Measuring Health Matters: Our Path to Partnership

What if health plans were equipped to more fully support care providers treating patients? What if health plans could help them identify patients' most significant needs with evidence-based tools — tools that help care providers make point-of-care decisions in their patients' best interest?

What if health plans and care providers viewed the individual the same way: as a person with various conditions, unique social needs, and complex circumstances? Would improving the disconnect between care providers and health plans lead to better partnerships with the possibility of treating the whole person?

The disconnect in how care providers and health plans see each person can be devastating. Disparities in health and healthcare can arise from a range of factors:

  • Cultural differences
  • Structural racism
  • Predisposing risk factors
  • Comorbidities
  • Variations in quality of healthcare
  • Social needs, such as lack of access to healthy foods, reliable transportation, social isolation/loneliness, caregiving burnout, and safe/stable housing

Bringing together those factors and understanding their individual contributions is essential to improve the quality of healthcare and reduce inequities. The toll of the disconnect and the resulting health inequities are reaching a tipping point — and health plans and care providers must work together to resolve them.

The Consequences of Health Disparities

Looking at maternal and child health, among mothers with similar socioeconomic status and insurance coverage:

Black mothers:

  • >30% higher rate of preterm births than white mothers among Elevance Health consumers1
  • 3X more likely to die from a pregnancy-related cause than white mothers nationwide2

The more vulnerable those mothers are, the worse birth outcomes they face.

Health inequities impact many of our populations beyond differences in race and ethnicity. We observe notable variation in the incidence of cervical and breast cancer screening based on differences in body mass index (BMI). Those with a higher BMI have a 20% to 30% lower probability of receiving a screening.3

Additional health inequities can be found among persons with disabilities, who are often viewed primarily by their disability. There are 61 million Americans with disabilities.4

Research indicates that people with disabilities face discrimination and preventable health disparities:

Adults with disabilities

Adults with no disabilities

Obesity rate4



Diabetes rate4

16.3%(1 in 6)

7.2%(1 in 14)

Poverty rate5



In the labor force6



Adults with disabilities are 2.5 times more likely to report skipping or delaying healthcare because of cost.7

Impact of Health-Related Social Needs on Consumers

When whole health is defined by the relationship among physical, behavioral, social, and pharmacy factors, it is easy to see that everyone needs help with their health. The pandemic revealed a strong relationship between social and healthcare factors. In fact, 1 in 10 Americans are worried about recovering financially from the pandemic,8 and 1 in 4 lack reliable access to transportation.9 When these social needs go unmet, healthcare costs go up and health outcomes go down.

1 in 10

Americans are worried about recovering financially from the pandemic

1 in 4

Americans lack reliable access to transportation

Our consumers' experiences mirror the nation's, as evidenced by a recent survey completed in the Commercial and Medicare Advantage membership of our health plan affiliates. The assessment looked to identify the health-related social needs (HRSNs) these consumers experience. HRSNs include healthcare insecurity, lack of social support, financial strain, low-quality housing, food insecurity, inadequate internet, safety concerns, housing instability, and transportation barriers.

Integrating the social needs assessment with clinical and claims data, we now know that unmet social needs lead to increased healthcare spending — $1,497 per member per social need11 — and poorer healthcare quality, including increased emergency department visits and higher reported unhealthy days, as compared to those with no reported social needs.10 Synchronizing social care coordination with healthcare delivery improves health outcomes. In fact, patients with at least one social need removed are 1.7 times more likely to schedule and complete their annual primary care provider visit and 6.9 times more likely to have a better BMI score.12

Working in Partnership

We know care providers do their best to treat their patients, making critical decisions and providing the best care possible. Knowing that 80% of a patient's health experience happens outside of the doctor's office,13 much remains unknown for care providers and health plans regarding social circumstances and experiences that happen outside the care provider's purview and what a health plan captures in claims and clinical data.

Together, we have an incredible opportunity to start with a common, holistic view of a person's health, utilizing that view to identify solutions that address their most pressing needs. Assembling a person's entire health journey will help care providers make evidence-based decisions. Building the journey begins with understanding our consumers deeply. Then, we can understand not only their conditions, encounters, and circumstances, but layer them together and understand how they interact to make up the person's full experience.

Understanding the full journey requires measuring whole health. We know that consumers have unique and complex sets of conditions, different access to preventive care, and diverse social needs that greatly impact their overall health. To understand what those inequities are — the intersection of how their physical, behavioral, social, and pharmacy needs weave together — we've developed a tool, the Whole Health Index (WHI). This tool quantifies an individual's relative health and reveals their most critical needs.

How the Whole Health Index Works

Adopting the framework from the National Academy of Medicine's Vital Signs, the WHI incorporates physical, behavioral, and social needs into one score, equally weighted between social needs and clinical needs.

Factors considered to calculate a social needs score include:

  • Financial strain
  • Transportation barriers
  • Housing instability
  • Food insecurity

In contrast, clinical needs are scored based on the presence of clinical conditions and quality of care:

  • Access to care
  • Patient safety
  • Appropriate use
  • Chronic disease management

Each consumer is scored on a scale of 1 to 100, with a score of 100 indicating the best possible health, for example, no chronic conditions, staying up to date with recommended healthcare services, and living in an area impacted by fewer health-related social needs, while a zero score indicates poor health.

The WHI has been calculated for over 40 million people14 with one of our affiliated health plans across all lines of business, including Medicare, Medicaid, Dual-Eligible, and Commercial. It is used to assess an individual's overall health, identify opportunities to address different health status drivers, and advance efforts within the care delivery ecosystem to improve the whole health of our consumers and communities. It allows us to evaluate consumers' relative health over time and measure racial and economic inequities associated with their health.

The Whole Health Index in Action

Our Whole Health Improvement Now (WIN) program identified a cohort of health plan consumers with the lowest WHI scores, indicating poorest health and greatest social needs, and further segmented those individuals into groups. The WIN program has enabled cross-cutting partnerships between our health plan affiliates and care providers to use the data to understand clinical and social drivers of health and improve whole health across multiple touchpoints with health plan consumers.

With this focused approach offered to more than 150,000 health plan consumers and their families, we are seeking to help them improve their overall health and monitor this improvement using the WHI. When we examined this population in detail, we found the top four conditions, present in more than half the population, include:15

  1. Cardiovascular conditions (16.5%)
  2. Diabetes (13.3%)
  3. Musculoskeletal conditions (11.4%)
  4. Pulmonary conditions (8.4%)

Additionally, we found that over 40% experience more than one social factor, more than 22% care for someone with a disability or have a disability themselves, and more than 15% lacked consistent, reliable transportation.14 These examples illustrate the deep connection among the components of whole health: physical, behavioral, social, and pharmacy.

What's Next for the Whole Health Index

We continue to evolve and improve how we measure whole health. The next iteration of the WHI will allow us to get a deeper view and enable a multitude of strategies, including data collection enhancement, but also the development of social impact programs.

Recognizing consumers' inequities and understanding their clinical and social needs relative to a broader population is undoubtedly important. Still, we will make real progress when we utilize this data and insights, in partnership with care providers, to focus on the most pressing opportunities. The WHI enables us to take action by deploying strategies, programs, and interventions aimed at the right consumers, identifying evidence-based solutions, improving decision-making, and driving quality improvement, hand in hand, with our care provider partners.

Forward Together

Elevance Health is committed to better synchronizing all aspects of healthcare to drive measurable improvements in costs and quality. The WHI has allowed us to effectively assemble, measure, and begin to understand whole health. Its true potential lies in being able to partner effectively with our care provider partners to co-develop solutions and enable them to make evidence-based decisions to address an individual's most critical needs.

We will continue our efforts to help improve the quality of care, reducing health inequities and advancing healthcare affordability.

1 Internal data (2022). 2 Centers for Disease Control and Prevention, Working Together to Reduce Black Maternal Mortality (April 6, 2022): cdc.gov/healthequity/features/maternal-mortality/index.html. 3 Internal data (2022). 4 Centers for Disease Control and Prevention, Disability Impacts All of Us (October 28, 2022): cdc.gov/ncbddd/disabilityandhealth/infographic-disability-impacts-all.html#:~:text=61%20million%20adults%20in%20the,have%20some%20type%20of%20disability. 5 National Disability Institute, Financial Inequality: Disability, Race And Poverty In America (February 2019): nationaldisabilityinstitute.org/wp-content/uploads/2019/02/disability-race-poverty-in-america.pdf. 6 Bureau of Labor Statistics, Persons with a Disability: Labor Force Characteristics — 2021 (February 24, 2022): bls.gov/news.release/pdf/disabl.pdf. 7 Krahn GL, Walker DK, Correa-De-Araujo R. Persons with disabilities as an unrecognized health disparity population. Am J Public Health. 2015;105 Suppl 2(Suppl 2):S198-S206. doi:10.2105/AJPH.2014.302182. 8 CNBC, 1 in 10 Americans say they'll never financially recover from the Covid crisis: Survey (March 5, 2021): cnbc.com. 9 University of Michigan, Poverty Solutions, The Transportation Security Index (Accessed December 2022): poverty.umich.edu. 10 Internal data (2022). 11 Internal data (2022). 12 The Commonwealth Fund and KPMG Government Institute, Investing in social services as a core strategy for healthcare organizations: Developing the business case (March 2018): healthcarevaluehub.org. 13  U.S. Department of Health and Human Services. Community Health and Economic Prosperity: The Problem, the Causes, the Opportunities, and the Solutions—At a Glance (January 2021): hhs.gov/sites/default/files/chep-sgr-at-a-glance.pdf. 14 Internal data (2022). 15 Internal data (2022).