SDoH and Health Equity: 3 Barriers to Preventive Health Screenings, How to Overcome Them

Preventive care is essential for staying healthy, yet only 8% of Americans receive recommended screenings each year. The COVID-19 pandemic has only heightened the problem. In fact, over the last 2 years, we’ve seen a rollercoaster of preventive care utilization due to hesitancy about how to approach routine care in such an uncertain time. 

Add to this the impact of social determinants of health (SDoH), which have a massive effect on how people understand and receive health care as well as the health actions they ultimately take.  

While the benefits of preventive health screenings are widely known, people still don’t always do what’s best for their long-term health. Yet, preventive care can save lives. Early cancer detection, for example, allows doctors to implement treatment to avoid the spread of disease. 

Three Barriers Impacting Preventive Screenings

The Icario research team looked into why members aren’t receiving crucial preventive health screenings. These findings could be helpful for health plans aiming to improve HEDIS gap closures and ultimately impact health outcomes for their members. We’ve zoned in on 3 barriers health plans can tackle to address this issue.

#1 Poor Health Insurance Literacy

The Journal of General Internal Medicine compiled results from over 21 studies showing that health insurance literacy is a direct indicator of preventive health care utilization. Those less familiar with health insurance are significantly less likely to use nonemergent health care. 

It’s no secret the health care system is complicated. Education helps members understand their plan’s offerings and how to approach the process, enabling them to navigate the system and receive quality care successfully. It may take several touchpoints from providers and plans to communicate with an individual successfully. 

Solution: Enhance Preventive Programs

Closing gaps in care sounds very transactional, but early detection of critical conditions can be a massive game-changer at the individual level.

Icario supports health plans in encouraging preventive screenings by leveraging behavioral research. For example, one effective strategy to engage new members is a New Member Survey, designed to get to know new members and their health history to identify gaps and improve outcomes in the new member-plan relationship. 

Understanding member preferences, social barriers, and baseline health care knowledge can lead to powerful, unique messages deployed through digital channels. 

Case in point, a multi-state Blues plan engaged 72% of their population to schedule breast cancer screenings using unique message sequencing while reducing member abrasion.

#2 Lack of a Primary Care Physician

Another reason people don’t receive preventive care: they don’t have a primary care physician (PCP). Decreasing proportions of Americans have identified a primary source for health care since 2002, leading to additional gaps in care. 

Providers play an essential role in establishing trust in the system and helping members understand and schedule needed services. Members with a PCP can schedule important screenings and more, but this often begins with an annual wellness visit (AWV). 

Members who get an AWV receive 62% more preventive screenings for chronic diseases than those who don’t.

AWVs are in many ways the gateway to preventive screenings. They allow a doctor to set members up with preventive care while connecting them to related providers or specialists as appropriate to advise them on the next steps. 

Solution: Connect Members to Primary Care

Whether you’re engaging with a new or long-term member, appointments to a primary doctor provide members the opportunity to take the next best action for their health. For example, to move people to take preventive health actions, one health plan partnered with Icario to deploy a program to drive people without an established PCP to schedule an appointment with one after a recent visit to the emergency department (ED). 

As a result, our Connecting to Care Program yielded a 13:1 ROI, and we saw a 41% improvement using multiple outreach channels that included interactive voice response. Additionally, the sooner we contacted a patient after visiting the ED, the more likely they would schedule an appointment with a PCP. 

AWVs are a practical first step in connecting members to various recommended preventive care services. They also establish a significant relationship with a provider, an essential piece of the member’s journey and experience.

#3 COVID-19

If there’s anything consistent within the past 2 years, it’s the presence of COVID-19. The pandemic has altered routines in working, going to school, socializing, and especially receiving health care. 

Early in the pandemic, policies, regulations, and recommendations enacted to minimize unnecessary exposure to COVID-19 in medical settings effectively reduced nonurgent care. Routine screening mammograms dropped by 99% by early April 2020. They rebounded in May but fell to 14% below expectations by July. 

COVID-19 has brought unprecedented circumstances for all of us, but more concerning is the drop in preventive screening utilization and its growing effects on underserved populations.

Black women are 40% more likely to die from breast cancer than White women, and Black men die from cancer at higher rates than men of other races and ethnicities.

Health disparities already existed in preventive care when COVID-19 hit. But due to an overall drop in utilization, gaps in care for underserved populations continue to widen. Early detection rates of cancer and other preventable conditions will undoubtedly see a persisting decline.

Black, Hispanic, and American Indian/Alaska Native (AIAN) Medicare beneficiaries had higher COVID-19 infection and hospitalization rates than White members. Underserved populations will continue to feel the ripple effects of the pandemic more intensely than others, especially in areas where disparities already exist.

Solution: Address SDoH and Improve Health Equity

SDoH barriers continue to exacerbate health disparities and widen gaps in care. For health plans serving Medicare and Medicaid, it’s as important as ever to know your members. What are their channel preferences? What’s stopping them from receiving care? And what will motivate them to make changes for their health and wellbeing? 

Gather as much data as you can through test and learn outreach and subsequent analysis to identify health disparities and break SDoH barriers. 

Icario’s SDoH survey collects information through 6 categories of questions to help us drive engagement and help you understand the unique needs of your population. The results can provide a roadmap for resource allocation—ensuring you promote only those programs that will impact at-risk members. In addition, you can customize the survey to address specific topics of interest, so all of your programming decisions are informed by real, actionable data.

Connecting people to preventive care is mission-critical for Icario. With personalization at scale, we can make the world a healthier place, one person, one screening, and one life at a time.