The Vulnerability Index

February 5, 2014 

TEDMED is a community that seeks to explore modern innovations and the future of health and medicine. TEDMED Great Challenges began in 2012 and is a platform for advancing the conversation about the greatest 20 dilemmas in modern health and medicine. To create the best and most unbiased dynamic, Great Challenges brings together leaders from all disciplines including researchers, doctors, scientists, entrepreneurs, government leaders, business executives, technology experts, patients, legal experts, representatives from the armed services and the media. Through an interdisciplinary approach, Great Challenges provides a forum to further the dialog surrounding complex issues in medicine.

The Vulnerability Index Discussion

Recently, TEDMED Great Challenges brought together a wide range of experts to discuss the issue of the Vulnerability Index, which is a way for insurers and employers to measure how outside influences like caregiving, financial troubles or marital issues affect health. These factors can make people more susceptible to chronic health problems from lower back pain to diabetes to mental health. According to the Eliza Corporation, the Vulnerability Index has three times the predictive power of self-reported problems or traditional methods.

The Panelists

Alan Blaustein is the founder of CarePlanners, a group that offers support and guidance to caregivers of aging loved ones.

Alexandra Drane is the founder of Eliza Corporation, an integrated health care communications strategist and publisher of the Vulnerability Index.

Joan Kennedy is a health advocacy leader for lifestyle management and chronic condition programs at Cigna.

Suzanne Mintiz is the co-founder and CEO-Emeritus of Caregiver Action Network and consults on caregiver advocacy initiatives in Washington, D.C.

Maryann Sterling is the co-founder of Connected Health Resources and principle at Sterling Health IT Consulting, where she works on improving how patients and caregivers navigate the health care system.

Key Insights

The Vulnerability Index found:

  • Health conversations, which often revolve around health problems such as diabetes or heart disease, should be expanded to include outside stressors.
  • Many people who need medical procedures like mammograms or better management techniques for diabetes simply can’t prioritize their own health because of extenuating personal circumstances like divorce, health care or job loss.
  • Health care companies do not traditionally address problems like divorce, job loss or life stressors despite the recognized impact on health.

In order to quantify the effect these non-tangible factors have, the Vulnerability Index uses an algorithm to assess how caregiving, financial stress and relationship stress affect health. The report also takes into account different coping strategies, including “buffer” coping mechanisms such as a strong network of peers, the ability to calm yourself and exercise. It also considers how “magnifier” mechanisms such as trouble sleeping, being sad or worried, or substance use affect individuals.

The Importance of Outside Stressors

  • Outside factors that can affect health include relationship problems, financial issues or family concerns.
  • Oftentimes, these “personal problems” are issues that employers are not comfortable discussing at work.
  • Caregivers are three times more likely to be highly vulnerable to health issues than non-caregivers. These health problems include immunity deficiencies, diabetes, back pain and mental health issues.

How Companies Are Using the Vulnerability Index

  • Insurance companies are starting to recognize the importance of treating both health issues and the “unmentionables.”
  • Companies like Cigna have used the Vulnerability Index as a guide to create pilot programs and reverse-engineer established programs so they specifically address outside stressors. The goal of such programs is to identify problems that employees are dealing with and then create a portfolio of programs, either through Employee Assistance Program (EAP) benefits or pilot programs, to address outside stressors.
  • EAP — in addition to having a negative connotation — is limited in resources and sometimes serves better as a crisis management point. Companies should instead partner with local agencies that can address the financial, emotional and physical stress of caring for a child or parents.

Providing Caregivers with Better Support

The success of an employer-sponsored program depends on individual managers and the attitudes they express towards caregivers and the stress they deal with.

  • To de-stigmatize these issues, upper management should make it clear that they recognize the importance of dealing with outside stressors and encourage employees to seek help.
  • Management should work to be equally sympathetic to the stresses of eldercare as they are to childcare.
  • Employers should create programs that connect caregivers to other caregivers to alleviate feelings of guilt or loneliness.

The Bigger Challenge

Outside of pilot programs and resources, there exists a need for a culture change in how the country looks at caregivers. The caregiver is an integral part of the team and must be included in the care plan. Additional support could reduce some of the stress and guilt associated with caregiving. It is a challenging job, and the Vulnerability Index could act as a catalyst for big and small changes, both in the workplace and in the world at large. 

MPH@GW, the online Masters in Public Health at GW, is proud to support the Great Challenges Program at TEDMED, funded by the Robert Wood Johnson Foundation. Through weekly dialogs with TEDMED’s intellectually diverse community, we move toward a more meaningful understanding of the Great Challenges of Health and Medicine. Click here to learn more about the Great Challenges Program. To share your ideas, join the discussion at #GreatChallenges.