Breaking the Cycle of Health Inequity
For health plans, building an actionable health equity plan requires treating the cause, not the symptom.
May 10, 2023

Health equity is more than a buzzword—it is a call to action—and an actionable health equity plan requires social AND financial support. There is no one size fits all solution.

Dismantling health inequity requires a hard look at why these disparities persist and also a multi-faceted approach to address the root causes. By doing so, health plans will achieve their desired quality goals and uplift their members to achieve healthier and happier lives.

How do health inequities persist?

First, we must address the distinction between health equality and health equity. When health plans use a health equality approach, the same practices and benefits are provided to every member regardless of socioeconomic status, racial demographic, etc. Equality is a wonderful approach if everyone had the same needs, but things are much more nuanced than that. Health Equity requires pinpointing precise areas of disparity and inequality on an individual basis. 

Equality treats the symptom, while equity treats the cause.

Illustrating Equality VS Equity by IISC

Health inequity doesn't start at the door of the doctor's office. Medical care itself only contributes to roughly 10-20% of health outcomes. The rest of the 80-90% are attributed to the Social Determinants of Health (SDoH) members face in their day-to-day lives, such as socioeconomic status, access to affordable and healthy foods, education, housing, and more. Additionally 40% of those health outcomes are attributed to individual behaviors as a result of a ripple effect from SDoH.

These ripples generate a cycle of health disparities that require the healthcare system to innovate solutions that will address the causes. 

Financial barriers to health equity.

Health care is expensive, totaling $4.1 trillion in annual costs. However, 90% of these costs relate to chronic illness and mental health; this means the cost burden of health care disproportionately affects people living with these conditions. 

Prolonged medication and care plan non-adherence costs patients and health plans $500 billion in avoidable utilization costs. And what happens when those medical bills start to pile up? Members may have to cut more corners, like deciding between refilling their medication or putting food on the table. 

In the US, 1 in 5 prescriptions are never filled, and of those filled, only 50% are taken correctly. 29% of adults report not taking their medicines as prescribed due to costs, and 12% have said they cut their pills in half and skipped doses to make them last longer.

The cost burden placed on low-income, chronically ill members feeds the cycle of inequitable care. 

Social barriers to health equity.

Financial and racial inequity in healthcare also creates systemic social barriers to adequate care. 

Health outcomes have a long history of being linked to racial and ethnic demographics and income level. In a study conducted between 1999 and 2018, Black individuals with low income continued to have the highest prevalence of poor or fair health status at 24.9%, while white populations with middle or high-income ranges had the lowest at 6.3%. 

Those who have faced discrimination based on income or a lack of insurance are 98% more likely to distrust their health plan. Additionally, members who have experienced discrimination based on race, ethnicity, or language barriers are 25% more likely to lack faith in the healthcare system. 

When there is a pervasive culture of discrimination and mistrust in healthcare, vulnerable populations will not be motivated to actively participate with their health plans. Social and financial inequities are intrinsically linked. Therefore one must be addressed in order to address the other. 

Turning metrics into action.

The industry has been abuzz with "health equity" and "social determinants of health" for years. Many regulatory and accreditation requirements have recently been put into place by organizations like CMS and NCQA to broaden demographic data collection and screening for social needs. 

Addressing these new requirements will help health plans collect data for Medicare Advantage Star Ratings and other quality measures. While this is an essential piece of the health equity puzzle, health plans have the opportunity to partner with programs that help plans do something with that data. The benefits of Wellth's approach to health equity provides specialized avenues of intervention and can bring greater returns to our partners while uplifting members' needs.

Reducing avoidable high-cost utilization by rewarding members and supporting their healthy behaviors.

Wellth works with members living with chronic conditions and motivates them to engage and follow through with their health care. Across partner programs, Wellth members have shown significantly improved health outcomes:

  • 42% average reduction in inpatient utilization
  • 29% average reduction in ED utilization
  • 16% average improvement in Medication Adherence 

For Medicare Advantage plans specifically, the results of prolonged program engagement also target significant Star measures (current and upcoming):

  • Controlling Blood Pressure (Increased to 3x weight for 2024 Stars)
  • Return of All-Cause Readmissions (increasing to 3x weight for 2025 Stars)
  • Introduction of Kidney Health for Diabetes measure (Implementing for 2026 Stars)
  • Medication Adherence Measures (Changing to continuous enrollment for 2026 Stars)

In Star Ratings 2027, the Health Equity Index will replace the Reward Factor to incentivize health plans to close health disparity gaps—particularly for those with certain social risk factors. A swift and actionable plan for social needs and racial stratification data will be integral to raising or maintaining Star Ratings. 

Happy members, happy health plans.

When members feel supported, they are more likely to trust and engage with their health plans. This often leads to better member satisfaction scores and greater member retention. 

"The best part of the program is that someone cares. I'm glad that my health plan took an interest in my health, and it gives me a little bit more interest in my own well-being. I have talked to people my age who are thinking about switching health care providers, and I give them my health plan's name and a five-star review." -Feedback from a Wellth Member.

With an average +75 Net Promoter Score (NPS), Wellth has proven that health plans can support their members in an accessible, encouraging, and helpful way.

Wellth is working to break the cycle of inequity.

Wellth's platform aims to target the cause of health inequities to improve how members interact with their health care. Wellth's program, built on the foundation of behavioral economics and paired with machine vision AI, creates a personal member journey that motivates members through incentives and social support.

Personalized member journeys as unique as each individual.

91% of Wellth members engage with the app every day. With every interaction, Wellth creates a personal and customized journey as unique as each member.

With keen social awareness and behavior learning, Wellth motivates members to engage with their health plans by fostering trust. Through transparency, listening, and timing, the Wellth program is able to optimize:

  • Reminders for Care-Gap closure activities
  • Sending easily digestible healthcare information
  • Sharing motivational and rewarding messages
  • Member surveys


These touch points are woven into the Wellth framework to ease access, provide clarity, and instill a sense of partnership and community.

When members need additional help or have stopped engaging with the app, a live support team acts as an additional touchpoint that can cater to an individual's needs with more nuance. 

"Wellth has been one of the best things to happen to me, and everyone at Wellth is so polite and leaves great messages. Also, getting the money is fun; it gives you something to look forward to. I feel like someone is looking out for me, and it makes me smile when life gets rough." -Paula, Wellth Member

Member incentives are member investments. 

Wellth uses rewards to bridge the intent-to-behavior gap members face with daily health behaviors, but the rewards also have another benefit: combating SDoH. 

Across all programs, Wellth members have primarily spent their rewards in areas of need, with nearly 60% spent on food and groceries alone:

Breakdown of Wellth member reward spending by category.

For some members, these incremental rewards have made the difference between being able to afford utilities and not. 

"Before Wellth, I always forgot to take my blood pressure medication. Wellth holds me accountable. I just used my rewards to pay a phone bill, which is really cool because I didn't have any money." -Suzanne, Wellth member.

Wellth's partner health plans contribute directly to members' communities through these rewards. Studies have shown that for each new dollar introduced into a community, there is an increase of $2.60 in economic activity. These contributions impact members' local communities, as 90% of everyday purchases are made within 20 miles of the home.

Incentivizing members generates benefits beyond a few extra dollars a month and creates a new ripple effect of improved health outcomes and community benefits.

Crafting an actionable health equity plan.

Innovation is effective when it addresses the root (the center) of a problem, not the symptom, and an actionable health equity plan addresses challenges where they begin—in members' day-to-day lives and in the challenges they face.

To craft a health equity plan that targets members needs, health plans can begin by:

  1. Taking the time to understand the unique needs of their members.
  2. Coordinating with benefits and programs that support those needs.
  3. Providing ongoing support and building meaningful relationships with members.
  4. Continuing to motivate members to stay engaged.

Wellth's multi-faceted approach to uplifting members through social encouragement and rewards enables health plans to address health inequity at the cause while helping deliver better health outcomes and improve quality ratings. 

At Wellth, our members are our mission, and we’re here to partner with health plans and providers to help break the cycles of inequity through direct action. 

Ask us how we are helping our partners address health equity with the Wellth program.