The 5 A’s of access for employer-sponsored healthcare 

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August 01, 2017

This post is part of a series on Value-Based Care.

In healthcare circles, there has been a resurgence of interest in what’s called the Social Determinants of Health, or SDOH, which seems correlated with the emergence of such concepts as Value Based Care, quality outcomes, population health management, and the personalization of healthcare. For costs to decrease and quality to increase, patients play an important role. They need to engage with their provider, comply with treatment protocols, and live a healthy lifestyle. And to do these things, their experience within the health care system needs to improve.

In thinking about what SDOH means for employer-sponsored healthcare, I go back to my roots in public health and,  in particular, to the research of its foundational thinkers: Donabedian, Penchansky, and Thomas. They provided an insightful view of the concept of “access” and how it intersects with the notion of SDOH.  Their work famously describes “The Five A’s of Access,” which include:

  • Affordability – Is the patient willing and able to pay the provider’s charges? In the employer-sponsored healthcare construct, this generally refers to ability to meet out-of-pocket expenses and costs before the deductible is met.
  • Availability – Does the provider have the requisite resources, such as personnel and technology, to meet the needs of the patient?
  • Accessibility – How easily can the patient reach the provider's location? This is closest to the traditional definition of access and is the centerpiece of an employer’s review of network access for the workforce.
  • Accommodation –The extent to which the provider's operation is organized in ways that meet the preferences of the patient; this would include things like hours of operation, telephone/digital communication options, and the patient’s ability to receive care without prior appointments.
  • Acceptability – The extent to which the patient is comfortable with the more immutable characteristics of the provider, and vice versa. These characteristics include the age, sex, social class, and ethnicity of the provider (and of the patient), as well as the diagnosis and type of coverage of the client.

My observation is that Acceptability is the critical element of access and drives many of the disparities in healthcare and health outcomes we experience in the US today. Yet this dimension of the access conversation rarely gets attention. Will an increased focus on SDOH and the social, economic, cultural, gender, and socio-economic impact of how healthcare is consumed shift the conversation in meaningful ways?

As plan sponsors and payers of the majority of costs associated with your workforce healthcare consumption, there are a few simple steps you can take to shine more light on this important issue:

  • What type of disparities in healthcare outcomes exist in my workforce?
  • How can I raise health literacy and health awareness in culturally relevant and appropriate ways?
  • Do the providers in my health plan’s network match my workforce needs in all dimensions of Access?
  • Can telehealth be a viable solution for my organization to create a better match with culturally and socially diverse providers?

Attention to these questions, in the context of The Five A’s of Access, can go a long way toward improving workforce health and organizational cost challenges. If ever there was a time to consider the implications of SDOH, it’s now.

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