Aetna Medicare Executive on Healthcare Inequity: 'I Feel More Hopeful'

Aetna's Medicare Multicultural Initiative seeks to improve equity for members who are Black and Hispanic.

April is National Minority Health Month. Thirty days is not enough time to focus on health equity. Neither is two years—the amount of time it took the pandemic, racial inequality, and their intersection to disproportionately shorten the lifespans of Black and Hispanic people, daily and across the long term.

Aetna and CVS Health are making an impact through data, focus, funding, and partnership, as illustrated by the health plan's Medicare Multicultural Initiative.

HealthLeaders interviewed two Aetna executives close to the program: Dr. Alena Baquet-Simpson, Medicare senior director of medical health services, and Dr. Jamie Sharp, VP and CMO of Aetna Medicare. With expansion planned, program results are promising—as is the revelation that history, memory, and hope have a role to play in health equity objectives.

Results from the Medicare Multicultural Initiative

Aetna, a CVS Health company, launched its Medicare Multicultural Initiative in January 2020 to bring a cross-functional approach to health equity for members who are Black and Hispanic. More than two years later, expansion is planned for more markets and conditions. Growth will remain rooted in the voices of Aetna's Medicare beneficiaries.

"Their voices were so powerful, the loudest" says Baquet-Simpson. From these focus groups, which also included providers, the initiative has achieved the following:

• Sustained funding. Committed dollars are any program's proof of concept. Baquet-Simpson understands full well that investment demonstrates Aetna's deliberate commitment to health equity.
   
• Guiding principles. As the initiative grows, it will continue to be guided by four principles to: Boost community involvement, involve members' families and loved ones, address whole health, and alleviate barriers.
   
• Community trust. The Medicare Multicultural Initiative brings services to where people are, from vaccine clinics to healthy cooking education. The program builds relationships with community- and faith-based leaders to leverage their influence and build trust.
   
• 800+ hours of training. As part of the initiative, Aetna team members, including physicians, have received cultural sensitivity training.

These results and objectives reveal two macro views: understanding that a member's health habits are often influenced by their family and that chronic conditions must be understood collectively, not individually. The Aetna initiative has embedded these macros in its Guiding Principles and targets members with three or more chronic conditions.

Examples of payer-provider collaboration

The Medicare Multicultural Initiative is also grounded in provider collaboration through:

• Data. "We are sharing social determinants of health [SDOH] data with our value-based providers," says Baquet-Simpson. Additional resources include internally developed SDOH indices, Z codes attached to claims, and collaboration with the medical economics team. Sharp adds: "We understand how hard it is for providers to get this data. We're using it to look at quality more broadly [e.g., Star Ratings]."
   
• Monthly reporting. Physicians receive reports that incorporate SDOH risk insights at the individual and community levels.

Health equity through the lens of history, memory, and trust

Baquet-Simpson emphasizes: "We know that disparities are not new. The pandemic's effects are a reminder of how much work is left to be done. It's a dire situation that we must address."

Reminders and memory are intertwined with the history of racial inequality.

In a November 2021 article about the initiative, Aetna invokes the 40-year Tuskegee Study, which left Black men untreated so that syphilis could be studied. It is but one example, says Baquet-Simpson, "of why there’s an absence of trust in the healthcare system." As part of the article, she adds: "One of the things that I heard the loudest [in the focus groups], and that really resonated with me, was that people wanted to know they were understood, they were heard and that we care."  With HealthLeaders, she adds that "we cannot exclude the impact of history from interventions."

So why do we forget?

Tuskegee and other injustices demonstrate how daily life can drown out even imperatives as important as health equity. Baquet-Simpson and Sharp acknowledge that healthcare is not immune to this "forgetting" and that it must improve.

"The silver lining, including the racial unrest of the past two years, have accelerated awareness that more work must be done on health equity," says Baquet-Simpson. "All stakeholders need to be working together and committed to breaking down barriers."

When asked about the state of equality during National Minority Health Month in April 2022 compared to 2020, she answers: "I feel more hopeful."

Broader CVS Health investment

Healthcare is now investing in what has always been true: that health outcomes are driven largely by SDOH dimensions such as food, medication, and housing. CVS Health has expanded its SDOH funding, including the more than $1.2 billion it has invested in affordable housing.

"Being healthy and having a roof over your head is a minimum basic need that many of us take for granted," says Sharp.

Other CVS Health investments include using medical and social needs data to design total health benefits and the addition of the first Chief Health Equity Officer—Dr. Joneigh Khaldun who joined the organization in October—to its executive suite.

"Health equity is going to be part of the conversation for how we can do our best," Sharp emphasizes. "It must be a foundational building block along with access and quality."