Hub services are expanding functions to facilitating access to needed therapies or devices and addressing barriers to adherence.
The CDC has defined social determinants of health (SDoH) as “the circumstances in which people are born, grow up, live, work, and age.” Those circumstances also include the systems in place that offer healthcare and services to a community. In turn, all of the foregoing conditions are shaped by a wider set of forces: economics, social policies, and politics.
In a recent Call To Action to address SDoH, the National Quality Forum’s President and CEO Shantanu Agrawal, MD, MPhil, noted, “Addressing social determinants of health is key to driving meaningful health improvement across populations.”
SDoH have become an important concern for payers and health systems. These stakeholders acknowledge outcomes and costs depend on factors that go beyond medical care. They are transforming their delivery systems to address social risk factors, aiming for better community engagement and clinical and financial outcomes in an environment that is increasingly incentivizing value-based performance.
Pharmaceutical and device manufacturers have a timely opportunity to help overcome the barriers that managed care organizations and practitioners face when trying to tackle socioeconomic factors, particularly in addressing medication and device adherence. For example, with U.S. pharmaceutical manufacturers annually losing an estimated $250 billion in potential revenue due to medication nonadherence, manufacturers should be interested in capturing additional revenues through support of adherence.
If so, manufacturers are likely to find collaborators in plans, PBMs, IDNs, health systems, and ACOs seeking resources and support to address SDoH. In a Precision for Value survey conducted this year of key access decision makers, all respondents reported they already have, are planning, or are willing to consider future collaborations with pharmaceutical and device manufacturers in addressing SDoH.
Based on results by survey participants, the social risk factors guiding their planning with manufacturers include:
Given this shared interest in lowering social barriers to care among plans, organized providers, and manufacturers, opportunities for ambitious, innovative solutions exist. For example, hub services offer opportunities for the delivery of patient-centric care, meeting patients’ growing expectations for acutely consumer-sensitive, “Amazon.com-like” care.
As noted by Nicholas Basta, editor-in-chief of Pharmaceutical Commerce, while hub services have historically focused primarily on helping patients and providers navigate the prior authorization process to obtain reimbursement for a therapy or device, hubs have been expanding their functions to “wrap-around services,” facilitating access to needed therapies or devices and addressing barriers to adherence. Precision Xtract industry consultants recently postulated this expansion is likely to accelerate in concert with the emergence of more complex therapies such as gene and cell therapies.
Hubs have the potential to serve as the primary coordinator of services and the cultivator of patient-consumer trust. They can collaborate with patients and their healthcare practitioners to streamline access to therapies, devices, and digital tools, as well as circumvent barriers to care like affordability, transportation, and insurance benefit navigation. In addition, hubs can provide specialized expertise when answering questions about complex devices, medications, and the management of their side effects.
Hubs are also platforms for centralizing the use of devices, tools, and resources developed by healthcare and pharmaceutical manufacturers for plans, providers, patients, and their communication.
Through the timeliness of telehealth outreach, the hub team strives to position itself within the patient’s personal treatment and support network as a trusted advisor and “professional friend.” The team is helpful in navigating the administrative and clinical shoals of care. Optimally, data-consensually collected through various, innovative, digital portals-provide hub teams with information about the patient’s unique care journey. This creates opportunities to close gaps of information and misinformation and to decrease social isolation, an often overlooked social risk factor, by providing patients encouragement and personalized “nudges” based on behavioral science concepts.
For example, as part of continuous quality improvement processes led by this author, plans have developed algorithms that prompt telehealth outreach to patients, their clinicians, and caregivers, which activate networks of support and encouragement and identify risk factors as potential precipitants of adverse events. These initiatives were recognized as best practices by national quality organizations, such as the NCQA and eValue8.
As an additional consideration, hubs can aggregate data on SDoH and develop community resources that facilitate the patient journey. This data can be used to plan the development of population-based strategies that will support patients, providers, and payers in their efforts to optimize access and adherence to appropriate therapies and devices.
In summary, manufacturer initiatives addressing SDoH in support of adherence could not only recoup some manufacturer revenues lost to nonadherence, but through robust hub services, help close gaps in care by improving access to medications and devices; facilitating better clinical and medication management outcomes; reinforcing patient trust and loyalty by collaborative manufacturer, payer, and provider goodwill; and enhancing a manufacturer’s brand through comprehensive, centralized patient services offerings.
Ultimately, population health will progress to precision population health, supporting vulnerable populations through personalized interventions to mitigate adverse factors like social risk factors. To get there, coordinated, continuous services, greater collaboration and innovation-that is, the partnership of high-tech with soft-touch among all stakeholders-will be imperative.
Maureen Hennessey, PhD, CPCC, CPHQ, is senior vice president, director of value transformation with Precision for Value.