Access Barriers to New Treatment Options may Compound Health Disparities 

It’s one of the few universal truths in healthcare: As science advances and our ability to treat medical conditions expands, healthcare becomes more costly. What’s less obvious, however, is that as new treatment options are rolled into the health plan, they may not be benefiting all members of the covered population equally. Employers need to take precautions to ensure health innovations don’t compound inequity and health disparity.

Broad population-based analysis and metrics can obscure variances in care among different groups in a population due to non-medical factors. Common contributors to disparity in medical care includes access and affordability (even within an employer-sponsored health plan), as well as cultural bias and intrinsic treatment bias among physicians. Research has shown that race, ethnicity, socioeconomic status and geography all can influence the care that individuals receive and their health outcomes.

One example of where disparity in access to innovative treatments is particularly problematic is with diabetes. The prevalence of diagnosed type 2 diabetes mellitus (T2DM) in the United States is highest among Black and African American and Native Americans, and lowest amongst White. Unfortunately, while individuals in certain groups are more predisposed to T2DM based on their race/ethnicity and social determinants of health (SODH), these same groups may also face greater challenges in seeking and obtaining the best treatment options. The latest clinical guidelines from the American Diabetes Association recommend expensive but effective medications called GLP1RA and SGLT2i for patients with cardiovascular comorbidities. But are these medications equally considered for all T2DM patients? Or will barriers of access and affordability make it less likely that those in lower socioeconomic groups will receive the most effective treatment? This doubled-edged disparity in disease prevalence and care access is common to many conditions.

Oncology is another area of concern, in which rapid innovation, care complexity, limited availability of qualified, experienced physicians and very high cost all converge to increase the risk of disparity. At any given point in time, the number of people within an employer health plan requiring cancer care is small, but the importance of each person having timely access to the best possible treatment options is paramount. How can an employer health plan sponsor ensure that newly diagnosed individuals have the same resources, the same access to qualified cancer specialists, are considered for any treatment option currently available (including clinical trials), and are able to afford the treatment?

Here are a few steps to consider for designing a health plan that reduces structural and process barriers to equal access and care:

• Quantify the risk and disease prevalence across an employer-sponsored health plan for various population segments.
• Assess disparities of disease prevalence by race/ethnicity, socioeconomic factors, or job roles.
• Review care patterns for these individuals via claims analysis to assess if there are unexplained variance in treatment, especially for costly or limited-access care. This informs the evaluation of plan design to address potential disparity in care that can be mitigated.

Disparity in care does not resolve or go away by itself. It requires awareness and a purposeful approach to identifying and addressing known disparities in care and requires a collaborative effort involving all stakeholders, beginning with the employer.