As retail pharmacy leaders continue to respond to market changes in the new decade, one thing remains constant: a focus on the patient. We’re seeing the rise of mergers among many industry leaders for the purpose of moving closer to patients and providing better care. Pharmacies will continue to drive patient experience improvements through various means, including direct customer engagement.
Pharmacies have begun working toward this goal by integrating social determinants of health, or SDOH, into their workflows. The conditions in which we live, learn, work and play significantly affect our health — even more so than factors relating to medical care. The influence of socioeconomic factors is becoming widely understood on a larger scale. A recent decision by the Centers for Medicare and Medicaid Services allowed Medicare Advantage plans to allocate their SDOH expenses as medical costs in medical loss ratios, meaning that plans will be better positioned to help members overcome foundational barriers to care. Given the growing trend of plans sharing responsibility for value-based outcomes with pharmacies via risk-sharing contracts and other incentive-based programs, pharmacies also will likely be expected to participate in these offerings.
By considering SDOH, pharmacists and other healthcare providers are addressing individual challenges and needs to more effectively engage on a personal level. Amid the rise of online competition, this strategy is likely to become a true differentiator.
Meeting patients where they are
Value-based care has put pharmacies on the front lines of improving patient population health through not only prescription therapies, but also patient consulting, seasonal vaccination programs, and other value-added activities. Many pharmacies have health kiosks that help customers measure and track their blood pressure, weight, and BMI, and a care concierge service for customer engagement.
Pharmacies also are using SDOH to drive patient-focused initiatives. SDOH insights provide a clearer picture of the patient to pharmacists and other clinical care providers, addressing possible barriers that stand in the way of optimal treatment.
Pharmacists can play an active role in community health efforts by allocating their time and resources to those who need support the most—from education and counseling to helping solve transportation or other challenges that can lead to poor medication adherence if not addressed. Predictive analytics can provide guidance on this front for each patient.
In approaching the integration of SDOH insights into workflow, it is important to remember that not all SDOH data correlates to health outcomes. For example, zip codes and other rudimentary demographic information can be useful for large-scale population health management efforts, but they only show a limited view into individual patients’ lives outside of clinical needs. The demographic data passed to pharmacies is often inconsistent or out of date; and self-reported data lacks credibility.
A key consideration when working with SDOH attributes is ensuring they have been clinically validated against actual health outcomes to confirm their predictive power. SDOH data should be current, comprehensive and longitudinal as well as easily standardized and integrated into pharmacy workflows.
Pharmacies can implement SDOH data in the form of attributes and scores. Attributes can be incorporated into the pharmacy’s own analytic models to identify community level needs and allocate appropriate resources to the right patient populations. Predictive health scores at the individual patient level already leverage hundreds of socioeconomic attributes to inform pharmacists about potential barriers to each patient’s optimal health and wellness.
Regardless of the type of SDOH input, the data can be used to create a specific health alert to flag an area of concern, or generate “high,” “medium,” and “low” risk levels per patient. Additionally, it’s possible to automatically identify the top three social determinant factors driving a patient’s risk for health outcomes such as medication non-adherence, thus alerting the pharmacist to spend more time with the patient addressing specific challenges.
For example, for some patients, lack of reliable transportation could be the one challenge preventing them from getting their prescription. Patients living in pharmacy deserts may also have low access to prescription medications. These circumstances may compromise patient adherence to the regimen. Knowing this upfront, the pharmacist can ask the patient about setting up a mail-order delivery to facilitate medication access. In a situation where a patient might be experiencing financial difficulties, a system-triggered alert can warn the pharmacist of the issue in advance, prompting the pharmacist to discuss discount programs with the patient.
Driving better outcomes
By using SDOH in workflow, pharmacists can leverage data-driven engagement with patients to treat them holistically and directly respond to their social and economic needs in addition to their clinical needs, thus offering a more personalized care treatment plan that improves the likelihood of adherence. It’s an exciting time for pharmacy and patients alike.
Jill Regan is the director of relationship management at LexisNexis Risk Solutions Health Care.