The Era of Pandemic Healthcare: The Social Determinants of a Health Crisis

May 15, 2020

Maureen is senior vice president, director of Value Transformation for PRECISIONvalue. Maureen has extensive experience as a C-level executive, clinician, academician, innovator, and coach in managed, integrated care. Nationally, she has developed innovative products and strategies for industry executives and access decision makers. Under her leadership, organizations have received recognition from eValue8, NCQA, and the National Academy of Medicine for innovative strategies that have reduced hospital readmissions, improved patient safety, and enhanced patient engagement. Since joining Precision, she has led more than 500 strategic quality and population health initiatives with 35 clients in 17 therapeutic areas. Her expertise includes adherence, behavioral health/social wellness, crisis management, patient engagement, population health, quality, social determinants of health, and value-based care.

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has exposed and further exacerbated the fractures in our healthcare and social delivery systems. There has never been a more urgent time for manufacturers to develop or evolve their strategic frameworks to address adverse social risk factors that have been exacerbated by the COVID-19 pandemic and contribute to health inequities glaringly evident during the pandemic. This article describes strategies pharmaceutical manufacturers must adopt to address social determinants of health and population health management challenges, supporting patients, families, and clinicians during this pandemic and beyond.

Introduction

The World Health Organization has noted that social determinants of health (SDOH) are responsible for most health inequities.1 Because health and wealth are often connected within the United States, low-income populations are expected to be particularly vulnerable to the severe effects of COVID-19 or the novel coronavirus.2 For example, black residents of Cook County, historically impacted by adverse social risk factors including poverty and poor care access, are dying from COVID-19 at disproportionately high rates, prompting Chicago Mayor Lori Lightfoot to declare a public health red alarm requiring multi-stakeholder community intervention.3

Furthermore, because of the legitimately rising anxiety about social, health, and financial disruptions associated with COVID-19, it is essential to anticipate, screen, and support efforts to reduce the impact of SDOH. For patients already grappling with social risk factors such as limited access to care and medications, financial distress, loneliness, and food and housing insecurity, the isolation, health, and financial stressors caused by COVID-19 will precipitate crises for unprecedented numbers of patients.

This situation is compounded by a surge of new individuals with serious social risk factors due to the pandemic-related economic downturn. American Enterprise Institute’s Matthew Continetti has warned of a global recession and possible depression, and New York University’s Eric Klinenberg has projected economic and social order collapse without government intervention, guaranteeing income for millions of workers at risk for job loss.4 These predictions signal the likelihood of millions more Americans and others around the globe experiencing severe hardships and health consequences from escalating social risk factors. Collaboration as a coping style has never been more important among all members of our healthcare community, extending to our broader communities.

New strategic solutions will be necessary to promote social stability, a prerequisite foundation for individual and population health. Harvard’s Archon Fung believes success in grappling with this pandemic will be more likely among American states in which government, civic, and private-sector leaders join their collective strengths for the common good.5 Pharmaceutical manufacturers, with their extensive biopsychosocial resources and global reach, have a unique opportunity to forge new solutions to address social risk factors and promote the social stability vital to population health, but they must act with a sense of urgency. Here are steps manufacturers can take to address SDOH.

Strategic Planning

  • Review organizational strategic plans for addressing SDOH and population health management, within the paradigm-shifting context of the COVID-19 pandemic. Recognize there is a new normal because of the lethality and virulence of COVID-19, requiring crisis management expertise
  • If your organization does not have a strategic plan for SDOH and population health, integrate planning within your organization’s COVID-19 management and response team to anticipate, identify, and address SDOH systemically for patients, employees, and families
  • Remember that the pandemic and SDOH landscapes are extremely dynamic, necessitating rapid refresh of data and refinement of plans and tactics to address evolving needs.

Analytics

  • Use current analytics capabilities to map social needs and predictive consumption, particularly in areas such as access to care and tests, medicines, transportation, food and shelter, and health literacy.
  • Identify additional analytics resources that the manufacturer, through collaborations with current analytics vendors and vendors with expertise in SDOH, can use to facilitate multi-stakeholder engagements with customers and their at-risk communities.

Support

  • Pharmaceutical Commerce noted in its March 2020 annual report on trends in patient support/hub services, “…a stronger push toward in-field services (at patients’ homes or at doctors’ offices); and a stronger drive toward providing so-called end to end services, ranging from patient acquisition, through drug dispensing, and on to follow-up care.”6 With that in mind, manufacturers can: Review in-field services to ascertain if they can be delivered with telehealth and other web-based technologies. Investigate how hubs can offer additional contacts, screening and services to streamline access to resources (eg, care, medicine, transportation, food), particularly for immunocompromised patients Use hub-based digital media outreach to directly engage patients. regarding various therapies. For example, a recent patient and caregiver survey found that more than half (56%) expressed concern about medication regimen interference due to the pandemic.7 This is an issue that could have been proactively addressed through digital media.

Virtual Support

  • The National Institute for Health Care Management recommends the use of social platforms to cope with the increased isolation associated with COVID-19 restrictions.8 These platforms can function as both supportive and data-aggregating portals for: Assessing and supporting individuals at greater mortality risk for COVID-19 due to comorbidities. Influencing medication adherence, of particular concern in light of recent findings that disparities are widening between low-risk and high-risk adherence patients on late refill rates, with nearly half of high-risk. patients (49%) still filling prescriptions late, post-COVID-19 outbreak9 Anticipating and identifying patients with health literacy challenges to promote understanding and practice of safe behaviors such as social distancing and appropriate medication use.

Plan for the Future

SDOH have a cyclical relationship with the COVID-19 pandemic. Failure to address poor health literacy exacerbates noncompliance with safe behaviors that mitigate the viral spread. Further, social risk factors, such as inadequate access to therapies, care, food and shelter, also exacerbate viral spread. In turn, the spread of COVID-19 will create additional economic and social instability, placing Americans at risk for adverse SDOH and associated deterioration of individual and population health. With that in mind, pharmaceutical manufacturers should consider the following:

  • Patients are ready to receive patient assistance directly from manufacturers or their contracted assistance and hub services. A recently published survey10 reported that: 63% of those with complex or chronic conditions would opt in to manufacturers’ support services and those with severe conditions such as cancer (73%) or lupus (86%) are even more likely to opt in. 42% reported that their prescriber is less than optimally accessible for medication questions, with nearly a fifth reporting they did not experience physician support regarding their medication(s). Patient preferences for types of support and media varied, suggesting the need for omnichannel support. However, only 20% of respondents indicated awareness of the patient support services currently offered by drug manufacturers.

  • These results suggest patients with complex and chronic conditions (and hence at greater risk for severe complications and death if diagnosed with COVID-19) are eager for further pharma-driven support and resources, particularly with regard to medication access, education, and emotional support. All of those unmet needs are associated with social risk and disparity factors (eg, access to drugs, health literacy, and social isolation) that are exacerbated during the COVID-19 crisis, and will persist beyond the surge stage of the pandemic. With that in mind, manufacturers should include the following in future planning: Review patient assistance program communication strategies to broaden engagement with key market segments. Engage in policy development that reduces unnecessary government restrictions and proposes structures and safeguards to advance innovation, patient engagement, and scientific research to address SDOH and promote population health11 within the COVID-19 environment and beyond. Strategically design patient assistance programs to optimize patient and clinician experience, consistent with the Quadruple Aim, and providing tailored support for patients, families, and clinicians experiencing unparalleled levels of stress associated with chronic disease, occupational stressors, and COVID-19. Leverage analytics aggregated during the crisis response period to develop social strategies for medications,12 and plan for multisegment, socially informed campaigns to be rapidly deployed to promote universal education and access as COVID-19 virus and viral antibody testing, evidence-based therapies, and vaccines for COVID-19 become available.

Conclusion

The COVID-19 pandemic has exposed and further exacerbated the fractures in our healthcare and social delivery systems. There has never been a more urgent time for manufacturers to develop or evolve their strategic SDOH frameworks, supporting multistakeholder collaborations to mitigate social risk factors, integrate biopsychosocial care, and advance population health, so we will be better prepared for the next pandemic. Pharmaceutical manufacturers have the opportunity to participate with plans, clinicians, health systems, IDNs, and other private and public stakeholders to reinvent our delivery system to expand value, close disparity gaps, and attain the Quadruple Aim. Finally, isolation and uncertainty are the hallmark stressors associated with social distancing,13 and manufacturers have opportunities to support both patients and clinicians with connection and credible information.

References

  1. World Health Organization. Social determinants of health. https://www.who.int/gender-equity-rights/understanding/sdh-definition/en/. May 2012. Accessed May 5, 2020.
  2. National Public Radio. Underlying health disparities could mean coronavirus hits some communities hard. https://www.npr.org/sections/health-shots/2020/04/01/824874977/underlying-health-disparities-could-mean-coronavirus-hits-some-communities-harde. April 1, 2020. Accessed May 5, 2020.
  3. LiveScience. Illinois: latest updates on coronavirus. https://www.livescience.com/illinois-coronavirus-updates.html. May 5, 2020. Accessed May 5, 2020.
  4. Klinenberg E. Less individualism. https://www.politico.com/news/magazine/2020/03/19/coronavirus-effect-economy-life-society-analysis-covid-135579. Accessed May 5, 2020.
  5. Fung A. A new civic federalism. https://www.politico.com/news/magazine/2020/03/19/coronavirus-effect-economy-life-society-analysis-covid-135579. Accessed May 5, 2020.
  6. Pharmaceutical Commerce. 2020 patient support/Hub services report. https://pharmaceuticalcommerce.com/brand-marketing-communications/2020-patient-support-hub-services-report/ March 7, 2020. Accessed May 5, 2020.
  7. Kanski A. Survey: more than half of patients concerned that COVID-19 will affect medication regimen. https://www.mmm-online.com/home/channel/survey-more-than-half-of-patients-concerned-that-covid-19-will-affect-medication-regimen/. April 7, 2020. Accessed May 5, 2020.
  8. National Institute for Health Care Management (NIHCM) Foundation. Managing loneliness. https://www.nihcm.org/categories/managing-loneliness. Accessed May 5, 2020.
  9. Landi H. Strategies to increase medication access during COVID outbreak aren't helping patients most in need. https://www.fiercehealthcare.com/payer/certain-patient-groups-at-risk-not-taking-their-medications-during-covid-19-analysis-shows. March 31, 2020.
  10. Human Care Systems. 2020 Pharmaceutical Patient Experience Survey. http://www.humancaresystems.com/wp-content/uploads/Patient-Survey-Executive-Summary_FINAL_HCS.pdf. Accessed May 5, 2020.
  11. Hennessey M. Pharma’s pivotal role in social determinants of health. https://informaconnect.com/pharmas-role-social-determinants-of-health/. December 6, 2019. Accessed May 5, 2020.
  12. Iskowitz M. Why every drug should have a social-care strategy (but most don’t). https://www.mmm-online.com/home/channel/features/why-every-drug-should-have-a-social-care-strategy-but-most-dont/ September 5, 2019. Accessed May 5, 2020.
  13. Huremović D. Social distancing, quarantine, and isolation. In: Huremović D. (eds) Psychiatry of Pandemics. 2019:85-94.