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Three Strategies to Combat the COVID Determinants of Health

November 05, 2020

By Sara Ratner, senior vice president, Government Markets & Strategic Initiatives, Revel Health

sara ratnerThe health care industry has adopted a greater acceptance of and a focus on Social Determinants of Health (SDoH). SDoH edifies the importance and impact of influencers and conditions, that are not health care related, on health outcomes such as where someone lives, learns, works, and spends time. The current unprecedented pandemic has exacerbated SDoH in unimaginable ways. Catalyzing a new and destructive trend, COVID-19 has produced newly defined COVID Determinants of Health (CDoH). Like SDoH, CDoH predominantly focuses on conditions influencing health outcomes that are not related to health care; however, CDoH further overlays these outcomes and risks with unique COVID-19 variables.

CDoH Trends

The CDoH implications are staggering and Revel is tracking emergent trends leveraging advanced analytics and artificial intelligence. One of the fundamental themes observed and studied is an unprecedented level of care avoidance, resulting in a consistent decline in vaccinations and preventive screenings. Our data, commissioned from The Harris Poll, highlights that only 49% of parents with children under age 18 reported a willingness to take their child to a well-child visit and/or vaccinations scheduled during the pandemic, leaving more than half of parents classified as “avoiding care.”1 Underlying the care avoidance predication is the uncertainty of the new processes (logistical), fear of creating and exacerbating health risk (personal), and fear of putting a loved one at risk (emotional). This health care trend is alarming and acute since, according to Scientific American, compared to 2019, monthly national vaccination rates are consistently down with some states nearing a 60% decline.2 Formidably, 50% of the missed vaccinations are for children.4 Because of this, data highlights the significant reduction in non-influenza and measles vaccinations.5 The impact of missed milestone vaccinations, particularly for children, lies in on our inability to quell disease spread while navigating the evolving epidemiological evolution.

The pandemic has also curtailed and precluded cancer screenings with an estimated 420,000 canceled or missed breast cancer, cervical cancer, and colon cancer screenings.3 Clear implications of declining appointments include rising costs and spending, as well as adverse outcomes by dint of deferred or cancelled treatment contributing to an increase in rates of undetected cancers, diabetes, and kidney disease.6 The ramification of unchecked and unmanaged conditions could lead to missed diagnoses and prevention opportunities, and potentially severe progression of certain conditions. Altogether, the impact of delayed appointments for important milestone vaccinations or for chronic health conditions hinders the prevention and mitigation of serious chronic conditions prevented with a vaccination or preventive screening. 

Three Strategies to Address CDoH

Understanding market trends depends on a greater insight into why members are deferring or cancelling care and the barriers that hinder health action. Member barriers are unique and personal; accordingly, a uniform approach enabling health action is ineffective. Here are three key strategies to manage and address CDoH. 

Use Personalized Member Messages to Incite Action

Health care, and the reason for foregoing care is personal. Influencing decision-making and action results through understanding individual barriers and building corresponding personal messaging. However, a generalized approach will compromise and impede success without consideration for individual beliefs and barriers formed through personal experience. 

Reduce Emotional and Logistical Barriers Without Trying to “Fact” Members Into Action 

A common misconception is that flooding people with facts influences belief and behavior change; yet, affecting change is achieved by appealing to emotions and personal belief systems. The desire to act must outweigh its barriers. COVID-19 has exacerbated existing barriers and even created new ones, with the data edifying that emotional and logistical barriers are two of the top cited reasons for delaying care. Fear is highly influential to many members avoiding care throughout COVID-19 with the conception that going to the doctor increases the likelihood of contracting COVID-19. Messaging that embeds emotional awareness and understanding is critical in driving health action.

For example, antivaxxers are typically well-informed, but emotionally rationalize their perspective with fear deriving from a potential adverse reaction. Members who avoid care due to emotion positively receive messaging where it fundamentally appeals to emotional triggers. Logistical barriers are also cited as a reason for avoiding care throughout COVID-19. For example, members can be wary about the flu shot with new protocols, lack of information, and changed access points. Thus, messaging should address logistical questions by focusing on where to go, newly developed processes upon arrival, and the overall experience.

Build a Multi-Channel Communications Approach 

Revel has discovered that using only one communication channel (such as email) produces only a 30%-member reach rate. Multi-channel communications help ensure a nonabrasive experience and accurate matching to a member’s communication preference. Our data reveals seniors, ages 60-to-70 years old, are the most likely age group to engage via text messages. It is important to understand each member’s needs and motivations to cultivate personal connections. Simply utilizing an invariably universal channel approach handicaps maximum member reach and activation. Personalization is central to matching communication preference and paramount in reaching members. This approach minimizes abrasion to accelerate and improve complete member engagement.

Communicate & Combat CDoH

While the pandemic has entirely upended life, it has personally, emotionally, and logistically reinforced and amplified health care barriers. More than ever before, and recognizing CDoH’s influence, it is crucial that health plans educate and inform members in personalized ways to keep them healthy. Without customized, multi-channel communications driving health action, health care will be constrained in ways antithetical to the demands aggravated by the COVID-19 pandemic.

More About Sara Ratner

A proven leader in the health care industry, Sara Ratner was the CEO of HealthEHR where she helped venture-backed organizations develop Medicare and Medicaid program strategies for emerging markets leveraging CMS and state frameworks to generate opportunities for program development and expansion. She has also served as SVP, corporate systems and compliance at RedBrick Health, President of NeoPath Health, and as general counsel, VP of Strategic Partnerships and Human Resources at CVS CareMark (MinuteClinic division). Sara serves on several boards of directors, including Proximal Health, a venture-backed health insurance company that she co-founded; she has also previously served on other for-profit and nonprofit boards of directors. Throughout her career Sara has received notable awards such as the Business Journal Top 25 Women to Watch, Top 40 under 40, and was named part of Twin Cities Business Real Power 50. She earned a BA, cum laude, from Washington University in St Louis, and her JD from St. Louis University graduating magna cum laude.

To learn more about Sara’s career path, listen to her podcast interview on So You Want to Be a Healthcare Executive?


  1. Mitigating the Spread of COVID-19 Determinants of Health [white paper]. September 24, 2020.*           
  2. Scientific American. Vaccinations have Sharply Declined Nationwide During the Pandemic.  covid-19-pandemic/.
  3. Epic Health Research Network. Delayed Cancer Screenings—A Second Look. Published July 17, 2020.
  4. The Guardian. risk-of-exposure-to-covid-19.
  5. Centers for Disease Control and Prevention. Effects of the COVID-19 Pandemic on Routine Pediatric Vaccine Ordering and Administration—United States, 2020. May 15, 2020.
  6. Canary Foundation. Early Detection Fact Sheet.

*The Harris survey was conducted online within the United States by The Harris Poll on behalf of Revel Health from August 25-27, 2020 among 2,067 U.S. adults ages 18 and older, among whom 792 are parents of children under age 18. This online survey is not based on a probability sample and therefore no estimate of theoretical sampling error can be calculated. For complete survey methodology, including weighting variables and subgroup sample sizes, please contact

Revel and NovuHealth merged on October 1, 2020 to become the leading technology platform company focused on healthcare member engagement. The Revel + NovuHealth platform delivers best-in-class, personalized healthcare loyalty programs with breakthrough applied behavioral research and health action technologies. Headquartered in Minneapolis, Revel + NovuHealth deliver personalization at scale for the most trusted healthcare organizations in all 50 states, including seven of the 10 largest health insurers and representing 65% of all members in government programs such as Medicare and Medicaid. Learn more at

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