As social determinants of health become more ingrained in health systems’ and payers’ care strategies, there is a clear need for a new type of care network that accounts for the groups that have experience meeting social needs but may not necessarily be a traditional healthcare provider. In July 2019, Aetna and CVS Health announced a partnership with a platform that specializes in connecting patients to community organizations that provide addiction recovery, access to food, and transportation assistance.

Broadly, social determinants of health have a great deal of potential for improving medication adherence, helping patients avoid unnecessary readmissions, and supporting value-based reimbursement models. Aetna and CVS Health’s new initiative with the social determinant of health platform, Unite Us, show the other ways social determinants of health may change health care.

How the pilot works

Unite Us offers two key services: software that connects the participating healthcare providers and community groups, and assistance creating the network of community groups, which may include youth advocacy organizations, food banks, or public assistance transportation programs. In coordination with Aetna, Unite Us selects community organizations. Unite Us then centralizes the information on a single platform. Aetna case managers then use member data to determine who would most benefit from the services and reach out to patients.

“In this current phase of piloting [with Unite Us], we’re operationalizing the program through the Aetna case managers,” Aetna Business Strategy and Consumer Experience Leila Nowroozi said.  “CVS/Aetna and Unite Us will create the portal. Case managers will identify the special needs, and enroll the member in the Unite Us platform. At that point, the member can log into the portal and look at other services beyond the programs they may have initially signed up for [with the case manager].”

The patient’s primary-care provider and clinical care team may know that the patient is receiving these kinds of services, but physicians are not involved in the actual platform at this time, according to Nowroozi. Unite Us will allow Aetna and CVS to track outcomes, such as how often a member used resources through the Unite Us network, and if the utilization had any impact on health outcomes and the cost of care.

Not every person with an Aetna plan or a prescription at a CVS pharmacy will be able to benefit from the Unite Us network, at least not yet. At first, Aetna and CVS plan to roll out the program in select areas. Those enrolled in Aetna’s managed Medicaid plan in Louisville, Kentucky, will be the first to have access. Aetna has approximately 17,600 managed Medicaid members in Louisville, according to DRG data. Next, Tampa, Florida, and southeastern Louisiana will have the platform for Aetna’s dual-eligible special needs plan enrollees later in 2019.

Data integration

Unite Us’ experience working with Goodwill, Kaiser Permanente, United Way, Northwell Health, and the U.S. Department of Veterans Affairs has likely provided the vendor with a wealth of data on the effectiveness of certain social programs across demographics and regions. The partnership with CVS and Aetna will only amplify this organization’s influence and data trove.

CVS and Aetna may integrate the platform into their retail clinics, Nowroozi said. Should the retail pharmacy become a center where patients can fill their prescriptions, visit a MinuteClinic, and otherwise be connected to vital community resources, watch for large health systems and payers to follow suit.

Payer competition

Humana also has social determinants of health programs in Kentucky, Louisiana, and Florida. In addition to Louisville, New Orleans, and Tampa Bay, Humana rolled out its social determinants of health program, Bold Goal, in other parts of Louisiana, Florida, Missouri, Tennessee, Kentucky, and Texas. Humana’s program similarly partnered with community organizations to improve health outcomes, and Aetna and CVS may follow Humana’s path. As competition grows, payers may try to form exclusivity deals with influential community organizations—paving the way for a new type of narrow network. Watch for Aetna and CVS to follow Humana’s geographic path.

The partnership is another example of commercial payers spearheading the integration of social determinants of health into the managed care model: earlier in 2019, UnitedHealthcare and the American Medical Association announced they will work together to develop standardized ICD-10 codes that would correspond to social determinants of health. In other words, the systems needed to support connections between payers, providers, and community resources are being built, and the codes needed to communicate across stakeholders are in process.


How the pandemic has impacted the Federal Health Insurance Exchange in the U.S.

View Now