Sree Chaguturu, MD, Senior Vice President, CVS Health and Chief Medical Officer, CVS Caremark
Health disparities are a longstanding systemic challenge — made all the more apparent by the pandemic, given its disproportionate impact on the most vulnerable. Disparities are preventable differences in access to care or outcomes that differ significantly between two populations. These preventable differences can be driven by factors like race or ethnicity, sex or sexual identity, geography, or socioeconomic status.
Health disparities not only take a toll on individuals and disadvantaged populations, but also place cost and resource burdens on the health system in ways that magnify their effects on all of us. As the pharmacy benefit provider for one in three Americans, CVS Caremark has a unique opportunity — and a responsibility — to do what we can to help close these gaps.
It’s not enough to know what disparities people or where they live but have a plan for how we are going to approach it. To do this, we have to better understand not only what disparities people face, but also where those impacted by inequities live. We combined more than 400 data points from public sources including the U.S. Centers for Disease Control and Prevention, the U.S. Census Bureau, and others, with our own prescription claims data to identify what gaps in care exist, and where. For example, our data analysis shows that people suffering from cardiovascular disease in disadvantaged populations are less likely to initiate treatment, and when they are on therapy, are less likely to be on a dosage optimized to help them meet their blood pressure goals.
Armed with this information, we’re using our deep ties in communities across the U.S. to directly address barriers to health equity, beginning with an approach that focuses on:
Ensuring awareness and availability of health education resources
Increasing testing and screening for chronic diseases
Improving access to health services
Targeting and optimizing treatment interventions
We can also develop health equity strategies for those who are at-risk and collaborate with partners in those communities to deliver interventions that are tailored to the specific inequities they face.
For instance, Sickle Cell Disease (SCD) is a life-long genetic condition that can have what is called in health economics a ratchet effect — a downward spiral of impact that can be difficult to reverse once set in motion. In the U.S., about 1 in 350 to 400 African Americans have SCD, and about 1 in 13 people are are born with the sickle cell trait, meaning their children could be at risk of acquiring the disease. In all, about 100,000 people in the nation are estimated to be living with the disease. Disorders like hemophilia and cystic fibrosis that each affect fewer than half the number of people in the U.S. with SCD, receive much more research funding
In some areas, the number of people with SCD has doubled because many people who carry the trait are not aware of it. The frequent painful episodes caused by the disease can be treated by hydroxyurea, an easily available, low-cost medication that can help people better manage their condition by reversing the sickling of blood cells, which left untreated, can lead to life-threatening complications. And yet, more than 75% of adults with SCD
Working with local and community organizations, we aim to double the number of people on hydroxyurea and increase trait testing to help patients make more informed decisions and prevent additional adverse events.
This is only one of many steps and one of many goals in addressing health disparities. No one company or group can fix this alone — but we can continue to work with local community organizations and advocacy groups to ensure those facing health inequities have access to the resources and care they need. By putting our data into action, we can understand where the greatest risk exists and implement the right interventions to prevent the challenges of the pandemic from further impacting care in these communities over time.