People aren’t using primary and preventive care enough. [1] In fact, 25% of adults don’t have a primary care provider and 69% are behind on their cancer screenings. [2, 3] Historically, even the 54.5% of the U.S. population with employer-provided benefits fail to use those benefits. [4] This is especially true for minoritized groups and is due, in part, to the complexity of navigation healthcare and benefits. A McKinsey study found that employees of color — even at the highest income levels — were 1.4 to 1.5 times more likely than white employees to think the resources and tools explaining their benefits were unhelpful. [5]

The lack of clarity on how to use benefits is just one of the barriers that prevent people from accessing care. For many marginalized communities, the road to healthcare is fraught with obstacles. Social determinants of health (SDOH) — such as income, education, access to care, and neighborhood conditions — create barriers that make it more difficult to access or prevent people from getting the care they need. This has obvious health impacts and creates challenges for employers, including avoidable healthcare costs and lower employee productivity and retention.

Using navigation to increase healthcare engagement

To address these challenges, Accolade partnered with six employers — including a public university system, a private university system, a national airline, a regional medical center, and two regional manufacturing companies — to deliver health navigation services to their employees and dependents. This health equity-focused intervention aimed to improve primary and preventive care use, make the healthcare system easier to navigate, and reduce future healthcare expenses. The early results of this undertaking were impressive. Individuals with an SDOH barrier versus those individuals without a barrier established a:

• 15% higher use of breast cancer screenings (75% vs 60%); and

• 4% higher use of primary care (48% vs 44%).

How Accolade increased primary care and cancer screenings

Our health equity-focused intervention gave each employee and their family — about 238,000 members — access to a Care Advocate, with support from a multidisciplinary Care Team that included nurses, pharmacists, and social workers. Members were able to connect with their Care Team via telephone and mobile app. The Care Advocate answered questions about healthcare and nonhealthcare benefits — from finding doctors and accessing maternity support to childcare assistance and transportation help.

Since Accolade’s Care Team had access to each member’s employee benefits information, they could:

• Look up and answer questions related to copays and deductibles.

• Find in-network providers for the members and their families.

• Find programs and services freely available to them through their employer or community, such as childcare support, transportation vouchers, or telemedicine benefits.

In addition, Care Advocates could proactively reach out to members based on risk stratification (dividing members into risk categories based on their clinical and lifestyle characteristics), SDOH barriers from claims, and demographic data. This was possible because of Accolade’s proprietary engagement and influence model.

Critically, the Accolade care team is trained in addressing SDOH barriers. The company trains its Care Advocates and nurses on this model, which is grounded in behavioral science principles and is known as LEARN2 (Listen, Engage, Assess, Resolve, Influence, and Enhance). Accolade’s proprietary LEARN2 model is designed to understand a person’s contextual needs. This approach, proven to build trust among historically marginalized communities, allows for planned interventions that consider a person’s unique needs. For example, when helping a member find a new doctor, Care Advocates are trained to ask whether members face any barriers to making appointments. If the question uncovers obstacles, such as transportation or logistics, the health assistant is trained to address those barriers, which may include helping a member find a bus route or other transportation to their appointment. Previous studies showed that Accolade Care Advocates are three times better than physicians at soliciting contextual barriers from members and then acting upon them. [6]

What employers should do to expand care access

What can employers do to encourage employees to take charge of their health? They can start by examining employee groups and how much they use primary care and preventive care. Employers also can look at their healthcare claims trend and employee healthcare experience. In general, employers can justify investing in health navigation when they have a high healthcare trend (>6%), low employee involvement with benefits, and low primary care use.

From there, employers can look at their existing ecosystem, including their health insurance carrier and benefit partners (e.g., wellness, telemedicine, digital point solutions), as well as the prevalence of healthcare deserts in their population to understand if any of these partners provide health navigation services or have services that can be carved out by a new health navigation partner. For example, Accolade often takes over member services and case management from carriers as part of its health navigation implementation.

The design of an employer’s healthcare navigation services will affect how the company addresses SDOH and reduces healthcare disparities. A core health equity principle is that interventions must be designed with a health equity lens from the start and not retrofitted at the end. When employers take concrete steps to promote health equity, they can make a significant difference in the health and well-being of their employees and enhance company performance.

Connect with our team to learn how Accolade can help you improve access, engagement, and healthcare return on investment.

[1] Nundy S, Hwang C, Chiang E, Ridella A, Safi Baurjan. Employers and Public Health: The Novel Use of Health Navigators in a Workplace Setting to Expand Equitable Access to Care. Submitted for publication, 2024, Washington, DC.

[2] https://www.kff.org/other/slide/one-fourth-of-adults-and-nearly-half-of-adults-under-30-dont-have-a-primary-care-doctor/

[3] https://www.preventcancer.org/2024/04/adults-behind-cancer-screenings-reasons-vary-race/)

[4] https://www.statista.com/statistics/323076/share-of-us-population-with-employer-health-insurance/#:~:text=In%202022%2C%2054.5%20percent%20of,insurance%20from%201987%20to%202022.

[5] https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/income-alone-may-beinsufficient-how-employers-can-help-advance-health-equity-in-the-workplace

[6] Schwartz A, Weiner SJ, Binns-Calvey A, et al. Providers contextualise care more often when they discover patient context by asking: meta-analysis of three primary data sets. BMJ Quality & Safety 2016;25:159-163.