News and Insights

Social Determinants of Health: Eliminating Barriers Through Pharmacy Management

September 2, 2024

The United States spends more on health care than almost any other nation, yet it often underperforms on key health metrics such as life expectancy, maternal and infant mortality, and reducing chronic heart disease.1 This paradox of high spending and suboptimal outcomes has spurred a critical discussion: How can we better align our health care investments with improved health outcomes? The answer lies in addressing the broader, non-medical factors that significantly influence health—known as Social Determinants of Health (SDOH).

The Crucial Role of Social Determinants of Health

SDOH are the conditions in which people are born, live, learn, work, play, worship, and age. These factors—ranging from economic stability and education to neighborhood environment and access to health care—play a profound role in determining health outcomes.2 According to the World Health Organization, SDOH can significantly affect a wide range of health, functioning, and quality-of-life outcomes. 3

While medical care accounts for only 10-15% of the impact on health outcomes, a staggering 80% is driven by SDOH factors.4 In a 2019 survey, 68% of individuals reported facing at least one SDOH challenge, underscoring the necessity of interventions that address these determinants to positively influence health outcomes.5

Health Equity, Health Disparities, and SDOH

Health equity is defined as the highest level of health for all people, requiring concerted efforts to eliminate health disparities—differences intricately linked with social, economic, and environmental disadvantages.6 Addressing SDOH is essential to achieving health equity, as it helps reduce health disparities and ensures that everyone has the opportunity to attain their highest possible standard of health.

PerformRx is deeply committed to advancing health equity by understanding and addressing SDOH. We recognize that the pharmacy team, as an integral part of the interdisciplinary health care team, is uniquely positioned to identify and mitigate barriers to care, ensuring access to appropriate, individualized treatment.

PerformRx’s Drug Therapy Management (DTM) Program: A Comprehensive Approach

At the heart of PerformRx’s commitment to health equity is our URAC-accredited Drug Therapy Management (DTM) program. This member-centric program is designed to optimize therapeutic outcomes across multiple disease states in both adult and pediatric populations. A critical component of the DTM program is addressing SDOH barriers that may affect a member’s health status.

Our clinical team conducts holistic Comprehensive Medication Reviews (CMRs) and nurse assessments, which are interactive, person-to-person consultations. These reviews aim to improve patients’ understanding of their prescriptions, over-the-counter medications, herbal therapies, and dietary supplements, while also identifying and addressing any concerns or problems. The goal is to empower patients to take control of their health.

One of the biggest barriers to medication adherence is health literacy. To address this, our clinical team provides disease state and medication education through telephonic coaching, mailed educational materials, and demonstrations of devices as needed. By using motivational interviewing techniques, we can better understand and address patient beliefs and attitudes, further promoting adherence and positive health outcomes.

Addressing SDOH Through the DTM Program

PerformRx’s DTM program goes beyond traditional medication management by directly addressing various SDOH barriers:

  • Access to Providers and Medications: Our clinical team assesses and intervenes when there are gaps in access to health care providers and medications. For instance, issues with transportation are addressed by identifying pharmacies that offer delivery services, assisting with mail orders, and providing other transportation resources.
  • Medication Costs: To address financial barriers, our pharmacists review formularies and assist with prior authorizations, step therapy, and alternative therapies. This ensures that patients have access to the most cost-effective and clinically appropriate medications.
  • Collaboration with Health Plan Care Management: We work closely with health plan care management teams to address SDOH issues that may fall outside the scope of pharmacy services, such as housing. This collaboration ensures that members receive the comprehensive support they need to overcome barriers to health.

Expanding the Impact: Community-Level MTM Program

To further reduce health disparities, PerformRx has expanded its efforts by collaborating with partners within our pharmacy network to assess and address SDOH in the context of a community-level Medication Therapy Management (MTM) program. This initiative leverages existing community relationships to provide resources and services directly where members are, ensuring continuity of care and ongoing support.

Formulary Management with a Focus on Health Equity

As a Pharmacy Benefit Manager (PBM), PerformRx is actively involved in formulary management, an integrated patient care process which enables physicians, pharmacists, and other health care professionals to work together to promote clinically sound, cost-effective medication therapy and positive therapeutic outcomes”.7 In addition to evaluating for safety, efficacy, and cost-effectiveness, keeping the population served at the forefront when formularies are developed and data is evaluated, ensures that health equity is a component of the assessment. Having a defined and consistent process to manage formularies, across medication classes, is an absolute necessity to minimizing bias.

Culturally and Linguistically Appropriate Services (CLAS)

Access to culturally and linguistically appropriate services (CLAS) is essential for achieving the best health outcomes. PerformRx communicates with members in their preferred languages and in ways that align with their belief systems. We utilize oral and written translation services, and a portion of our associates are bilingual, ensuring that our support is both linguistically and culturally appropriate. All associates undergo comprehensive training in health equity and CLAS, empowering them to engage with members in ways that promote health equity.

Engaging with Communities to Advance Health Equity

Understanding the needs of the populations we serve is crucial to advancing health equity. PerformRx associates participate in multiple outreach programs within our communities, providing support and gaining insights that help us tailor our programs and services to meet specific needs. This community engagement is an essential component of our strategy to address SDOH and reduce health disparities.

Addressing Pharmacy Deserts and Expanding Access

Pharmacies play a critical role in the health care system, providing not only medication dispensing services but also preventive, diagnostic, and emergency services. However, disparities in pharmacy access, known as pharmacy deserts, disproportionately affect Black and Hispanic/Latino neighborhoods.8 While PerformRx cannot solve this issue alone, we are committed to expanding our pharmacy network to increase access to care wherever possible.

A Multidisciplinary Approach to Addressing SDOH

Addressing SDOH requires a multidisciplinary approach, and the pharmacy profession plays a significant role in this effort. PerformRx is dedicated to assessing and addressing health inequities and disparities within the populations we serve. By finding meaningful solutions across all areas of our organization, we can have a positive impact on SDOH, reduce health disparities, and advance health equity.

Join PerformRx in Making a Difference

At PerformRx, we believe that addressing SDOH is key to improving health outcomes and advancing health equity. Our DTM program is designed to identify and overcome barriers to care, ensuring that every member has the opportunity to achieve their best health. We invite health care providers, community partners, and members to join us in this critical mission. Together, we can create a healthier, more equitable future for all.

Contact PerformRx at info@performrx.com to learn more about our DTM program and how we can support your plan’s members.

This blog post is a summary of an article from the Winter 2024 edition of PerformRx Review. If you enjoyed it, sign up to receive new editions and discover more content like this.

References:

  1. Centers for Medicare & Medicaid Services. “CMS Issues New Roadmap for States to Address the Social Determinants of Health to Improve Outcomes, Lower Costs, Support State Value-Based Care Strategies.” https://www.cms.gov/newsroom/press-releases/cms-issues-new-roadmap-states-address-social-determinants-health-improve-outcomes-lower-costs (accessed October 31, 2023)
  2. Healthy People 2030, U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. “Social Determinants of Health,” https://health.gov/healthypeople/objectives-and-data/social-determinants-health (accessed October 27, 2023)
  3. World Health Organization. “Social Determinants of Health,” https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1(accessed October 27, 2023)
  4. Health Payer Intelligence. “Addressing the Real Implications of Social Determinants of Health,” https://healthpayerintelligence.com/news/addressing-the-real-implications-of-social-determinants-of-health (accessed October 27, 2023)
  5. Academy of Managed Care Pharmacy. “Survey Highlights High Prevalence of Social Determinant Challenges, Need to Better Address Them,” https://www.ajmc.com/view/survey-highlights-high-prevalence-of-social-determinant-challenges-need-to-better-address-them (accessed October 27, 2023)
  6. Healthy People 2030, U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. “Health Equity in Healthy People 2030,” https://health.gov/healthypeople/priority-areas/health-equity-healthy-people-2030 (accessed October 27, 2023)
  7. Academy of Managed Care Pharmacy. “Formulary Management,” https://www.amcp.org/about/managed-care-pharmacy-101/concepts-managed-care-pharmacy/formulary-management (accessed October 27, 2023)
  8. Jenny S. Guadamuz at al., “Fewer Pharmacies In Black And Hispanic/Latino Neighborhoods Compared With White Or Diverse Neighborhoods, 2007–15.” Health Affairs2021 40:5, 802-811.

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