Elizabeth Colyer on State Level Takeaways From Sharecare's Flatten the Curve Survey

From a state-level perspective, Sharecare's Flatten the Curve survey highlights the negative impact of COVID-19 on respondents in states with typically high mental, financial well-being, as well as the lack of change in those within states already known for these negative tendencies, said Elizabeth Colyer, senior vice president of Community Well-Being Index at Sharecare.

Transcript

AJMC^®: The ShareCare Well-Being Index has always taken snapshots at the state level. What are some state-level findings that stand out?

Colyer: So, I'll give you 2, and again, not that we can say that these are representative of the entire state, but we had about 2000, on average about 2000 respondents plus per state. So, we felt good again, that a lot of this was covering a population for which these results would be significant. I think 1 was really in Hawaii, just an incredible amount of financial worry that we were seeing there. Really even seeing Hawaii top the charts when it comes to declines in physical behaviors like exercise was also incredibly surprising to us. Hawaii is our star from a well-being standpoint and always has been. They rank first in the country and have ranked first in the country or very close to it in many years, as well as in financial well-being, they also ranked number 1.

So, to see the significant amount of financial worry we are estimating or assuming at this point that some of that is based off of the travel industry, some of it is based off of the culture there, but, again, that's some of those juxtapositions, these areas, Alaska and Hawaii, where we see very much being our well-being stars to see that level of stark contrast and starting to see some of the highest levels of worry and changes in physical behavior—that was very profound for us, at least again, based off of our experience.

I'd say the other thing and moving kind of to the other end of the spectrum when it comes to if Hawaii is our star, I would say states like Alabama and Mississippi haven't necessarily been stars in previous well-being index rankings, typically ranking in the last quintile, or the lowest quintile when it comes to our rankings. We saw that within states like Alabama and Mississippi that respondents in those states were the least likely to have adopted an additional negative health behavior, which was interesting, right? Because you think about ranking well into the 40s in physical well-being, seeing low levels of exercise there, high levels of obesity, and diabetes, all the things that you think coincide typically with negative lifestyle behaviors, but what we recognized in the way that we had positioned the questions was that it was about well-being change.

So, we were asking people relative to what you do or what you normally do, are you doing better or worse? So, there's a lot of theories that will unwind as we explore community well-being more specifically for the rankings released this summer, but our current theory or hypothesis around that is that many of the individuals just haven't changed their behaviors. So, it's not that they're getting—it's not that respondents in the states are behaving the healthiest, it's just that maybe they've kept some of the negative health behaviors that they were already participating in before COVID-19, and that they just really haven't therefore had a lot of change since that time.

So, again, I think those were probably the 2 things, seeing some of our stars, really, seeing some stark issues there with mental well-being and physical well-being and then kind of in the lowest areas seeing a really broad view of less negative change. So, the question is, and again, this will only unfold as the rankings release, as we start to get closer to that this summer, is are we going to see kind of states sort of coming more towards the middle, where we don't have nearly as much of a range or variability across states, because some of those states who were doing very well maybe doing worse, and the states that are doing the worst may be staying much closer to where they are.

AJMC^®: We’ve seen that COVID-19 is hitting particularly hard among people of color and shining a light on social and income disparities. How was this reflected in the survey results?

Colyer: Yeah, so we were very specific in this first iteration, being highly consumer focused and wanting individuals to feel very safe in their responses. We didn't ask specifically about income, we didn't ask specifically about race, and that was by intention. That's something that we do, do in our Community Well-Being Index because we do want to make sure that it is nationally representative, which of course requires waiting against those variables; but we did look at certain criteria to see how—as proxies for whether or not some of the social needs in potentially lower socioeconomic categories, and I think the biggest thing that came about this was when we compared respondents who had no health insurance to respondents who were on Medicaid to respondents who had private health insurance. I'll just give you a few examples of that.

One was individuals with no health insurance, were 8 times less likely to seek care during COVID-19 compared to individuals on private health insurance, which again is not surprising, but I think it reinforces the importance of having insurance and being willing to engage with the health care system, which I think has only been exacerbated during COVID-19. The other thing we looked at was Medicaid and some of those health behaviors because the broad assumption at this point across many individuals in the public health sphere is that there's going to be a higher percentage of people on Medicaid after this who are going to need support from the government to receive health insurance.

When we compared individuals on Medicaid versus individuals who have private health insurance, individuals on Medicaid were twice as likely to seek care via the emergency room (ER), and they were about half as likely to indicate that they would seek care during COVID-19 via telemedicine. So, when we think to the future, and again, as we said earlier, Sharecare’s always looking to pair data with an intervention—we're starting to engage with Medicaid across several states, and so our goal is to ensure that we're using that data to truly contextualize how do we ensure that those groups that don't necessarily engage as much with the health care system because they don't have health insurance, or moreover, because they're on Medicaid–that we're meeting that user where they are, that we're educating them on the benefits and importance of things like telehealth. In particular, if you're in a rural context or you're in a family planning situation, ensuring that that is an outlet that starts to get adopted more broadly, within every context, but in particular within the Medicaid population. Then we're also educating on things like ER utilization, which we know have been very big drains on health care expenditure at large.

AJMC^®: Can you discuss the impact that COVID-19 is having on sleep, including some of the differences at the state level?

Colyer: Sleep among other lifestyle behaviors was interesting. I think we anticipated really, really big changes broadly across the population when it came to lifestyle behaviors, and I think sleep, like many of the others, we saw that the majority or the vast majority of respondents indicated that they were sleeping the same. However, when we looked at the percentage who were sleeping more versus less, which we know is generally good, but can also be an indication potentially of sleeping too much—we did see that 23% of respondents were sleeping less, while 77% of respondents were either sleeping more or the same. So, again, I think that is going to certainly have an impact on well-being at large. We know sleep is incredibly critical when it comes to everything from mental well-being to co-occurrences that we see with eating and exercise; but I think broadly, seeing that 77% of people have been able to maintain or sleep more based on COVID-19, I would say is a silver lining.

AJMC^®: How about healthy eating and exercise? What are we seeing in those areas?

Colyer: So, I'd say again, and it was surprising to us that, yes, there are people who are eating less healthy, and yes, there are absolutely people who are exercising less; but broadly, the vast majority of individuals, again, similar to sleep in those categories, indicated that they were either eating the same, or they were eating more healthy than they were before. Then the same thing with exercise. So, we saw that a lot of individuals indicated that they were the same, exercising the same, or actually exercising more and I think we looked at that not only when it came to just broadly—are you achieving these healthier lifestyle behaviors? Are you able to maintain the same? But we also looked at it for groups who work from home versus groups who don't work from home.

We saw that working from home there was a significant difference in individuals who are able to work from home and being able to achieve some of these lifestyle behaviors or moreover, potentially not exhibiting some of the negative lifestyle behaviors. So I think, again, at large, there has been a change in lifestyle. There is definitely a connection between those individuals who are experiencing financial stressors and seeing negative lifestyle behavior changes, but I think we were very impressed at least throughout the month of April as we surveyed these individuals that a lot of people were able to maintain at least their same lifestyle behaviors or improve them during this pandemic.

AJMC^®: How can someone participate in the survey if they want to share what's happening to them during the pandemic?

Colyer: Yeah, so the survey is still live on Sharecare. If you go to our COVID-19 hub, you'll be able to access the Sharecare Flatten the Curve survey, and we would absolutely love that feedback and to continue to keep the momentum going, A) to ensure that we're all continuing to do our part even as states reopen, but also to make sure that we're managing our physical and mental resilience. We know coming out of this with a strong population well-being is going to be incredibly important.

AJMC^®: When should we expect to see the next round of results?

Colyer: So, as the world evolves, Sharecare is also evolving. Our thinking relative to what are the most critical questions for us to ask populations. So, while the Flatten the Curve survey is absolutely something we're still analyzing and looking at, and again, to support optimizing against our existing protocols, as well as how we can bring packages together to bring people back to work safely; but I think the next generation of results is going to be kind of 2-fold.

One is going to be, again, shifting beyond just—are we flattening the curve? Because we knew that that was incredibly important, but also understanding people's state of mind when it comes to readiness to go back to work. So, that's a huge thing that we're evaluating right now as we pulled together an employer readiness package that really helps employers to better contextualize, A) what are their employees, key fears, requests, desires as they go back and they re-enter normalcy, ‘normalcy,’ but also, what are the tools and assets. Again, replicating some of what we've done. So that's a huge next piece.

Then, as we've discussed, another major sort of suite of results beyond just evolving these surveys to understand user needs immediately is going to be our rankings released this summer, again, that will both comprise what was our 2019 state of well-being pre-COVID-19, but then also, how have we seen well-being trend throughout the year, and what will that mean for us in the future. Again, as we know, the financial ramifications continue to be real when it comes to job loss, pay decreases, and company closures. So, I think, the summer will only be the beginning of continuing to analyze the impact that COVID-19 will have on our national well-being.

AJMC^®: Lastly, is there anything else from the results you would like to add?

Colyer: I think everybody needs a good message these days. So, beyond some of the silver linings we've spoken to about the percentage of individuals who have been able to maintain healthy lifestyle behaviors or maintain/improve their lifestyle behaviors—I think something that we were very impressed by was that in spite of 40% of respondents having canceled vacations, in spite of the massive amount of stress that we were seeing, over a third of respondents indicated that they were experiencing feelings of gratitude. I think as we move out of this pandemic, the concept of community, community driven care, community well-being, and leaning in and volunteering and really contributing to the next phase of our reopening–I think those feelings of gratitude are going to go a long way, again, in people's mental well-being and contributions that we make to others and to our communities.

AJMC^®: To learn more, visit our website at ajmc.com. I'm Matthew Gavidia. Thanks for joining us!