Understanding Health Disparities in Cardiovascular Disease

Strategically addressing disparities can improve health, lower costs

BRIEFING
April 12, 2022
Senior Medical Director, CVS Caremark
Chief Medical Officer, CVS Health

An American will have a heart attack every 36 seconds.Centers for Disease Control and Prevention. Underlying Cause of Death, 1999–2018. CDC WONDER Online Database. Atlanta, GA: Centers for Disease Control and Prevention; 2018. Accessed March 12, 2020.

Cardiovascular disease (CVD) is the leading global cause of death and accounted for approximately 18.6 million deaths in 2019.https://www.heart.org/-/media/PHD-Files-2/Science-News/2/2021-Heart-and-Stroke-Stat-Update/2021_heart_disease_and_stroke_statistics_update_fact_sheet_at_a_glance.pdf In the United States, CVD accounts for one in every four deaths, totaling 868,662 deaths in 2017.https://www.cdc.gov/heartdisease/facts.htm:

Coronary heart disease and heart attacks are among the 10 most expensive health conditions treated in the United States.https://www.heart.org/-/media/PHD-Files-2/Science-News/2/2021-Heart-and-Stroke-Stat-Update/2021_heart_disease_and_stroke_statistics_update_fact_sheet_at_a_glance.pdf Annual costs of CVD, including health care services, medicines, and lost productivity due to death, total $363 billion each year.Ibid.

Annual health care costs are approaching 20 percent of Gross Domestic Product in the United States.https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical#:~:text=U.S.%20health%20care%20spending%20grew,spending%20accounted%20for%2019.7%20percent. Addressing health disparities to reduce preventable disease is critical to helping reverse that trend. CVS Health has ambitious plans to establish a leadership position in health equity. A key goal is reducing heart health disparities by 2030. If we are successful, we will not only improve the health of Americans broadly but also help reduce costs for payors and plan members.

Disease burden and drivers of disparities

Patients who belong to underrepresented racial and ethnic groups confront more barriers to CVD diagnosis and care, may receive less optimal care and experience worse adverse outcomes than White patients.https://www.ahajournals.org/doi/epub/10.1161/JAHA.121.023650

Heart disease is the leading cause of death for Black, Native American, Alaska Native and Hispanic people, as well as for White men.https://www.heart.org/-/media/PHD-Files-2/Science-News/2/2021-Heart-and-Stroke-Stat-Update/2021_heart_disease_and_stroke_statistics_update_fact_sheet_at_a_glance.pdf

The burden of cardiovascular disease in Black communities is disproportionately high and is a primary cause of disparities in life expectancy between Black and White individuals. Approximately 30 percent of the mortality difference between Black and White men, and 40 percent of the difference between Black and White women, is driven by disparities in CVD outcomes.https://www.ahajournals.org/doi/epub/10.1161/JAHA.121.023650 It is 32 percent more likely that Black adults will die from CVD.https://www.heart.org/en/about-us/2024-health-equity-impact-goal/age-adjusted-total-cvd-mortality-rates-by-race-ethnicity

Reducing disparities in CVD can lower health care costs for all

People of color and other underserved groups experience higher rates of illness and death across a wide range of health conditions.https://www.kff.org/racial-equity-and-health-policy/issue-brief/disparities-in-health-and-health-care-5-key-question-and-answers/ The COVID-19 pandemic brought the issue of health equity to the fore by highlighting inequities and disparities among high-risk patient populations.https://www.jacc.org/doi/10.1016/j.jacc.2021.04.025 Black deaths from COVID-19 outpaced White deaths by nearly two to one; in the poorest counties in the United States, death rates were as much as 17.5 times higher.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8404537/#:~:text=Conclusions,racism%20in%20a%20given%20county.

Heart disease is the leading cause of death among every racial and ethnic group in the United States. An individual’s ability to access and use modern cardiac care and procedures may have profound implications for improving diagnostic precision, relieving symptoms and reducing premature mortality from heart-related conditions.https://www.kff.org/racial-equity-and-health-policy/fact-sheet/racialethnic-differences-in-cardiac-care-the-weight/

Further, high-value services from primary care providers – including preventive care such as nutrition counselling, smoking cessation and early screening as well as chronic disease management – are associated with fewer hospitalizations. However, when there are barriers to obtaining primary care, people are more likely to seek treatment in more costly care settings such as the emergency department.Ibid.

Health disparities lead to significant financial waste in the US health care system, which negatively impacts all payors. The total cost of racial/ethnic disparities in 2009 was approximately $82 billion — $60 billion in excess health care costs and $22 billion in lost productivity. The economic burden of these health disparities is projected to reach $353 billion in 2050 if the disparities remain unaddressed.Wyatt R, Laderman M, Botwinick L, et al. Achieving Health Equity: A Guide for Health Care Organizations. IHI white paper. Cambridge, MA: Institute for Healthcare Improvement; 2016. www.ihi.org/resources/Pages/IHIWhitePapers/ Achieving-Health-Equity.aspx. A

CVS Health’s unique integrated value

We believe that health equity means every person, regardless of personal characteristics or circumstances, should have the chance to achieve optimal health. At CVS Health, our retail footprint, health insurance and pharmacy benefit management capabilities give us a unique position in the marketplace to make a difference. We have guaranteed touchpoints with patients throughout their entire health journey, giving us the ability holistically to

  • Support patients throughout prevention, diagnosis and treatment optimization
  • Remove barriers to optimal health via omnichannel networks
  • Improve access to health and health care

Advancing health equity in CVD: Goals and focus areas

We are committed to preventing the number 1 cause of death in America through our unique ecosystem of resources.

To reduce disparities and improve health outcomes in CVD, our main goal is to increase initiation of therapy in underserved communities. To deliver on that goal, we have organized our efforts into four focus areas:

Education & awareness Testing & screening Access to care Treatment optimization
  • Steps to achieve optimal blood pressure
  • Blood pressure checks in the community
  • Connect to local options
  • Low-cost, free clinic availability
  • Optimal dosage
  • Adherence
  • Timing for second line therapies
Education & awareness
  • Steps to achieve optimal blood pressure
Testing & screening
  • Blood pressure checks in the community
Access to care
  • Connect to local options
  • Low-cost, free clinic availability
Treatment optimization
  • Optimal dosage
  • Adherence
  • Timing for second line therapies

Championing education and awareness: We’re focused on providing culturally appropriate education for condition management by crafting a wraparound community engagement strategy to engage with vulnerable populations through:

  • Physician engagement
  • Patient support groups
  • Community leaders, faith-based groups
  • Health systems and academic centers

Testing and screening: Once we identify at-risk communities, we work in conjunction with clients to increase access to testing and screening, beginning with those affected by cardiovascular disease and other conditions such as sickle cell disease and HIV. These conditions have a high disease burden among minorities and those impacted by social determinants of health that hinder access to care and treatment.

Through our Project Health initiative, we bring mobile health services directly to these communities, providing screenings for risk factors such as body mass index, blood pressure and total cholesterol. An estimated one-third of participants first become aware of a health concern or condition through these screenings.

Access to care: Once screened, participants are offered the opportunity to speak with bi-lingual nurse practitioners or physician assistants to help understand their risks and appropriate next steps. The nurse or PA will refer patients who require additional medical care and follow-up to no- or low-cost medical facilities nearby or to their primary care physician.https://cvshealth.com/social-responsibility/our-giving/community-support/project-health

Treatment optimization: Our approach is to find the most efficient, clinically rigorous path to care. This means not only identifying the most effective treatments for the lowest cost, but also looking at how we can best ensure adherence to those treatments.

We communicate health information and provide care that meets members where they are. For instance, we can deliver clinical support at locations — such as a local CVS Pharmacy or MinuteClinic — closer to their home. We can connect them to a certified specialist who they trust and help them utilize telemedicine and other digital tools — whatever is most likely to work for the member’s lifestyle and preferences.https://cvshealth.com/news-and-insights/articles/using-health-data-as-a-tool-to-correct-historic-health-inequities

The need for solutions to reduce racial disparities in clinical outcomes, coverage, access to clinicians and many other gaps in care is clear.https://www.commonwealthfund.org/publications/scorecard/2021/nov/achieving-racial-ethnic-equity-us-health-care-state-performance These efforts are just the beginning.

BRIEFING
April 12, 2022
Senior Medical Director, CVS Caremark
Chief Medical Officer, CVS Health
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