Advancing health equity: How Optum Rx is overcoming challenges

Scott Draeger: Corey, let's start with the basics. Can you level set for us what health equity is and why it's important? 

Corey Coleman: Sure, Scott. I really appreciate the question because I think there's a lot of talk about health equity. I try to be really clear and intentional around the language that I use when talking about health equity. Fundamentally, the Center for Disease Control and Prevention has defined health equity to be the state in which everyone has a fair and just opportunity to attain their highest level of health.

Achieving this requires ongoing societal efforts to:

• address historical and contemporary injustices
• overcome economic, social and other obstacles that may impede health and health care
• eliminate preventable health disparities

Additionally, when we think about the importance of health equity and our ability to understand health inequities, health disparities, one of the things that comes to mind that I think is really important for the audience is, “What's the financial cost of not doing anything around some of these challenges?” Recently, a study predicted that health inequities could impose a staggering $1 trillion price tag within the U.S. health care system by the year 2040.

So, it’s important for all of us to understand that not addressing health disparities and the inequities that exist within our system does have a price tag on it. It really requires all of us to lean in, better understand the challenges and provide better care for the patients that we're supporting.

Scott: Sumit, you mentioned earlier that you lead the Optum Rx clinical organization. What role does the clinical organization play in addressing disparities in health equity?

Sumit Dutta: Let me start by noting that Corey and Scott and I know each other really well. Both Corey and Scott are big readers, and I am, as well. We trade books and read on a variety of topics. Corey sent me a book within the last year called Medical Apartheid. It makes an important point that I want to share. That is that the history of inequity is long, and that history in health care, in particular, is also long. In this book, it talks about the Tuskegee studies where, essentially, a group of people were not treated in order to see what the effects of syphilis would be. Can you imagine that? Talk about inequity. There's a long history of it.

The second thing [to note] is it's easy to overlook it. Health inequities exist in our society today and they're easy to overlook unless you try. Back to Corey's comments — you have to work at it. You have to recognize it's an issue, and you have to move forward.

Getting back to your question, Scott, how does the clinical department have a role? We have a role to be vigilant and look for it using our data, using our interactions with our patients. We then create effective policies and programs to address the discrepancies in access to care and outcomes. Corey, anything that you would add to that?

Corey: I think you've hit it right on the head, Sumit. Being vigilant, number one, is the most important thing we have to be. Dr. Sumit oftentimes quotes something to me that I think is really important. Really, what's at the heart of this work is uncovering the undiscoverable, making the invisible visible.

A lot of the work we're describing is how many of us within our organization are being really intentional around trying to understand where these disparities exist within the patient populations that we have responsibility for. That intentional vigilance is really at the heart of this work. It helps to provide insight around the art of the possible and our ability to create new solutions and strategies to support the patients and clients we have responsibility for.

Sumit: I'll give one more example, Scott. All the things that we've talked about, the vigilance, the data, it also takes collaboration. Corey worked with one of our analytics experts, Will Wittkopf, in order to devise a tool that uses data to uncover discrepancies in treatment of diabetes. That kind of collaboration within the company is essential in order to develop the techniques that we use in order to make the invisible visible.

Scott: Sumit, I love that example of leveraging analytics. Obviously, health equity can be broad and complex. Building off your last statement, what specific areas is Optum Rx really focused on addressing?

Sumit: Well, I'll give two examples, but they're certainly broader than that. We just spoke about the diabetes care. I think we've done a number of things that are important here. I find health equity and affordability are subjects that are tied at the hip. When we can make drugs more affordable, member cost share more reasonable, we also address health inequities.

Some of the work that we've done is driving insulin copays below $35. Scott, you've been instrumental with your team in making that happen. I've seen the tremendous progress in the number of prescriptions that the copay is less than $35 or even zero for insulins increase under your guidance. I think that that is one important example.

Maternal care is another. From a corporate perspective, we focused on maternal fetal disparities in certain groups of people. That's been an important initiative for us, and there's more work to be done there. Let me start there. Corey, would you add anything to the list?

Corey: From an Optum Rx standpoint, we have really focused on five particular key areas:

1. address disparities in pharmacy access
2. drive equity and medication adherence
3. address high and rising costs of specialty pharmaceuticals
4. enable maternal and child health drug safety
5. facilitate multi-language support

It's really worth noting that our endeavors have garnered steadfast support from our entire leadership team. I cannot express how important this is for our organization, and really any organization, to meaningfully advance health equity. We have to be intentional around understanding how we can make an improvement. I say this with pure joy. I'm really, really proud of our organization, and I mean this sincerely. Leaders throughout our organization are really leaning into this work.  

As a result, some of the results that you're starting to hear about, such as the diabetes medication adherence dashboard, are really starting to make an impact. We are beginning to lay out new strategies that allow us to really uncover data and patterns within the patients we're serving that we've not been able to see before. That's really powerful work and it gives us the opportunity to better support our members, be able to identify disparities within the patients we're serving.

Scott: Corey, let me stay with you here. What other examples of programs or maybe initiatives does Optum Rx have in place today to continue driving equity?

Corey: Thanks again for that question, Scott. We have an array of strategies in place and plans in place, and a couple that I will call out.

I'd start with our Genoa pharmacies. We have Genoa community pharmacies spread throughout the country today. Working with that team, we've been able to pinpoint through data and data analytics the communities that are facing adverse health outcomes as a result of their zip code. We're able to pinpoint those particular populations, overlay that information with our Genoa community pharmacies, and be intentional around making flu vaccines available to them. These are community members that are seeing adverse health outcomes as a result of not having ample access to flu vaccines. We know, again, in order to really move this work forward we have to be intentional around making these kinds of services available for the patients and the community members we serve.

In addition to that, I would really pinpoint some of our new programs and strategies that are underway. We're currently developing new techniques and new support services for clients based on their employee mix and disparities that we are uncovering from within their respective organizations. Those insights are helping us to create new, tailored and intentional programs to recognize the specific problems that each specific client has. I think that this is really the strategy we'll be moving forward with for more and more clients.

Another important program that I think demonstrates how Optum Rx is really advancing health equity forward is with our network team where we're working with local pharmacies throughout the country that are really serving as point of care support services for patients.

Also, we also have a new program in place today in which we are actually providing social determinants of health assessments for patients to better understand what are the specific challenges that may be getting in the way of an individual trying to secure their medication. It may be because of transportation challenges. It may be because of food insecurity challenges. These social determinants of health assessments really provide the kind of insights needed to inform new strategies to support the members.

Lastly, at Optum Rx we also recognize how important it is for us to be intentional around diversifying the workforce. Optum Rx, in collaboration with Florida Agricultural and Mechanical University (FAMU), a historically black university in Tallahassee, Florida, recently established a new scholarship program to support students in the College of Pharmacy. One of the things I think is important about this commitment to supporting diversifying the workforce is recognizing that representation of minorities in the pharmacy profession is low, with limited access to funding for graduate pharmacy programs being a major barrier.

This effort by Optum Rx really speaks to the overall commitment we have to helping to realize health equity by being intentional around providing resources to the communities that we know are challenged. One of the things that I think we're really pleased about is that there's going to be about 15 students who are going to benefit from up to $100,000 to support their ongoing matriculation through the pharmacy program at FAMU. So, this is a key part of our overall strategy to advance health equity forward.

Scott: Sumit, you just spoke about the organization's work to encourage plan sponsors to use reasonable member cost share for lifesaving medications like insulin. What other programs or initiatives do you see Optum Rx putting into play here over the next several months?

Sumit: I think critical drug affordability writ large. We have made progress in insulin, as I've mentioned. Scott, you're my partner in this. Frankly, it’s you and your team that have done that and made it real.

We have also followed suit with our colleagues at UnitedHealthcare to focus on five critical drugs that include insulin, but also are drugs where making the copay affordable matters. Drugs like naloxone, which recently went over the counter, is a drug that treats overdose of opioids. We do not want there to be a barrier for people to get drugs like that.

I think the opportunity is continuing to expand that list and convince our clients that it's important to invest in their members that way. That really does require conviction. It requires convincing people, our clients, that it's in their members’ best interest to do it. Not always do we control all of the ability to make those decisions. Sometimes it's in our hands and sometimes it's in our clients' hands. When that's the case, our role is to be the advocate for the member. Again, thank you to you and your team to make that happen.

Scott: From my perspective, I think it's really inspiring to hear about the investment that the organization is making on this really, really important subject. To conclude our discussion today, I'd like to get each of your perspectives as to what type of role plan sponsors can play in helping to advance health equity. Corey, I'd like to begin with you.

Corey: Sure. I think it's really important for clients to take stock of some of the challenges that they may be facing from an employee standpoint, understanding where those patterns are. Are you able to, today, uncover disparities within your employee mix? If that's the case, I think our organization is willing and excited to work with you to help tailor solutions to resolve some of those health care challenges and chronic conditions that they may be facing.

I would also add that being intellectually curious around some of the challenges you may be having from a subpopulation standpoint. Why are there adverse health outcomes with certain groups? So, I think being really intellectually curious around that is a really great starting point.

As Dr. Dutta mentioned earlier, there are a number of really great books out there. There are people who dedicated their lives to this field of study. So, there are plenty of experts that can provide insights around how to move this particular body of work forward. But I would say know that you can always reach out to Optum Rx. We are a willing partner in position to help support the clients we serve.

Scott: Thank you, Corey. Sumit, what about from your perspective? What can plan sponsors do to help advance health equity?

Sumit: I think there are three things they can adopt as a framework. By the way, it's the same three that we adopt as a framework. Scott, you just sent me a biography on Robert F. Kennedy. It’s a fascinating book, and it was a hole in my reading of presidential biographies, so thank you. RFK really worked on voting right inequities. That was one of his causes. When he approached a problem, he did three things, the same three things I'd say to plan sponsors and I would say to my colleagues out there, too.

One is to understand the issue. To understand the issue is an active process. It's not a passive process. Scott, you know I have a love of travel and reading. I think what I really like is that those activities allow me to actively explore the cultures of people that are different from myself. If I don't understand what the situation might be like for someone else, then it's hard for me to have empathy. It's hard for me to understand that there's a problem. That's number one, understand, and we can help our clients do that.

Number two, we talk about visualization. It's using the data to prove a point, or maybe to increase your understanding, or even change your understanding. A data-driven approach is important. Understand, seek to understand. So, two is to visualize.

Three, maybe the most important part, is to take action. It's incumbent on us. Think of what RFK did relative to voting rights. After he understood the situation and had the data, he enacted policies to make changes. We rely on individuals. In this particular case, we at UnitedHealth Group are leaders. I rely on my colleagues that are listening to this to understand, to visualize and then to take action.

Scott: Thank you, Sumit and Corey. Your leadership in this space is so critical to closing gaps in health equity. 

For those looking to delve deeper into this topic, Corey Coleman recommends the following titles. 

• Health Disparities in the United States: Social Class, Race, Ethnicity, and the Social Determinants of Health by Donald A. Barr
• Just Medicine: A Cure for Racial Inequality in American Health Care by Dayna Bowen Matthew
• Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present by Harriet A. Washington