Understanding social determinants of health

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6 min read
Understanding social determinants of health

By Meron Gartner, PharmD, Senior Product Manager at Outcomes®

Healthcare is nuanced. Professionals in this field learn early that effective provision of healthcare requires a deep understanding of the communities in which they work. As the daughter of two pharmacists, I witnessed the positive impact of personalized care in communities. I inherited my parents’ dedication to understand and support their patients, and I’ve carried on this commitment as a pharmacist myself. I became interested in the factors that impact health outcomes and access to quality healthcare, which led me to evaluate the community pharmacist role in understanding social determinants of health.

Defining social determinants of health
To understand the important role that pharmacists can play here, we must first define SDOH. Social determinants of health (SDOH) are the environmental and social circumstances that shape health outcomes. According to the Centers for Disease Control and Prevention (CDC), SDOH are “conditions in the places people live, work, play, and worship that affect their health.” Factors outside the healthcare system affect a person’s health outcomes, like economic stability, education and access to food. The COVID-19 pandemic exacerbated economic inequalities and social isolation. Understanding the SDOH framework can aid healthcare workers in recognizing the effects of social and environmental factors on health outcomes. Because SDOH factors are unique to individuals, collecting and aggregating data is the first step in tackling unmet needs. To address gaps that negatively impact patients’ health, healthcare payers can rely on the robust pharmacist network with Outcomes.

Understanding the 5 domains of SDOH
Healthy People 2020 is an initiative that defines five domains of social determinants of health:

1. Economic stability
Financial resources and socioeconomic status can be linked to health outcomes because of the impacts on a person’s access to food, housing and healthcare. For example, if someone needs to choose between affording food or a prescription, depending on the importance of the medication, a person may be forced to forgo the medication that month.

2. Education access
Education can be linked to improved health outcomes and wellbeing. One’s education level also impacts their understanding of basic health information. Health literacy empowers individuals to properly care for themselves.

3. Healthcare access and quality
Being uninsured is a major health risk. However, even if an individual is insured, they can still experience barriers to healthcare. For example, is there reliable transportation? If someone cannot physically get to a pharmacy for their prescription, it’s not feasible to receive the healthcare they need.

4. Neighborhood and built environment
The environmental conditions in which one lives play a big role in their access to proper healthcare. Are there any pharmacies within 20 miles? Do they have access to healthy food? Food and healthcare deserts impact the ability to seek necessary care.

5. Social and community context
Having a strong social network, whether it be friends, family or coworkers, is critical for mental health. If an individual is living in isolation or doesn’t have many connections, their health and wellbeing can suffer.

Leveraging the Outcomes network for meaningful connections
At Outcomes we believe in empowering connections between pharmacists and patients, so we’re adding a new patient consultation to our program that engages pharmacists and pharmacies to collect SDOH data and close gaps for patients. We know that pharmacists are the most accessible healthcare professionals and have the potential to make a lasting impact on patient outcomes. Outcomes piloted an SDOH screening service in 2019, and results were published in the Social Determinants of Health Resource Guide (page 38) by the Pharmacy Quality Alliance (PQA). More than 9,800 screenings took place at 2,100 retail pharmacies over about two months. Patients who had completed an SDOH screening with the pharmacy showed an average of $1,500 in decreased medical spending. This pilot demonstrates the positive impact a pharmacist can have on patients in their community by starting the conversation around SDOH factors. The Social Determinants of Health Assessment solution scales across the Outcomes nationwide network of pharmacies—this is done through a narrowed set of validated questions, standardized documentation and detailed reporting. Assessment questions are based on the validated questions from the Accountable Health Communities Health-Related Social Needs tool by the Centers of Medicare and Medicaid Services (CMS). They focus on high need areas like food, housing and transportation, which align with proposed quality measures in the SDOH space. Responses to assessment questions, as well as an inventory of which health-related social needs were addressed by the pharmacist, are all available within reporting to the patient’s health plan.

Pharmacists are uniquely positioned to screen patients for social determinants of health because of their accessibility and footprint in the community. Like many of my fellow pharmacists, I feel a deep sense of purpose and commitment to ensure patients achieve the best outcomes. Though facilitating this conversation can be challenging, the benefit we stand to gain from learning more about our patients makes proactive SDOH consultations the right direction for our profession. The Outcomes network is full of pharmacists who have a strong presence in their community and are likely already facilitating conversations on the topics of job instability, food insecurity and housing access. It’s time to start collecting SDOH information in a more standardized way and compensating pharmacists for their role in these efforts. Through this assessment service, Outcomes can assemble data that enables payers to uncover patient needs for services related to SDOH. The success of medical treatment is dependent on resolving unmet needs related to SDOH, making this information vital to improving adherence and achieving high performance in quality measures for health plans. The National Committee for Quality Assurance (NCQA), a leading organization that establishes quality measurements, is preparing a quality measure that includes screening for SDOH factor metrics and referrals in its performance evaluation criteria for payers.

Connecting healthcare providers for better patient outcomes
As we are learning, successful health outcomes are heavily influenced by SDOH factors. With the pharmacy profession at the forefront of healthcare interventions, it makes sense to include pharmacists in strategies to address unmet social and environmental needs for patients. Outcomes is here to equip pharmacists with resources to help patients overcome healthcare access barriers. As a result, payers and pharmacies gain new opportunities to provide more inclusive services, achieve operational goals and reach top performance for quality ratings.