News and Insights

PerformRx Clinical Programs Can Help Identify and Address Member SDOH Issues

December 13, 2023

According to the World Health Organization (WHO), social determinants of health (SDOH) are the “non-medical factors that influence health outcomes.”1 Healthy People 2030 explains SDOH as

The conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.2

SDOH can significantly influence health care inequities, as well as outcomes. Generally speaking, health and wellness correlate to income – the lower the socioeconomic position, the worse the health.1 In the United States, it has been estimated that 68% of individuals have at least one SDOH challenge.3

PerformRx has developed drug therapy management (DTM) programs focused on optimizing medication regimens, improving member outcomes, and ensuring access to appropriate care. These programs also help assess and screen for SDOH. A key component of many PerformRx DTM programs is a holistic comprehensive medication review (CMR). PerformRx CMRs are interactive, in-person, or telephonic consultations, conducted in real time between the patient and/or another authorized person and the pharmacist or nurse. The goal of PerformRx CMRs is to:

  • Improve patients’ knowledge of their prescriptions, over-the-counter (OTC) medications, herbal therapies, and dietary supplements.
  • Identify and address problems or concerns that patients may have.
  • Empower patients to self-manage their medications and health conditions.

PerformRx DTM programs are pharmacist-led to leverage the unique training and knowledge of clinical pharmacists, as well as their position on the member’s health care team as the medication experts. In addition to reviewing and answering questions about medications, PerformRx pharmacists can identify SDOH barriers a member may face and help close any gaps that may exist.

During a CMR, if the interviewing pharmacist identifies an SDOH issue that falls outside the scope of DTM, she or he can create a referral to the patient’s plan care management team to notify them of the issue. This ensures that optimal care and resources are provided to the patient, addressing issues that might otherwise remain unreported or unresolved.  

To help address SDOH barriers, PerformRx has developed and continues to enhance SDOH interventions as part of its clinical program.

Below are two recent case studies of members whose SDOH issues were addressed with help provided through PerformRx’s clinical programs.

Telephonic member outreach program: SDOH issue identified during CMR

In March 2023, a PerformRx pharmacist initiated a CMR by phoning a member who had recently been discharged from the hospital following knee surgery. During the CMR conversation that followed, the member mentioned that she had recently applied for a meal-delivery program through her health plan, but had not received any deliveries and was anxious to know the status of her application.

The pharmacist flagged this issue as a barrier for the patient. After the call, the pharmacist created a case-management referral for the member’s health plan, in accordance with internal PerformRx workflows. The referral notified the plan’s case management team that the member needed assistance with her meal-delivery program.

To further ensure coordination of care between PerformRx and the plan’s case management team, the PerformRx pharmacist performed an additional follow-up on the referral 30 days later. The pharmacist was happy to learn that the plan’s case management team had contacted the member, resolved the delay, and that she was now enjoying regular meal deliveries. In addition, the health plan had proactively scheduled further follow-up with the member to ensure continuing delivery. 

Meeting members where they are at: A community SDOH intervention

For 2023, PerformRx has integrated SDOH assessments into its retail-level medication therapy management (MTM) program in partnership with OutcomesTM. This program prompts retail pharmacists to offer appropriate members an SDOH assessment based on the Accountable Health Communities (AHC) Health-Related Social Needs (HRSN) screening tool. For this example, the community pharmacist consulted the patient’s electronic account and was prompted to offer them the HRSN screening tool, which the patient accepted.

After the patient completed it, the pharmacist reviewed the assessment and identified a number of SDOH issues the patient was facing:

  • They were struggling to pay for basic necessities like food, housing, medical care, and heat.
  • They were worried they would run out of food before receiving money to buy more.
  • They lacked reliable transportation, which had, in turn, prevented them from attending medical appointments, meetings, and work, and from accessing routine things they needed for daily living.
  • They were facing difficulty performing day-to-day activities such as bathing, preparing meals, shopping, and managing finances.

As a result, the pharmacist was able to provide the member with customized, local resources, to help address their SDOH needs. This information was also shared with the health plan to allow for continuity of care. We say that this intervention “met the member where they are” as it leveraged the existing patient-pharmacist relationship due to the HRSN screening tool and takeaway being provided during the pharmacy consultation.

To learn more about PerformRx SDOH assessments and how we can partner with your organization to help address medication issues and more, contact us at:

Email: info@performrx.com

PerformRx Information Phone: (866) 533-5492

To request more specific information on PerformRx products and services, contact:

Email: sales@performrx.com

PerformRx Sales and Marketing Phone: (866) 533-5492

 

References.

1.     “Social Determinants of Health,” World Health Organization, https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1.

2.    “Social Determinants of Health,” Healthy People 2030, U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, https://health.gov/healthypeople/priority-areas/social-determinants-health.

3.    Social determinants of health are a significant factor in improving health outcomes, but they still go largely unaddressed, https:/.healthpayerintelligence.com/news/addressing-the-real-implications-of-social-determinants-of-health.