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By Megan Maltenfort, VP, Environmental, Social and Governance (ESG)

At Cardinal Health, we believe that everyone deserves access to high-quality healthcare. We know that by addressing health disparities and increasing equitable access to healthcare, we are building a healthier future for our employees, our customers and our communities.

What are health disparities? They are differences in health that are “linked with social, economic, and/or environmental disadvantage,” according to Healthy People 2030. These differences may occur because of income, education, disability, race, ethnicity, sex, age or various other factors and they put underserved populations at greater risk of poor health outcomes. They also create a great financial burden: A study funded by the National Institutes of Health (NIH) found that they cost the U.S. economy $451 billion a year – a combination of medical care, lost productivity and premature deaths among impacted groups.

With a health equity lens and targeted strategies, we are working to reduce health disparities and improve access to care to help improve patient health outcomes.

Advancing health equities among employees

According to a 2022 report from JP Morgan Chase’s Morgan Health, large health disparities exist across chronic conditions, maternal health and behavioral health, even among individuals with employer-sponsored healthcare.

To reduce disparities among Cardinal Health employees, we work with our health plans to improve employee preventive care and screening rates. For example, when we found that a significant number of employees at two of our Southern California facilities were not seeking preventive medical care, we worked with Kaiser Permanente to pilot an onsite mobile health vehicle and brought in a Spanish-speaking health representative to provide health education. Among the results was a 10.2% increase in breast cancer screening rates; the pilot also revealed an increased risk for heart disease among this employee population, which prompted us to provide more preventive education.

We encourage all employees and their covered family members to seek regular care to identify issues early, when they are most treatable. This year, we restructured our annual incentive program to promote a primary care physician relationship: Employees and covered spouses or domestic partners who complete a check-up with their healthcare provider during this calendar year will receive a discount on their 2024 medical premiums.

In addition, we offered reduced or flat premiums for most health plans, and focused on increasing affordability based on income level. We also introduced a copay health plan to reduce monthly premiums, and provided employees with information about how to choose providers based on both cost and quality.

Increasing healthcare access virtually: The pandemic caused rapid adoption of telehealth and proved that virtual care can reduce access barriers like lack of local or culturally competent providers or access to transportation and childcare, according to Harvard Law School's Bill of Health. So we have ramped up opportunities for our employees to access primary care, behavioral health services and musculoskeletal support online.

Ensuring access to mental healthcare: Among our employees, we focus on normalizing conversations around mental health issues, reducing stigma, and ensuring access to mental health support. Through a global initiative called MindMatters, we work to create a psychologically safe workplace where employees can talk about what’s happening in their lives. Here are some of the steps we’re taking to support employees’ mental well-being:

• Providing essential tools: Through online learning programs, we equip leaders with the skills they need to address employees’ mental health issues. In addition, employees have free access to Headspace, a meditation and mindfulness app.
   
• Encouraging use of our Employee Assistance Program (EAP): Our EAP is available to all employees; each member of an employee’s household (ages five and up) has access to eight sessions of free, confidential counseling per issue, per year. These sessions can be either in-person or virtual.
   
• Bringing on mental health professionals: Through our EAP provider, we have dedicated mental health specialists available to our workforce. They host trainings and video podcasts, and support each of our employee resource groups (ERGs) in creating mental health awareness sessions relevant to the ERGs’ constituencies.
   
• Training employees: All U.S. employees have access to Mental Health First Aid (MHFA) training to learn to identify and support anyone experiencing a mental health issue, and connect them with appropriate care. Employees also can take Question. Persuade. Refer. (QPR) training to learn to recognize the warning signs when someone has suicidal thoughts, offer hope and direct the person to proper help.

Helping customers provide equitable care to patients

We are steadfastly committed to helping our customers provide the best possible care to their patients. Through multiple Cardinal Health businesses, we support customers in providing equitable access to care for vulnerable patients.

Sonexus™ Access & Patient Support: Specialty medications hold the promise of better health outcomes, but they come with significant barriers. They are costly and often require clinical management, special storage, handling, administration and monitoring. Those patients who don’t have adequate health coverage and/or financial assistance are often excluded from these therapies. That’s where Sonexus Access and Patient Support comes in: Sonexus partners with biopharmaceutical companies to offer expertise and tailored solutions that help patients get on, and stay on, prescription medication therapy. In fiscal 2023, Sonexus supported more than 116,000 patients who have cancer, rheumatic diseases like osteoarthritis or rheumatoid arthritis, or other rare diseases.

The business offers patient assistance programs (PAPs) to uninsured or underinsured patients, and offers services that assist patients who are waiting on a response from their insurance company to get time-sensitive medication, if possible. In fiscal 2023, PAPs dispersed more than 1,650 shipments a day, totaling more than $5.1B in free medications.

In addition, Sonexus call center representatives, including a team of nurses, are trained to support patients, respond to their questions and help minimize their stress by providing education on what to expect as they go through treatment.

at-Home Solutions: Through at-Home Solutions, a medical supplies provider that serves people with chronic and serious health conditions in the U.S., we launched Velocare, an exciting new care model that intends to enable hospitals to provide hospital-level care to patients in their homes. Traditionally, a patient’s quality of care has been primarily determined by the quality of the healthcare system in the patient’s immediate area. The hospital-at-home care model aims to break down these geographic constraints by allowing a physician-patient relationship to exist without the two needing to be in the same place. Our goal is to help our customers provide the best quality care to patients regardless of where they live.

Velocare, a supply chain network and last-mile fulfillment solution capable of reaching patients within one to two hours with critical products and services required for hospital-level care at home, is creating critical infrastructure to make hospital-at-home programs work and grow.

We are currently supporting several health systems as they provide at-home, acute-level care to patients. Ultimately, we believe care at home can significantly advance equity, lower costs and improve patient outcomes.

Cardinal Health Community Health Center Pharmacy Services: Cardinal Health owns and/or manages the pharmacies at more than 60 Community Health Centers across the country. These are federally funded nonprofit health centers that serve medically-underserved populations, and provide primary care services, regardless of a patient’s ability to pay. With an onsite pharmacy, a clinic can expand services and improve patient care and health outcomes. An onsite pharmacist ensures that clinic patients can get their prescriptions filled easily and affordably; the pharmacist also provides education that helps patients increase medication adherence. As part of the clinic’s health team, the Cardinal Health pharmacy staff has access to patients’ electronic medical records (EMR) and has a full picture of the patient’s history, drug interaction and compliance.

Outcomes™: With a social determinants of health (SDoH) screening service, Outcomes™ helps pharmacists identify high-need areas among their patients and present local resources to help resolve gaps. SDoH include food insecurity, unstable housing, and lack of transportation, and can dramatically impact health outcomes. When pharmacists understand the challenges that their patients face, they can connect patients with community resources and better support them in medication adherence and overall health.

In a two-month pilot of the Outcomes screening service, pharmacists in 2,100 retail pharmacies screened more than 9,800 patients; those patients showed an average of $1,500 in decreased medical spending compared to patients who didn’t participate in the screening.

Note: The transaction merging our Outcomes™ business into Transaction Data Systems (TDS) was completed in July 2023. Operating as a single entity, in which Cardinal Health holds a minority stake and a board of directors seat, the combined offerings of Outcomes and TDS will empower pharmacies to offer better care, operate more effectively and achieve better clinical and financial results. 

Addressing inequities in our communities

The Cardinal Health Foundation is focused on improving equitable health outcomes in the communities where our employees live and work. By focusing on long-term outcomes and seeding programs with partners, the Foundation is helping to create permanent, positive change.

Advancing diabetes care: Diabetes is a costly issue in this country: The 2020 National Diabetes Statistics Report shows that 34.2 million people in the U.S. have diabetes, and costs associated with diabetes exceed $240 billion a year, according to the American Diabetes Association.

Addressing hunger, particularly for those with chronic illnesses, is a key priority of the Foundation, now a supporting partner of Feeding America. The Foundation’s food pharmacy initiative, called Food Rx for Health, is designed to help low-income patients with diabetes better manage their condition. Through this initiative, the Foundation funds community health centers to increase access to healthy foods among their diabetes patients and track the A1C scores of participants in the program. (A1C scores reflect a patient’s average blood sugar level; the higher the patient’s A1C score, the poorer their blood sugar control and the higher the risk of diabetes complications.) All participating health centers work together in a learning collaborative to support and learn from one another.

Establishing suicide prevention initiatives within healthcare systems: Nearly 46,000 people in the U.S. died by suicide in 2020, according to the Centers for Disease Control and Prevention (CDC). Many of those who die by suicide have had contact with a healthcare provider within months or even weeks of their death.

In fiscal 2021, the Foundation launched its Zero Suicide Collaborative, bringing hospitals together to implement the Zero Suicide Institute’s framework for system-wide transformation to prevent suicide among individuals in healthcare systems. Participating hospitals received a two-year Foundation grant, plus training and expert consultation from the Zero Suicide Institute to build a preventative health system. This initial cohort touched more than 1.4 million patients, and completed its grant-funded work early in fiscal 2023 with several positive systemwide changes.

In fiscal 2022, the Foundation evolved its suicide prevention program to focus on children and created Preventing Youth Suicide: A Cardinal Health Foundation National Collaborative with 17 children’s hospitals across the country. The Foundation has engaged the national Children’s Hospital Association (CHA) as a long-term partner in the Zero Suicide framework. By 2024, in partnership with CHA, the Foundation expects to have 40 pediatric hospitals participating in this work.

Advocating for our customers, their patients and our employees

Late last year, in response to our advocacy and that of many other organizations, Congress passed a bill called the Hospital Inpatient Services Modernization Act, which extends the COVID-19 public health emergency order waiving certain Medicare requirements for acute hospital care. This means that providers of hospital-level care to patients in their homes can continue to be reimbursed for it through December 2024, and advocates have until then to try to make the waivers permanent.

We continue to advocate for policies that address health inequities. We support legislation that would ensure that pharmacists can continue to be reimbursed for services they provide related to testing and vaccines for COVID-19, influenza, RSV and strep throat. This legislation would ensure the continuity of accessible pharmacy-based care.

We also have sent letters to Congress advocating against Medicare reimbursement cuts that would threaten access to care, and have urged the Centers for Medicare and Medicaid Services (CMS) to close gaps in coverage for Continuous Glucose Monitors (CGM) and other critical supplies for patients with diabetes.

As a member of the Healthcare Leadership Council (HLC), a U.S. coalition of healthcare executives, we participated in workshops that helped inform a report outlining measures to reduce health disparities. We also signed HLC’s Health Equity Pledge, acknowledging our long-term commitment to eliminating health disparities.

We know that increasing equitable access to healthcare is a journey. There is more work to be done, but we are making significant progress, and we remain committed to a healthier future for all.

With deep expertise, Megan Maltenfort, VP of ESG, is responsible for guiding a cross-functional working group of leaders from across the company in building and driving an ambitious enterprise-wide ESG strategy. Prior to joining Cardinal Health, Maltenfort served as Director of Corporate Responsibility & Sustainability at the Campbell Soup Company, where she co-led the creation of Campbell’s enterprise-wide ESG strategy; external corporate responsibility reporting; stakeholder management with investors, non-governmental organizations (NGOs) and customers; and more.