Aug 29, 2023
Unequal treatment revisited: Innovative approaches to health equity

Quick Take

  • Advancing health equity requires collaborative, innovative thinking.
  • The Cigna Group takes a data-driven approach to health equity.
  • Our organization is embedding health equity into our culture and policies. 

This year marks the 20th anniversary of the landmark report, "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care," published by the National Institute of Health and the National Academies Press. After its publication in 2003, this report shed light on the alarming reality of racial and ethnic disparities in health care, highlighted significant gaps in access to care, quality of care, and health outcomes among racial and ethnic groups. These findings acted as a wake-up call to our health care system, demanding immediate action to address these disparities and ensure equitable health care for all.

At The Cigna Group, we believe that access to high quality, affordable health care is a basic human right. As we recognize the milestone anniversary of Unequal Treatment, it is crucial to reflect on the progress we have made in addressing racial and ethnic health disparities in health care, and remain laser-focused on the continued work that lies ahead. We are committed to partnering with our peers across the health care ecosystem to work together to find new, innovative ways to address health disparities and advance health equity.

This was the topic of discussion at a recent workshop hosted by the National Academies of Sciences, Engineering, and Medicine’s ad hoc Committee on Unequal Treatment Revisited a group tasked by the National Institutes of Health to examine the current state of U.S. racial and ethnic health disparities. In conversation with other thought leaders across various industries, Cigna Healthcare’s Dr. Neema Stephens, national medical director for health equity, shared some of our innovative approaches to improve health care access and quality, and provide more personalized and inclusive care.

Read on below for highlights from Dr. Stephens’ presentation.

Leveraging data and analytics to address health disparities

Dr. Stephens outlined The Cigna Group’s framework for advancing health equity – starting with our approach to using data and analytics to better understand and address health disparities among our customers. For example, we developed a proprietary Social Determinants of Health Index (SDI) to better identify under-resourced communities whose overall health status may be negatively impacted by social determinants of health, and where additional resources may need to be deployed to reduce barriers to optimal health.

We use data and predictive models to help us identify customers at risk for certain health conditions. By aligning coaches and case managers with customers experiencing complex medical conditions, we are able to impact health literacy and other health-related social needs. “Our goal is to engage people as early as possible, when our services can have the greatest impact,” said Dr. Stephens. One example is our early cancer identification model for breast, lung, and colorectal cancers. This has improved our ability to identify patients earlier in their cancer journey, so we can better support them, answer medical questions, and help with overall care coordination.

Embedding health equity into our culture and policies

For the past 15 years, The Cigna Group has been an industry leader in advancing health equity because we’ve embedded this work into every aspect of our culture, Dr. Stephens said.

One example of how we’ve done this is through our Coverage Policy Unit (CPU), which is responsible for developing our medical coverage policies to ensure our customers are receiving evidence-based, medically-appropriate care. We’ve implemented a process that applies a health equity lens to coverage policies to identify any unintentional bias that may limit access to care and recommends changes when health disparities are observed. The CPU has successfully reviewed all coverage policies – and continues to do so on an ongoing basis – resulting in a number of changes to our medical coverage policies that improve equitable access to health care.

We also embed health equity in our culture through our partnerships with providers, who are on the front lines caring for our customers. Our Collaborative Accountable Care (CAC) program has improved access to care by working with networks of doctors, hospitals, and specialty providers to adopt value-based metrics that reward providers based on the improved outcomes, affordability, and experiences they achieve – rather than just the number of services they provide. “The CAC takes this model to another level as an industry leader in embedding health equity outcomes into these value-based relationships,” said Dr. Stephens. We do this by creating a culture of collaboration and accountability, and through financial rewards for providers who proactively screen for SDOH and create programs or initiatives to address health disparities.

Connecting with people where they live, work, learn and play

“Collaboration is key to better meet the needs of the communities we serve,” Dr. Stephens said. One example is our support for the Health Advocates In-Reach and Research (HAIR) initiative with The University of Maryland School of Public Health. With long-standing support from The Cigna Group Foundation, HAIR is a community intervention program rooted in a network of barbershops and hair salons, transformed into culturally relevant portals for trusted health information designed to eliminate disparities and advance equity for historically underrepresented communities.

We are also leveraging community health workers (CHWs) to promote the delivery of personalized and inclusive care for at-risk individuals living with diabetes. In addition to our network of in-person CHWs in Memphis, Tennessee and Houston, Texas, we also offer a virtual CHW network with a nationwide reach. Through their shared backgrounds and experiences, these CHWs engage and build relationships with individuals with uncontrolled diabetes to provide support and address health-related social needs. By addressing both clinical and social needs, these CHWs provide more holistic, personalized support for customers to improve their health outcomes.

Another example of community collaboration is The Cigna Group’s maternal health pilot. In recognition of the ongoing maternal health crisis affecting African American/Black and Hispanic/Latina mothers, we partnered with OBGYN providers to find ways to deliver culturally appropriate and high-quality prenatal care. The pilot offers free prenatal vitamins and aspirin with home delivery to prevent preeclampsia, comprehensive risk screenings to identify mothers at risk for preterm birth and prenatal and postpartum depression and anxiety, and oral health and nutritional education/support. The pilot also works with OBGYN providers to reduce bias in maternal care through training and education, specific to prenatal care, in partnership with the March of Dimes.

“Trust is a significant issue when engaging with underrepresented communities, so we truly believe its vital to find new, innovative ways to better connect with the communities we serve. We are constantly looking for ways to meet people where they are, address social needs, and provide more personalized and inclusive care,” said Dr. Stephens.

The examples Dr. Stephens shared represent just a few of the many ways we are working to address health equity, improve access to quality health care, and provide more personalized and inclusive care and engagement. We achieve this through our framework of leveraging data and analytics, embedding health equity into our culture and policies, and connecting with local communities. There are a number of systemic challenges that persist beyond this framework, both historical and contemporary, that affect our communities and The Cigna Group is committed to finding innovative approaches and collaborating with partners across the health ecosystem to address health equity.

two happy employees clapping

Health equity at The Cigna Group

The Cigna Group 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.

Learn more