As a nephrologist in a clinical practice, Dr. Neema Stephens cared for patients with kidney disease, from diagnosis to transplant and beyond. “I noticed health disparities, and I felt like I could only impact the people within my reach,” Dr. Stephens said in a recent podcast for Becker’s Hospital Review, which you can listen to below.

Today, Dr. Stephens serves as Cigna’s national medical director for health equity – a role she describes as a phenomenal opportunity to effect change.

“We look at populations of people and are really involved in population health. There's a lot going on right now in health care today, but we pay very close attention to trends in mental health, maternal health, and basically any and all activity related to health equity.”Dr. Neema Stephens, national medical director for health equity at Cigna

Behavioral Health: A Rising Tide of Anxiety, Depression, and Loneliness

“We're seeing a huge surge in the rates of anxiety, depression, and loneliness,” Dr. Stephens said during the podcast. “The statistics are sobering.” One in three Americans has struggled with depression since the beginning of the pandemic in 2020, and 30% of Americans have developed an anxiety disorder. The number of Americans who say they have considered suicide has doubled since 2018.

While we’re seeing the impact on all age groups – from preschool-age children to adults – not all people are impacted equally, she said. “For example, young people who identify as LGBTQ+ have higher risk of mental health conditions.” There is an urgent need for mental health support in America, she said, and Cigna has a role to play to remove the stigma in seeking help.

She outlined some of the ways Cigna is working to reduce that stigma and making it easier to access care. For example, we are increasingly integrating behavioral health within our medical programs. “We're partnering with our health care providers to give them actionable data, so they can actively engage their high-risk patients, screen for depression, and then provide care coordination to behavioral health care services,” she said. In addition, we have developed a quick referral guide for providers that includes digital and virtual offerings and connects them with the behavioral health team at Evernorth, Cigna’s health services business.

Maternal Health: Racial Disparities Are Reflected in High Death Rate

“The U.S. has the highest maternal mortality rate among developed nations, and despite all that we spend on health care and all the advancements in medicine, our rates in maternal morbidity and mortality are actually going up,” Dr. Stephens said. “When you take a closer look, you'll find there are significant racial disparities.” The maternal death rate among Blacks is three or four times as high as among whites, and Native Americans are more than twice as likely as to die of pregnancy-related complications.

She also pointed to significant disparities in terms of infant morbidity and preterm births. To address that, Cigna has a pilot program that enrolls people early in their pregnancies in pregnancy care management programs.

“In addition, we have added an additional layer of support by screening for social needs,” she said. For example, if people lack access to healthy foods or transportation to and from appointments, the program connects them with appropriate services. In partnership with Express Scripts, we are able to ship to prenatal vitamins and other essential medications free of charge to the homes of program participants.  By implementing targeted interventions to individuals at highest risk, we strive to reduce preterm births.

Health Equity: Enabling the Best Possible Health for All

“At Cigna, we strive to ensure that all people – not just Cigna customers, but all people – have the opportunity to achieve their full health potential, regardless of socioeconomic status, regardless of environmental circumstances,” Dr. Stephens said.

She explained that Cigna has a data-driven strategy that allows us to identify health disparities in our patient population and identify root causes. We advance this work by enhancing solutions and benefits, collaborating with clients and health care providers, and expanding access to digital solutions while taking steps to reduce the digital divide.

“Now we're working to embed health equity into everything we do, and that includes training our workforce,” she said, which numbers more than 70,000 people.

This work has improved access to equitable care in a number of ways. For example, we updated our provider directory to make it easier for customers to find health care providers who are providing inclusive care for LGBTQ+ patients. We also enhanced our approach to medical coverage policies, incorporating a health equity review that has expanded access to treatments that will help improve health disparities. “One example, I'm proud to share is the bariatric surgery policy,” she said. “In the past, you had a universal body mass index [BMI] criteria for all people when they're being evaluated for bariatric surgery.” That changed when we learned that people of Asian descent were at elevated risk at a lower BMI. “We took the time to carefully research [this] and [ultimately] adjusted our coverage position.”

As another example, we’ve seen a surge of people in need of basic necessities like food and transportation, as well as problems maintaining housing. In response, our medical and behavioral case managers and health coaches are actively screening patients for social needs.

“This is an opportunity for me that I don't take for granted – to be able to really focus on efforts that promote diversity, equity, and inclusion, and to be able to be really focused on programming to reduce health disparities,” Dr. Stephens said. “It's been incredibly rewarding.”