After the death of George Floyd in 2020, SCAN Health Plan, like many companies, decided to take a look at its own efforts in improving health disparities. It ultimately achieved this by tying its executives’ bonuses to the issue.

“You’re at a time when the whole healthcare industry is saying that we care about reducing health inequities,” SCAN CEO Sachin Jain said. “But candidly, when you look around, there’s not a lot of real action around it.”

One aspect SCAN Health Plan — a Medicare Advantage plan based in Long Beach, California — looked at was medication adherence among its members, numbering  270,000 across Arizona, California and Nevada.

While medication adherence exceeded 80% for all of SCAN’s members, there was still a difference between races. About 86% of the company’s White members took cholesterol medications as prescribed, compared to 83% of Black members and 81% of Hispanic numbers, according to an essay from the company published in Harvard Business Review.

When it came to oral diabetes medications, 86% of White members took them as prescribed, compared to 81% of Black members and 84% of Hispanic members.

“While we were heartened to see that we had medication adherence rates that were in excess of 80% across our whole population, we were disappointed to see that we had a disparity that existed between our Caucasian members and our African American and Hispanic members,” Jain said.

So when the leadership team presented the information to the board, they also suggested setting a goal for 2021: to reduce the disparity by more than 25%, Jain said. 

A year after launching the initiative, SCAN Health brought cholesterol medication adherence up to 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 did SCAN achieve this? The company tied about 10% of its senior managers’ bonuses to their success in achieving this disparity reduction.

The company chose this course of action “to make it real,” Jain said. “It’s not real until you make it real for people. Otherwise, it’s kind of like ‘Oh, yeah, it’d be great if we did this.’ And we wanted to send a strong signal to our organization that this was not something that was nice to have. This is a must do.”

Identifying the problem 

The first thing SCAN had to do was identify the reasons for the disparity, Jain said. 

“Our course of action was identifying it, creating alignment within the management team that this was a problem that we wanted to solve,” Jain said. “And then I think it was about really trying to understand the underlying causes of why people were not adherent.”

The senior vice president of health care services, along with the business excellence and diversity team and consumer insights group, conducted interviews with sample groups of its non-adherent members. The company also talked to staff members of Independence at Home, the company’s community benefit program that offers services to seniors even if they aren’t members of SCAN. Lastly, it had listening sessions with its Black and Hispanic pharmacy employees.

In doing this research, SCAN found several reasons for non-adherence. Many non-adherent members weren’t aware of the prescription benefits SCAN offered, they held more trust in nurses than doctors and sometimes there was a language barrier. Additionally, some cultures relied more on herbal treatments than medications, and some people were unable to receive transportation to a local pharmacy.

How it reduced disparity

The company’s initial course of action mostly began with reaching out to those non-adherent by telephone. But about six months into the initiative, SCAN looked at the data and saw it wasn’t meeting its goal.

The company recruited more staff to include more Black and Hispanic pharmacists and care navigators. SCAN trained its pharmacists and navigators through an education program designed by the Western Region Public Health Training Center at the University of Arizona’s Mel and Enid Zuckerman College of Public Health. The training taught the participants how to understand cultural bias and how to adapt to the needs of each patient.

SCAN’s legal team contracted with outside vendors as well. This included MedArrive, which conducted in-home medication consultations, and Arine, which expanded its pharmacist network. The company also worked with the University of Southern California School of Pharmacy, which provided patients with fotonovelas — Spanish-language stories with photos that stressed the importance of taking medications.

“I think it starts with telephonic outreach,” Jain said. “But then I think it extends to, in some select cases, in-person visitation. I think in other cases it was ultimately about a repetitive set of interactions around medication counseling. Some of it was actually engaging with people’s pharmacies on ensuring their medications were refilled correctly. So there’s a lot of different activities that add up.”

Message for others

When it comes to how other companies can achieve similar reductions in health disparities, Jain recommends getting out of the planning phase. A lot of the learning comes from actually starting the process to reduce inequities, he said. For example, when SCAN began with mostly telephonic outreach and had to later add initiatives when the company found its goal was not being met.

“One of the observations of our industry is that there are a lot of organizations that are virtue signaling around this topic,” Jain said. “They’re putting out carefully-worded statements when various events happen in the news. They’re signaling that they care about [these topics], they appoint chief health equity officers. But when you actually look at what they’re doing at a tactical level on the ground to address the issue of healthcare disparities, there’s very little.”

Jain said this first initiative with medication adherence has now created a “template” for future efforts in health equity. He added that SCAN is now planning to choose an area every year where it can reduce disparities. This year, it’s working on flu vaccinations among its Black members, Jain said. 

“We’re going to be relentless,” Jain said. “We’re going to do what we can to hardwire improvements into our system until we feel confident that all members of SCAN Health Plan are receiving high quality care and equitably, regardless of their condition, regardless of race.”

Photo: bong hyunjung, Getty Images