What Can My Pharmacy Do? The Path to Health Equity, Part 5
The following is part 5 of 5 in a series of articles titled, "The Path to Health Equity" by Jason Ausili, PharmD, MSLS, Head of Pharmacy Transformation for EnlivenHealth, as well as other contributors to Ask Your Pharmacist.
Community pharmacies have the potential to transform the health landscape. While their primary role has historically lied in dispensing medications, pharmacies can transcend their traditional boundaries and become catalysts for change, addressing social determinants of health (SDOH) and promoting health equity.
But how?
Embedded within communities, pharmacies can identify and address SDOH needs, bridging the gap between medication adherence and overall health improvement. By partnering with local organizations, pharmacies can connect patients with essential resources, such as food banks, housing assistance programs, and transportation services. They can also provide education and counseling on healthy lifestyle choices, empowering patients to make informed decisions about their health.
But not all pharmacies are alike, of course. And their approaches to SDOH needs can be just as varied as the medications they keep on their shelves.
Different Solutions, Different Methods, One Goal
Independent pharmacies and retail chain pharmacies approach addressing social determinants of health from distinct perspectives, each offering unique strengths and potential impacts.
Independent pharmacies, deeply rooted in their communities, often possess a more intimate understanding of the specific SDOH challenges faced by their patients. This localized knowledge enables them to tailor their approach to address the specific needs of their community, building trust and fostering meaningful patient-pharmacist relationships. Additionally, independent pharmacies are often more nimble and adaptable, allowing them to quickly adopt innovative SDOH interventions and pilot new programs.
On the other hand, retail chain pharmacies, with their extensive reach and operational resources, have the capacity to implement SDOH initiatives on a larger scale. They can leverage their centralized infrastructure and data analytics to identify SDOH trends and develop targeted interventions across their network of pharmacies. Furthermore, chain pharmacies often have established partnerships with community organizations, healthcare providers, and insurance companies, enabling them to seamlessly integrate SDOH initiatives into their existing care pathways.
In essence, independent pharmacies shine in their personalized approach and ability to adapt to local needs, while big chain pharmacies excel in their ability to implement SDOH interventions at scale and leverage their extensive resources. Both types of pharmacies play a crucial role in addressing SDOH and promoting health equity, each contributing their unique strengths to the pursuit of a healthier society. Our healthcare system spends most of the time on clinical care when as much as 50% of outcomes are dependent on SDOH. Together, community pharmacy can make a substantial impact on health equity by shifting focus to the more dominant unmet needs in our community.
A New Avenue for Reimbursement for Services
In addition to promoting health equity and improving patient health outcomes, SDOH screening can also provide a new revenue stream for community pharmacies. For example, the Pennsylvania Pharmacists Care Network (PPCN) recently implemented an SDOH screening program across many of its member pharmacies. Through a partnership with payers like UPMC Health Plan, PPCN community pharmacists are getting reimbursed for delivering SDOH screenings and other services.
From August 2022 to March 2023, PPCN pharmacies performed over 1,100 SDOH screenings for patients. During a webinar sponsored by pharmacy software provider EnlivenHealth®, PPCN Executive Director Stephanie McGrath, PharmD, shared that a Medicare managed care organization reached out to PPCN and specifically asked for help identifying and resolving SDOH-related needs for their highly vulnerable members. "Pharmacists are so accessible," said McGrath. "Pharmacists can reach members of health plans when they won't pick up the phone for someone they don't recognize. One of the reasons pharmacies are so valuable is because of their accessibility to patients."
Under PPCN's program, pharmacists are compensated for administering the SDOH screenings and for making referrals. The screenings are performed under a hybrid fee-for-service and value-based payment model, with the value-based part coming from the referral.
In an August 2023 press release, PPCN President and Chief Operating Officer Brandon Antinopoulos, PharmD, said, "Our pharmacies go above and beyond to identify patients' needs that keep them from effectively managing their chronic conditions and connect them with resources to meet those needs so they can focus on their health, manage their chronic conditions, and improve health outcomes."
Big Reach, Big Scope, Big Results
On the chain pharmacy front, CVS Health's groundbreaking pilot program, "Destination: Health," demonstrates the company's commitment to addressing social determinants of health and promoting health equity among its patient population. This program leverages the power of CVS's personalized messaging platform to identify and address SDOH needs, bridging the gap between medication adherence and overall health improvement with targeted messages and resources for patients.
Taking the initiative a step further, CVS Health invested $114 million in affordable housing in 2020 and 2021, leading to the construction or rehabilitation of 2,800 affordable housing units in 30 different cities.
In December 2023, healthcare powerhouses Kroger Health and Soda Health, Inc. announced a joint venture known as the Smart Benefits program, combining the services of Kroger Health with Soda Health’s “&more” debit program that makes it easier to do things like purchase healthy foods and pay for transportation to medical appointments using healthcare funds.
Finally, noted pharmacy chain Walgreens is also no stranger to the push for health equity. With one of the greatest reaches of a single pharmacy brand, Walgreens has administered 40 million vaccines in underserved communities, operated 1,500 offsite clinics in 46 states, and visited 19 cities across 12 states as a part of its mobile vaccination bus tour.
Coming To a Pharmacy Near You(rs)
Community pharmacies are well-positioned to implement SDOH screening programs due to their accessibility and frequent interactions with patients. Two models have been shown to be effective in implementing SDOH screening programs in community pharmacies: the SDOH specialist model and the community health worker (CHW) model.
The SDOH specialist model involves training pharmacy technicians or drivers to identify, screen, and refer patients to SDOH resources. This model is a sustainable first step because it is easier to train current staff to be SDOH specialists than it is to train CHWs to be pharmacy technicians. Also, where states allow, specialized pharmacy technicians are prime candidates for the CHW designation with appropriate training. “Pharmacy technicians can—and have been—trained to be CHWs”, according to Tripp Logan, PharmD, from L & S Pharmacy in Charleston, MO.
Historically, the CHW model involved hiring certified frontline public health workers to provide care management, circumvent barriers, and advocate for patients. This model is more comprehensive than the SDOH specialist model and may also be more expensive, but if you can leverage your existing technician staff as CHWs you can amplify professional growth and retention among valuable community assets.
Regardless of which model is used, SDOH screening programs in community pharmacies should include the following steps:
Identify and screen patients for SDOH needs using trigger questions. Trigger questions are designed to identify patients who may have an SDOH need, such as food insecurity, utilities and bill payments, stable housing, childcare, healthcare costs, transportation, health literacy, and safety.
Assess and refer patients to the appropriate resources. Once a patient has been screened for SDOH needs, the pharmacist or CHW should assess the patient's needs and refer them to the appropriate resources. This may include community organizations, government programs, or other healthcare providers. Sources such as findhelp.org offer zip code level access to many different community resources.
Create a care plan. The pharmacist or CHW should work with the patient to create a care plan that addresses their SDOH needs. This care plan should include goals, action steps, and follow-up dates.
Follow up with patients. The pharmacist or CHW should follow up with patients to track their progress and make sure they are accessing the resources they need.
By implementing SDOH screening programs, community pharmacies can play a vital role in improving the health of their patients and communities.
A Beacon of Hope
The impact of a single pharmacy may seem small, but when replicated across communities, it can generate a ripple effect, transforming the health trajectory of individuals and fostering a more equitable healthcare system. Pharmacies, armed with knowledge, compassion, and a commitment to community well-being, can become beacons of hope in the pursuit of health equity.