Health Equity Committee, which includes representatives from all over the organization, including Cigna's Medicare and CareAllies president, Aparna Abburi. This multi-disciplinary committee collaborates on research, testing, and solutions to prevent chronic diseases and improve health outcomes in minority communities. Over the last few years, the committee has accelerated its efforts to address clinical care, social determinants of health, and health behaviors.

We sat down with Dr. Zilbering to explore the health barriers that the senior population faces, as well as what providers and the health care industry as a whole should be doing to reduce gaps in care and improve health outcomes for all Americans.

Tell me about yourself.

I am an internal medicine physician and have cared for patients as a primary care doctor, an urgent care physician and a hospitalist. I previously worked for the City of Philadelphia Department of Public Health, where I was a primary care doctor for uninsured patients who had multiple social and economic barriers. I joined Cigna in 2013, and from day one, I have been impressed by our focus on patient-centric care. I currently live in a suburb of Philadelphia with my husband and two children.

I am originally from Russia and grew up in a very diverse immigrant community in New York City. From an early age, I have been aware of how one’s community and access to resources can impact basics like health and education.

What are some of the most common health disparities for older adults?

The health disparities that seniors face aren’t all that different from the disparities that younger adults face, but they are compounded over time and with disease progression. What I mean is that the non-medical factors that contribute to an individual’s health – such as access to care, food insecurity, and low-quality housing – are now coupled with limited income, decline in physical function, and complications of chronic disease.

For example, if someone does not have access to a primary care doctor throughout their life they are less likely to have age-appropriate cancer screenings, such as a mammogram for breast cancer, and therefore more likely to be diagnosed at a later stage. Additionally, patients that have chronic obstructive pulmonary disease (COPD) – a group of diseases that cause airflow blockage and breathing-related problems – are going to have more exacerbations and more severe disease if they live in an area with air pollution. And, finally, a healthy diet full of vegetables is essential for diabetic patients but an elderly adult who lives in a food desert may not be able to take public transportation to get to a supermarket.

What role do providers play in driving health equity for the senior population?

Partnering with physicians and health care organizations is imperative. At Cigna, we look at data on a population level, identify where there are gaps in care, and then use a variety of strategies to identify the barriers and offer solutions. In the example above around breast cancer screening, we may connect with the customer directly to help them find a primary care doctor that is able to connect with them on their level. We also provide education in the customer’s preferred language. We assist customers with transportation to get to necessary doctor appointments. And in communities where appointments are limited, we bring a mammogram van directly to the patient’s doctor’s office.

Our goal is to deliver actionable insights to doctors and providers that care for our customers. This is where value-based arrangements really make sense. By identifying the disparities and SDOH, we can work with providers to develop programs and interventions for the patients that need it the most.

What are the broader implications of the disparities that seniors are facing?

The disparities that seniors are facing due to race, ethnicity, sexual orientation, gender identity, socioeconomic status, lack of caregiver support, and more, contribute to a lower overall life expectancy and reduce quality of life for many Americans. These disparities erode trust in the health care system and that becomes its own barrier for delivering preventive care. The health care industry needs to do more to foster trust and provide quality care early on.

How is Cigna working to advance health equity for older adults?

First and foremost, if you don't know the problem, you can't fix it. So, we do a lot of work around screening for social determinants of health as well as looking at the data and outcomes to really understand where patients and communities are in their health journey.

To address access to care and financial limitations for seniors, as an example, some of our plans offer discount programs for drugs like insulin, telehealth options for certain types of doctor visits, home visiting services when appropriate, as well as a home-delivery pharmacy option. To address food insecurity for the Medicare population, some of our plans offer the Cigna Healthy Food Card as well as a meal program to help seniors get access to healthy foods following a hospital admission. We also have a meal delivery program for patients with end-stage renal disease on dialysis. For seniors, transportation is often a challenge and they may no longer be able to get down and up the staircase or may no longer drive. We offer transportation to approved health-related facilities, and even the grocery store in some plans.

Our approach is to use data to guide us toward bringing solutions, programs, and partnerships to address disparities.

You mentioned telehealth. I would expect that many patients in the Medicare population would have trouble with accessing virtual care. Is that not the case?

Telehealth is huge opportunity for home-bound seniors, seniors in rural areas, and seniors with other transportation issues. It is a way for the seniors to have more frequent contact with the health care system when a physical presence may not be necessary, such as a behavioral health visit and routine medication management. Telehealth is also a great option for management of chronic diseases like diabetes, hypertension, and congestive heart failure.

However, there are challenges to telehealth. According to the Journal of the American Medical Association, 13 million (38%) of older adults say they lack the knowledge and capacity to get online, let alone operate, troubleshoot, and communicate via the internet. Many seniors do not have a smart phone/computer or reliable internet connection. The COVID-19 pandemic gave us a crash course in telehealth. In spring of 2020, more than 50% of all Cigna Medicare doctor’s visits were telehealth (combination of telephone and virtual care). It has declined and stabilized since then but at the end of 2021 telehealth comprised 10% of all Cigna Medicare doctor’s visits. Ten percent is huge! What we have seen is that older adults need some assistance to get onto a new platform but once they start using it they stay with it.

We ran a program in Arizona that connected members with a patient navigator – an IT support person who helps educate the older adult on how to access virtual care so that they don’t experience issues during their appointment time. This program proved that education is a really important factor in driving health equity and access among seniors, and really any demographic.

Cigna is Committed to Health Equity

For more than a decade, Cigna has promoted the identification of health disparities and influenced the development of solutions that result in more equitable health among our customers, our workforce, and in the community.

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