Employers Take on Social Factors Weighing on Employees’ Health

July 16, 2021, 9:30 AM

Employers increasingly are getting involved in the movement to help identify and address social factors that can have an adverse impact on the health of their workers.

Kentucky state and local governments, GE Appliances, Humana Inc., and Highmark Blue Cross Blue Shield are among the employers participating in a program with the Centers for Disease Control and Prevention and other organizations to identify problems their employees may encounter that affect their health but aren’t normally covered by health insurance.

These social determinants of health can include inadequate housing and a lack of access to healthy food and transportation. Financial stress and a lack of child care are also concerns many workers have faced during the pandemic.

The focus on social determinants of health has increased over the past several years, but it usually has come from social service groups and health insurers. Getting employers involved may be a key component to improving the health and lives of their workers, who may be quietly struggling without their knowledge.

“Employers are increasingly getting into adjusting social determinants of health as a core part of their health strategy and benefits strategy,” Jessica Brooks, president and CEO of the Pittsburgh Business Group on Health, said in an interview.

“They have not traditionally led it,” Brooks said. “I think Covid-19 exacerbated that, and made it very clear that employers are in the business of public health,” she said.

The Leading by Example program has helped the Pittsburgh-based health-care coalition, which has 85 employer members covering about 2 million people in western Pennsylvania, use data employers have to identify social factors, Brooks said.

In trying to determine when to bring employees back to work, for example, employers learned that leave policies didn’t allow for parents who had children home from school and couldn’t be in an office, she said. In addition, employers may not realize that some employees are homeless, Brooks said.

“What was highlighted since 2020 are these different variables that we oftentimes assumed was outside of our workplace, that it was community issues. And now we realize, oh no, this is my workforce directly impacted.”

“Employers have to be actively engaged,” rather than just relying on government programs to help people in need, Brooks said.

The approximately 160 million people in the U.S. covered by employer health plans are being left “off the table” otherwise, she said. “They’re not traditionally being served through the government programs, and community agencies aren’t necessarily targeting workers above the poverty level.”

Food Trucks, Farmers Markets

The Leading by Example project also is intended to help employers share best practices and develop a plan to work on at least one social determinant of health, Randa Deaton, president and CEO of the Kentuckiana Health Collaborative, said in an interview. The Kentuckiana collaborative is a purchaser-led health-care group in Kentucky.

One business in the collaborative now brings in a food truck with fresh food and hosts a farmers market at its work site, and another business started allowing workers to get advance paychecks so they don’t have to get cash advances, she said.

“Financial stress is a huge issue,” Deaton said. “Businesses are looking at how they can support employees to address financial well-being through classes and education and benefits.”

Deaton said the project found it isn’t just low-wage workers who are affected by social determinants of health. For example, restricting financing and other services to minorities has created additional barriers to housing, transportation, food, and digital access, she said.

“Systemic racism is the undercurrent to a lot of the social determinants of health,” Deaton said.

Many employers lack the data that would make it easy to identify social factors.

“We realized we don’t have a lot of data that goes to race, gender, those kinds of things, with respect to all of our 300,000 members,” Sharron Burton, deputy commissioner of the Kentucky Department of Employee Insurance, said in an interview.

The Kentucky Employees’ Health Plan (KEHP), which includes more than 400 public employers in the state, also is participating in the Leading by Example program. It focused on data it had available on behavioral health providers, Burton said.

“What we did find out is, yes, we do have some provider deserts in the state of Kentucky with respect to being able to access behavioral health services,” she said.

The KEHP is examining programs it has available that “maybe our members aren’t tapping into,” such as tele-behavioral health and telehealth services through employee clinics, Burton said.

UnitedHealthcare Analytical

Covid-19 “heightened some of these inequalities and brought them more to the forefront in a new, different kind of way, with particular focus on mental health,” Rebecca Madsen, chief consumer officer for the Minnetonka, Minn.-based UnitedHealthcare said in an interview.

UnitedHealthcare plans to start offering analytical capabilities for some fully insured employer health plans to help them identify workers in need of social support. The program would begin in 2022.

UnitedHealthcare currently has an analytical program used by some larger employers to identify who is the most likely to have social needs based on claims data, Madsen said.

In addition, call center agents listen for comments such as, “I’m hungry, or I can’t make my rent, or my lights are going to be turned off,” Madsen said. The company has a database of resources it uses to refer consumers to food banks or for financial assistance, she said.

The company plans to begin offering a similar analytical in early 2022 for fully insured plans as small as 300 employees, Madsen said. Companies pay fixed annual premiums to health insurers, which are responsible for covering all claims, in fully insured plans, which are typically used by smaller companies.

To contact the reporter on this story: Sara Hansard in Washington at shansard@bloomberglaw.com

To contact the editors responsible for this story: Fawn Johnson at fjohnson@bloombergindustry.com; Brent Bierman at bbierman@bloomberglaw.com

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