Social Determinants of Health Landscape Across Clinical Programs
October 3, 2024
In today's evolving health care landscape, the focus on health equity and patient outcomes is more critical than ever. Social determinants of health (SDOH) play a significant role in shaping individual health outcomes and quality of life. At PerformRx, our clinical programs not only provide essential services but also actively engage with members to identify and address these SDOH barriers. Here's how we’re making an impact across diverse member populations.
What Are Social Determinants of Health?
SDOH are conditions in the environments where people are born, live, learn, work, play, worship, and age that play a significant role in individual health outcomes and quality of life.1 The U.S. Department of Health and Human Services outlines five main domains of SDOH within its Healthy People 2030 framework:
- Health care access and quality: Ensuring timely access to necessary health services.
- Economic stability: Promoting financial stability for better access to healthy food, healthcare, and housing.
- Neighborhood and built environment: Creating safe and supportive physical spaces.
- Social and community context: Providing robust social support networks.
- Education access and quality: Offering high-quality educational opportunities, particularly for younger populations.
Each of these domains shapes the overall health and wellbeing of individuals. At PerformRx, our clinical programs are structured to touch on each of these key areas.
PerformRx’s Approach to SDOH
Our clinical programs provide numerous touchpoints with members, caregivers, and healthcare providers, creating opportunities to address SDOH barriers. While we don’t yet use a formal screening tool, our teams are trained to identify SDOH challenges during member consultations. When such challenges are uncovered, we either provide the necessary resources or refer members to their health plans for further assistance.
In 2023, we conducted a quantitative analysis of SDOH interventions across various programs. This included tracking the number of comprehensive medication reviews (CMRs) and SDOH barriers identified within different member populations. Notably, SDOH barriers were more frequently identified in our Medicaid populations compared to our Medicare members. Further, our Dual-Eligible Special Needs Plan (D-SNP) and Medicare-Medicaid Plan (MMP) members faced more SDOH-related challenges compared to those in Medicare Advantage Prescription Drug Plans (MAPD).
Health Care Access and Quality: A Common Barrier
Across our clinical programs, issues related to Health Care Access and Quality were the most frequently identified SDOH barriers. Many members face difficulties accessing medications and medical equipment, either due to insurance limitations or a lack of understanding of their benefits. One of our members, for instance, was unable to read his blood sugar readings or order supplies because he couldn't read or write—a poignant reminder of how health literacy impacts care access.
Economic Stability and Neighborhood Challenges
For many members, economic instability and challenges in their living environments can create significant health barriers. Food insecurity, financial strain, and unsafe housing conditions are some of the SDOH issues our clinical teams encounter regularly. For example, one member shared that their inability to afford healthy food was directly affecting their ability to manage diabetes, despite having low or no co-pays for their medication.
Similarly, the physical environment plays a vital role. One member, living with sarcoidosis, struggled with respiratory issues because her neighbor's smoking habits exacerbated her condition. Addressing such environmental factors is crucial to improving overall health outcomes.
Social and Community Context: Insights from the MAPD Population
While our Medicaid and D-SNP/MMP populations tend to receive more hands-on case management, our MAPD members are generally more independent. However, despite this independence, many MAPD members report feeling socially isolated or lacking a strong support network. For example, one member’s spouse reached out to our team, requesting information on local support groups to help combat feelings of loneliness and isolation.
Pediatric Focus on Education Access
Although SDOH challenges related to education are not as commonly documented, our pediatric programs place a strong emphasis on keeping children healthy and in school. For instance, our Asthma Management Program ensures that children have completed Asthma Action Plans and access to rescue medications at school, allowing them to manage their condition and participate in daily activities.
Moving Forward: Continuous Improvement
At PerformRx, we believe that identifying and addressing SDOH barriers is critical to achieving health equity. By listening to our members, understanding their unique challenges, and advocating for the resources they need, we can help reduce health disparities. From overcoming barriers to accessing medications and medical equipment, to providing resources for economic stability and safe living environments, our clinical teams are here to help.
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:
- Social Determinants of Health. Healthy People 2030, U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Retrieved 14 Mar 2024, from https://health.gov/healthypeople/objectives-and-data/social-determinants-health
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