How specialty innovation can help address social determinants of health

A good specialty partner leverages data, tools and health equity-focused programs to manage social determinants of health issues head-on.

What are social determinants of health—and why do they matter?

Social determinants of health, or SDOH, are underlying conditions all around us that affect health and quality of life. The domains of SDOH can influence our individual health positively or negatively, and on a macro level, reduce or increase health inequities.

Environmental factors, socioeconomic status, education, neighborhood attributes, infrastructure, food access and more can have a greater effect on our health than biology or clinical care: in fact, social determinants impact 80–90% of overall health outcomes.

Negative outcomes disproportionately affect underserved and under-resourced communities, increasing their risk for worse health outcomes. Consider how unreliable transportation keeps people from attending necessary preventive care appointments, or how people without access to healthy food in grocery stores have a higher risk of conditions like cardiodiabesity.

Not everyone’s health journey has the same starting point—that’s why it’s important to meet people where they are.

Addressing SDOH in order to deliver positive specialty care outcomes

Everyone deserves to live their healthiest, best life and thinking beyond the clinical setting helps providers better understand their patients’ needs and barriers to care. Whole person care leads to better outcomes. For plan sponsors, addressing SDOH needs lowers overall health care costs and improves employee vitality and productivity.

It’s particularly important to identify these needs in a specialty population. Specialty patients have to navigate complex conditions and treatments, which can be overwhelming, especially for those with SDOH needs. Medication side effects and dosing complexities can make normal day-to-day activities difficult to navigate, and the financial costs of dealing with these disorders are stressful and challenging, compounded by the cost of drugs themselves.

When specialty patients don’t adhere to their treatment regimen, the stakes are high—there’s potential for disease progression, hospitalization and deterioration in quality of life.

Related: Social determinants of health influence breast cancer outcomes

How can specialty partners take the lead on SDOH issues?

Specialty partners play an important role in bridging gaps and addressing the needs of patients that are impacted by negative SDOH.

That may mean providing access to social workers who can coordinate transportation options for appointments and pharmacy visits. To overcome communication barriers, it could include printing educational materials in multiple languages, providing telephonic translation services and matching patients with home infusion nurses who speak their language. And specialty partners should assist patients who are struggling financially with navigating benefit complexities and coordinating access to copay assistance or foundation support programs.

It’s important that a specialty partner approach these potential obstacles to care from a holistic perspective, enabling increased access wherever possible to provide connected care and improve members’ health.

New digital health tools create new opportunities to address SDOH

By providing patients with better access and engagement through digital tools and technology, Accredo is able to help address SDOH issues in a personal, scalable way. With a new screening assessment program which begins with a simple, one question survey about how often patients have trouble adhering to their specialty medication because of a lack of basic needs, Accredo is able to support patients by connecting them with the resources they need to live healthier lives.

Knowledge from the Evernorth Social Determinants Index, or ESDI, is used to improve patient outreach and care on a community by community basis. The ESDI considers six domains—culture, economy, education, infrastructure, health and food access—and then uses data aggregated at the zip code level to determine areas that are under-resourced. This tool helps clients identify the biggest opportunities in their member population and use analytics to better inform their decisions.

How should plan sponsors approach SDOH for specialty patients?

There are a few ways that plan sponsors can address the impact of negative SDOH on their specialty population:

  • Ensure that they’re with a specialty partner that’s addressing health equity issues.
  • Educate members about all of the resources available to them, such as copay assistance programs or social workers who can help patients access community resources such as transportation services.
  • Address access barriers by providing benefits that include telehealth, home nursing care and medication home delivery options.
  • Use relevant data and emerging tools to understand needs across their population and to offer programs and services that address those gaps.

Social determinants of health affect every aspect of member wellness, so addressing adverse elements is key to optimizing outcomes and helping people get access to and engage in the care they need.

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Evernorth Specialty Management
Specialty can be a major driver of your total benefit spend, especially considering changing regulations, growing drug approvals, and alternative treatments coming to market. Evernorth Specialty Management can help you get the most out of every health care dollar spent on specialty-related treatments, services, and procedures. We empower plan sponsors with tools and solutions to make smart, effective benefit decisions in a complex specialty environment.