The role of health equity in improving medication adherence
Why health plans and providers need to address social determinants of health like food insecurity to improve member outcomes
April 15, 2021

The COVID-19 pandemic has increased media coverage and heightened awareness of the health inequities many of our communities face. 

With roughly 74.7 million individuals losing work, 24 million adults experiencing hunger, and over six million people reporting fear of eviction or foreclosure due to inability to make housing payments—social determinants like food insecurity are becoming a more real threat for many. 

Unaddressed, food insecurity can lead to many chronic conditions later on—and exacerbate existing conditions. 

The prevalence of food insecurity across America’s patient populations

The COVID-19 pandemic has negatively impacted households across the country—with charities and food banks functioning at maximum capacity. In 2020, 80 percent of food banks reported serving more people than in 2019, and 40 percent of those visiting were coming to a food bank for the first time. 

Medicare and Medicaid populations have been especially impacted, making it critical for plans to anticipate these needs and provide support in identifying and addressing food insecurity in their members. However, it’s important to recognize that while COVID-19 has brought food insecurity to the forefront of our minds, its prevalence was a problem long before the pandemic ever hit. 

The scope of food insecurity pre-COVID-19

In 2019, one in ten families lacked access to nutritious food. Breaking down this statistic, the Feed America organization shows that number represents 35.2 million people, 10.7 million (or 1 in 7) children. 

Understanding this, it becomes clear that even when businesses and economies reopen, the startling food insecurity rates observed during the pandemic will not evaporate overnight. One 2019 study found that 64 percent of Americans are unprepared to cover a $1,000 emergency without going into debt or reducing expenses. Further studies have shown that, in households making $35K a year—or roughly 30 percent of the U.S. population—47 percent of adults were behind on housing payments and 25 percent were struggling to put food on the table.

Source: Ramsey Solutions

For Medicaid and Medicare populations, those numbers are even more significant, with early 2020 studies at the onset of the pandemic showing that one in four Medicare beneficiaries have less than $8,500 in savings. In addition, Medicaid enrollment showed a 10.8 percent increase during the pandemic—or an increase of 7.7 million individuals. 


The health impact of food insecurity

When examining the impacts of food insecurity on long term health outcomes, the difference between calories and nutrition becomes crucial. 

For example, while a family struggling with food insecurity may have the means to buy cheap calories (say… a four-item-for-$4 value meal at a fast food chain), scrounging up the money for a nutritious meal that provides needed vitamins and nutrients for health is a different story. 

As a result, these individuals face personal daily “food deserts” that deprive them of the nutrition they need to be healthy. Over time, this deprivation leads to development of chronic conditions strongly-linked to lifestyle, such as type 2 diabetes, cardiovascular disease, high blood pressure, CKD, and more. In addition, food insecurity has been linked to poor medication adherence, with one study published in SpringerLink stating:

Food insecurity and housing instability most consistently impacted medication adherence. Although included studies were heterogenous and varied widely in SDH [social determinants of health] and MA [medication adherence] measurements, adverse social determinants overall were significantly associated with lower MA. The relationship between SDH and MA warrants more attention and research by health care providers and policymakers

The financial impact of food insecurity on healthcare

For the healthcare system, such chronic conditions end up being costly. According to the CDC, 86 percent of health costs annually are spent on chronic disease. Of these diseases, 70% are preventable. 

Simply providing access to fruits and vegetables can go a long way in managing and ultimately preventing these chronic conditions, as a recent Tufts University study shows. And in preventing these conditions, not only do we build healthier communities, but initial pilot results showed that by simply subsidizing the cost of fruits and vegetables, healthcare organizations could save $40 billion in care costs. If programs were expanded to include other health foods, the savings could exceed $100 billion. 

While the healthcare system may not be quite ready with a solution that allows prescription vegetables, health plans and providers can start to address the issues of food insecurity and its impact on medication adherence and health outcomes by implementing programs that increase access to healthy foods.

Improving medication adherence and health equity by addressing food insecurity through member reward programs

Implementing reward programs like Wellth that offer financial incentives for improving care plan adherence and completing key health-related tasks allows health plans and providers to give back to their members meaningfully while improving medication adherence. It simply comes down to three key components:

Behaviors need to be trackable 

Tracking member behavior needs to be quick, easy, and accessible for patients—regardless of their socioeconomic status—to be effective. 

For example, using a simple smartphone app that works with their existing phone (and providing other options for those without a smartphone) increases the likelihood of member engagement by lowering barriers to participation. From that app, members can receive customized notifications, motivational nudges, and satisfying “congratulations” messages that keep them engaged and checking in to log their medication and care plan adherence daily. 

Life needs to be accounted for (the importance of behavioral economics)

Oftentimes, prescribed medication and care plans are built on assumptions that the member will follow-through with the prescribed tasks. Unfortunately, that assumption is often untrue. More often than not, these individuals face unique challenges in their day to day life that compound to prevent them from following their care plans and taking medications as prescribed—even if they truly want to.

This intent-behavior gap is critical to address and solve for to achieve the high levels of adherence, which is why platforms like Wellth that leverage behavioral economics have high rates of success—achieving an average of 90.1 percent care plan adherence.

To learn more about behavioral economics, download our ebook

Rewards need to be flexible

The most impactful rewards programs will be those that allow members the flexibility to use their financial incentives for what they want while adding parameters to guide decision making toward necessities. This means avoiding gift card-like rewards—that limit where the member can redeem the reward—as well as cash equivalents, which could be lost on alcohol, street drugs, or lost on internet and phone scams. 

Wellth rewards are flexible—allowing members to spend them as needed on food, rent, utilities, gas, prescriptions, gifts and more—while maintaining certain safeguards that protect members from fraud.

What’s more? Even with this freedom, an overwhelming majority of members are still spending their rewards on food and groceries. 

  • 68 percent of Wellth rewards are spent on food and meals
  • 7 percent are spent on vehicle maintenance and fuel
  • 5 percent are spent on home repairs
  • 20 percent are spent on miscellaneous costs, including prescription medications, utilities, clothing, gifts, and more

The impact that these rewards—though seemingly small—have on members food security is significant. As some Wellth members share: 

“Wellth is a good program because it reminds you to take your pills and it’s really important for us elderly people to do that. It really helps to know that the Wellth rewards are there at the end of the month, almost like a safety net, and that I can use it for groceries, gas or medication.”

“The financial rewards helped me a lot also. I am part of a low income population. We work so hard every day for a basic salary. It is hard to be able to afford many things. We need to pay for  rent, electricity, food and medications. With the rewards I received, I was able to buy shampoo, soap, some groceries, and vitamins. I feel that it is really beneficial to have this kind of program available for us since it creates healthy habits for us and at the same time helps us have a better quality of life.”