How much of a role can pharmaceutical manufacturers play in the social determinants of health? Industry experts, Maureen Hennessey, PhD, and Dominic Galante, MD, discuss how much they can stand to gain in medication adherence and outcomes from partnering with other industry stakeholders and programs around the issue.

Pharma Manufacturers Could See Better Adherence, Outcomes With Focus on SDOH
by Jane Anderson
AIS Health

Pharmaceutical manufacturers stand to gain in medication adherence and outcomes if they take steps to partner with other health care industry stakeholders on programs to address social determinants of health (SDOH). That’s the word from two industry experts, who say some pharma manufacturers may not realize they could have an important role to play in SDOH.

“Having a strategy — a traditional approach around social determinants of health — could tie into greater patient adherence to medication,” says Dominic Galante, M.D., chief medical officer, access experience team at Precision for Value.

Galante tells AIS Health that it also could result in greater access to care for patients and better product utilization for manufacturers. “Pharmaceutical manufacturers, while they may not have been as close to this topic [as others in the health industry], are evolving to being partners and being part of the solution,” he says.

In fact, Galante says, some manufacturers already are involved in activities that touch on SDOH, even if they don’t have an overarching strategy to address multiple SDOH factors. But although the topic of SDOH is in vogue, some people in the pharmaceutical manufacturing community still aren’t certain exactly what SDOH really means and how they can collaborate on SDOH projects, he says.

Pharmaceutical manufacturers generally have expressed interest in working on SDOH, although “some are more involved than others,” notes Maureen Hennessey, Ph.D., senior vice president/director of value transformation at Precision for Value.

They should want to become involved, Hennessey tells AIS Health, because addressing social determinants of health provides several benefits for them. For example, she says, SDOH initiatives can help a manufacturer expand appropriate utilization of products and can expand the universe of patients for whom the manufacturer provides care.

“It can grow revenue,” Hennessey says. “Some estimates say the U.S. pharmaceutical industry loses $250 billion per year just due to medication nonadherence. It’s an opportunity to collaborate with customers. And if you’re developing [an SDOH initiative] around services, it gives manufacturers an opportunity to further differentiate themselves.”

SDOH Covers Literacy to Housing

According to the federal Office of Disease Prevention and Health Promotion Healthy People 2020 initiative, SDOH spans the gamut from access to food and safe housing to cultural issues. They include:

• Access to educational, economic and job opportunities;
• Access to health care services;
• Quality of education and job training;
• Availability of community-based resources that support community living and opportunities for recreational and leisure time activities;
• Transportation options;
• Public safety;
• Social support;
• Social norms and attitudes (e.g., discrimination, racism and distrust of government);
• Exposure to crime, violence and social disorder (e.g., presence of trash and lack of cooperation in a community);
• Socioeconomic conditions (e.g., concentrated poverty and the stressful conditions that accompany it);
• Residential segregation;
• Language and literacy;
• Access to mass media and emerging technologies (e.g., cell phones, the internet and social media); and
• Culture.

Health and health care together are considered one of the Healthy People 2020’s five key SDOH factors. The others are economic stability, education, social and community context, and neighborhood and built environment. However, those in the health care industry, particularly providers and insurers working in lower-income areas, realize that it’s important to address all five key factors in order to help improve people’s health.

Health insurers — particularly state Medicaid plans and Blue Cross Blue Shield plans — have been the most active in SDOH to date, often partnering with provider groups in value-based contracts. In addition, state Medicaid agencies increasingly are asking for plans to address SDOH when they recontract with their plans. For example:

• Blue Cross Blue Shield of Arizona joined with Equality Health, a Phoenix-based health delivery system that caters to underserved and uninsured populations and focuses on SDOH, to offer individual market coverage on the Affordable Care Act marketplace in Maricopa County. Network physicians are trained to assess patients’ behavioral, social, cultural and environmental factors as well as medical factors, the organizations say.
• The Oregon Health Authority will require its Medicaid coordinated care organizations to invest in services and initiatives to address SDOH components, with an emphasis on housing-related supports and services in the first year. The state agency also reserved the right to establish a new statewide SDOH priority during subsequent contract years.
• North Carolina formed a task force to determine how health systems and community-based organizations can partner to address SDOH under North Carolina’s planned transformation to managed Medicaid.

Additional stakeholders are investing in highly visible SDOH initiatives. For instance, in early 2019 CVS Health Corp. and its insurer subsidiary Aetna launched the Building Healthier Communities initiative, which the company describes as a five-year, $100 million commitment to support critical programs and partnerships with local and national nonprofit organizations. The program will address chronic disease, opioid abuse and youth tobacco use, according to CVS Health, and will enable providers in CVS Health’s retail clinics to refer patients for nonmedical services, such as food and transportation.

Data, Analytics, Literacy Are All Options

While pharmaceutical manufacturers might not participate directly in SDOH projects that address housing, food and transportation issues, they still can partner on data and analytics, in addition to direct work on other issues, such as health literacy.

For example, Merck & Co., Inc., partnered with health literacy leaders at Northwestern University and Emory University, gathered patient feedback and worked with the FDA on health literate patient labels for new molecules. Laurie Myers, director of global health literacy at Merck, says she and her team now are working to incorporate health literacy principles into other areas of the business, including packaging and clinical trials.

As the health care system increasingly adopts population health management and value-based care models, all the stakeholders need to transform how they pay for and value care, Hennessey says. “Every entity, including pharmaceutical manufacturers, needs to rethink how they approach population health.”

As providers and insurers develop initiatives around social determinants of health, she adds, “they’re expecting pharmaceutical manufacturers to be their partners.” It’s important for pharma manufacturers to support the triple — now quadruple — aim, she says.

“To reduce some of the barriers, such as affordability, health systems are also providing explanations and assistance to patients, especially those taking complex medications,” says Hennessey. “This holds the opportunity to improve health literacy.” Pharma manufacturers can help providers improve health literacy in their patients by offering them tools to accomplish that goal, she says.

Still, Hennessey points out that pharma companies face some hurdles in potential work on SDOH issues, including, in some cases, a lack of awareness and understanding, a lack of resources and a lack of time and expertise to tackle the necessary issues.

Earlier this year, Hennessey says, Precision for Value surveyed delivery systems. Results indicated that around 29% currently collaborate with at least one pharmaceutical manufacturer on educational initiatives related to SDOH, and another 25% expect to do so within the next 18 months.

These results indicate energy around these collaborations, which have significant room left to grow, Hennessey says. “It’s really still emerging,” she says. “There are more that are under consideration and in the works.”

SDOH is “really the big buzzword, but very little has been done” up until now, Galante says. “We know there are some private endeavors between health systems and manufacturers. I think we’re going to start to see more around this area. They will look at the patient from a more holistic perspective.”

New ways of contracting for expensive products, particularly contracts based on outcomes and value, should spur pharma manufacturers to embark upon projects that impact SDOH, Hennessey says: “Increasingly, pharma companies are entering into value-based contracts, and so they have more incentive to collaborate on population-based health strategies.”

Provider Education Is Important

Pharma manufacturers can play a key role in educating providers about SDOH and the roles they play in overall health care, Galante says. Ideally, this would involve identifying best practices and developing screening tools and other resources that can be disseminated at the provider level, he says.

Provider education on SDOH can help to support health literacy, says Galante. In addition, he says, pharma manufacturers potentially can help to improve access to care by working to expand the infrastructure to provide telehealth services. “There is a host of additional challenges that patients may have that can be addressed by telehealth,” he says.

Various telehealth digital tools can be used to monitor and engage patients, particularly in underserved populations, Hennessey says. Pharma manufacturer data also can be collected and analyzed for SDOH issues and then utilized to help decrease some of these barriers to care, she says.

“At the end of the day, the role manufacturers can play in social determinants of health is in collaborations or partnerships with providers and other stakeholder communities,” Galante says.

However, there are some potential bumps in the road as pharma manufacturers look at possible ways they can get involved in SDOH initiatives.

For example, in October, CMS proposed two new rules aimed at clarifying how self-referral anti-kickback statutes impact care coordination and value-based care. Notably, pharmaceutical manufacturers were not included in most of the proposed rules’ safe harbors for value-based activity. This exclusion stems from worries that certain value-based arrangements could impermissibly encourage use of particular products, CMS says.

If the rule is adopted as proposed, Hennessey warns, government restrictions could inhibit or prevent pharmaceutical manufacturers from being a major player in value-based care and population health initiatives, which could impact their ability to work on SDOH.

Manufacturers need to make their case for why they should be involved in these initiatives, she argues: “One of the things that becomes really important is for pharmaceutical manufacturers to identify areas from which they bring particular value in SDOH, so CMS can understand the role they’re playing.”

Hennessey says manufacturers should work with other stakeholders to show their value in condition-based management, particularly on SDOH strategies. “I think pharmaceutical manufacturers need to develop global strategies by therapeutic area for the role they want to play in SDOH,” she says. The role a manufacturer could play in a condition such as diabetes, she explains, could look different than the role a company might play in patients who have been diagnosed with cancer.

Contact Galante and Hennessey via spokesperson Lessly Delcid at ldelcid@coynepr.com.