Following the death of George Floyd in 2020, SCAN Health Plan, like many companies, decided to look at its efforts to improve health disparities. It finally did this by tying executive bonuses to the issue.
“You’re at a time when the entire healthcare industry is saying we care about reducing health inequalities,” said SCAN CEO Sachin Jain. “But frankly, when you look around, there’s not a lot of real action around.”
on the one hand Scan health plan — a Long Beach, Calif.-based Medicare Advantage plan — looks at medication adherence among its members, with 270,000 members in Arizona, California and Nevada.
Although medication adherence was over 80% for all members of the SCAN, differences persisted between races. According to one study, about 86 percent of the company’s white members are taking cholesterol medication as prescribed, compared with 83 percent and 81 percent of black and Hispanic members, respectively. prose The company was published in the Harvard Business Review.
When it comes to oral diabetes medication, 86% of white members are taking it as prescribed, compared to 81% and 84% of black and Hispanic members, respectively.
“While we are pleased to see drug adherence rates of over 80 percent for our entire population, we are disappointed to see differences between our Caucasian members and our African American and Hispanic members,” Jain said .
So when the leadership team presented their information to the board, they also suggested setting a goal for 2021: closing the gap by more than 25 percent, Jain said.
One year after launching the program, SCAN Health achieved cholesterol medication compliance of 87.4% for Black members, 86.6% for Hispanic members, and 89.6% for White members. For diabetes medication adherence, these numbers rose to 87.9%, 88.4%, and 88.9%, respectively.
How does SCAN do this? The company tied roughly 10 percent of senior executive bonuses to their success in closing the gap.
Jain said the company chose this course of action to “make it happen.” “It’s not real unless you make it feel real. Otherwise, it’s kind of like, ‘Oh yeah, it would be great if we did that. “We wanted to send a strong signal to our organization that this is not a good thing. It has to be done.”
Identify the problem
The first thing SCAN had to do, Jain said, was to figure out the reason for the discrepancy.
“Our course of action is to identify it, to create alignment within the management team, and that’s what we want to address,” Jain said. “And then I think it’s really trying to understand the root cause of why people aren’t complying.”
The Senior Vice President of Healthcare Services, along with the Business Excellence and Diversity team and the Consumer Insights team, conducted interviews with a sample group of their non-loyal members. The company also spoke with staff at Independence at Home, the company’s community benefit program that serves seniors even if they are not members of SCAN. Finally, it held listening sessions with black and Hispanic pharmacy employees.
While conducting this research, SCAN identified several reasons for non-adherence. Many non-SCAN-compliant members are unaware of the prescription benefits SCAN provides, trust nurses more than doctors, and sometimes have language barriers. Also, some cultures rely more on herbal remedies than drugs, and some cannot accept transportation to local pharmacies.
How it reduces the gap
The company’s initial actions largely began by contacting those who didn’t comply by phone. But about six months into the program, SCAN looked at the data and found it fell short of its goals.
The company has hired more staff, including more black and Hispanic pharmacists and nursing navigators. SCAN trains its pharmacists and navigators through an educational program designed by the Western Regional Public Health Training Center at the Mel and Enid Zuckerman School of Public Health at the University of Arizona. The training taught participants how to understand cultural biases and how to adapt to each patient’s needs.
SCAN’s legal team also contracts with external suppliers. This includes MedArrive, which conducts home medication consultations, and Arine, which expands its network of pharmacists. The company is also partnering with the USC School of Pharmacy, which provides patients with fotonovelas — stories and photos in Spanish that emphasize the importance of taking their medication.
“I think it started with phone outreach,” Jain said. “But then I think in some specific cases it extends to in-person visits. I think in other cases it ends up being about a series of repeated interactions around drug consultations. Some of those are actually working with people’s pharmacies , to make sure their medication is being replenished correctly. So there are a lot of different activities that add up.”
message others
When it comes to how other companies can achieve similar health gap reductions, Jain recommends getting out of the planning stage. He said a lot of learning comes from actually starting the process of reducing inequality. For example, when SCAN started out primarily as telephonic outreach, it had to add initiatives later when the company found that its goals were not being met.
“One observation from our industry is that there are a lot of organizations around this topic that are signaling virtue,” Jain said. “When various events are in the news, they make carefully worded statements. They are implying that they care [these topics], they appointed a chief health equity officer. But when you really look at what they’re doing on a tactical level to address health care disparities, there’s little. “
The first initiative to adhere to medication now creates a “template” for future health equity, Jain said. He added that SCAN now plans to select an area each year where the gap can be reduced. This year, it is vaccinating its black members against the flu, Jain said.
“We’re going to persevere,” Jain said. “We will do everything we can to improve our system until we are confident that all members of the SCAN Health Plan are receiving high-quality care, regardless of their condition or race.”
Photo: bong hyunjung, Getty Images
