Health equity, defined by the CDC as a “state in which everyone has a fair and just opportunity to attain their highest level of health,” is a somewhat new concept—only just beginning to gain traction in the early 2000s. While the symptoms of health inequalities are arguably not new, the COVID-19 pandemic has resurfaced these issues and spurred ever-increasing urgency to find better solutions. Unfortunately, the root causes of health inequities are deep and often multifaceted. This makes health inequity extremely difficult to tackle.
It is a commonly held belief that social determinants of health (SDOH) are mostly responsible for health inequities and greatly affect health outcomes. Data from GoInvo indicates that 68% of the impact on health comes from SDOH factors versus other factors such as genetics and medical care (see Figure 1). Understanding and addressing SDOH factors are necessary steps in the journey to reduce health disparities and achieve health equity.
What are social determinants of health (SDOH)?
SDOH are broadly defined as the conditions in which people are born, grow, live, work and age. With mechanisms in place to address social needs—for example, lack of food or housing—healthcare organizations can help bring lasting impact to the community and support better health outcomes.
Instead of operating in silos, healthcare organizations need to recognize how valuable cross-industry partnerships are when addressing the SDOH factors that contribute to health inequities. Some health plans and provider organizations have already adopted this approach, but today’s SDOH landscape requires involvement from additional organizations including pharmaceutical companies, technology companies, universities, community-based organizations (CBOs) and other health-focused organizations. All parties stand to benefit from the influx of resources, expertise and new perspectives that come from partnering with each other.
Merck and ZS, for example, have partnered to develop a fresh perspective on how healthcare organizations can play a role in shaping the future of SDOH programs. This is one instance of how healthcare companies, including pharma companies, have an opportunity to become more active and make a significant impact.
Health plans are early SDOH collaborators, but more involvement is needed
Some health plans and provider organizations are actively working to better understand the ecosystem that affects patient health. They have found that by addressing SDOH-related inequities, they can achieve better health outcomes for patients and generate substantial value for the healthcare system. UnitedHealth Group (UHG), for example, has invested more than $400 million to “build 80 communities in 18 states, resulting in more than 4,500 new, affordable homes with onsite support services to help people live healthier lives.” UHG studies have shown investments that address homelessness can result in a 50% drop in emergency department admissions and a 60% decrease in the total cost of care for an enrolled member.
By investing in SDOH initiatives, such as addressing transportation challenges or food insecurity, health plans and provider organizations hope to lower healthcare costs and improve the patient experience. Given that the U.S. spent $3.3 trillion or 17.9% of the gross domestic product on national health expenditures in 2018, tremendous pressure is being placed on health plans and provider organizations to move to value-based care—with the goal of maintaining high-quality care while lowering the cost. Health plans and providers also are under pressure to address changing patient expectations by providing a transparent and seamless healthcare experience. By understanding the socioeconomic factors that affect patient health outcomes, healthcare ecosystem players can deliver meaningful impact, better meet customer and patient expectations, and help shape the healthcare landscape.
Traditionally, health plans and health systems have addressed SDOH programs independently. But both segments recognize the greatest SDOH impact can be made through broader partnerships and coalitions. In fact, to fully address SDOH at a holistic level, partnerships that break down the silos across healthcare, public health and social services are needed.
FIGURE 1: The value of SDOH interventions
2. Intervention spending is the money spent to address the problem, not the total money spent in that area.
Pharma companies can, and should, play an active role in addressing patients’ social needs. In fact, SDOH influence every part of a pharmaceutical product’s life cycle from research and development (through representative clinical trial recruitment) to launch. These factors also can shape a product’s growth, maturity and eventual decline in the market. Pharma companies are well-positioned to identify social risk factors and unmet social needs and can play an important role in addressing and mitigating those needs. While investing in SDOH programs could affect each stakeholder’s bottom line differently, there’s value in forming partnerships within the healthcare industry and beyond.
Top considerations as healthcare ecosystem partners join forces in SDOH programs
Pharma companies, health systems and health plans should consider three factors as they form partnerships and deepen their investments in SDOH-based programs:
1. Create productive partnerships
Healthcare ecosystem players need to approach partnerships from a perspective of flexibility, transparency and co-creation, ensuring that they’re value driven. Before partnering, organizations need to establish the right internal support, capabilities, objectives and partnership evaluation criteria. Organizations should objectively assess their own capabilities as well as the barriers to addressing SDOH and seek out partners that can fill capability gaps or help knock down those barriers. Some of the most common gaps occur in knowledge, access, finances or infrastructure.
The right partnerships can help build credibility and improve overall public perception of the program. For example, coalitions that include pharma companies, health plans and CBOs allow all parties to better address needs and access populations at a local level. Such partnerships can ensure that the health plan’s membership data reaches the right people, while pharma companies can potentially supply the infrastructure and sophistication needed to execute on an SDOH initiative. Partnering with a health plan gives the program credibility within the SDOH space, while partnering with a CBO gives the program credibility within the community. CBOs also gain increased scale, resources and technical expertise from these partnerships, while health plans receive external resources, expertise and access to key membership populations.
There are multiple factors to consider and actions to take when establishing best-in-class SDOH partnerships across pharma, health systems and health plans:
- Achieve universal alignment on the objectives for SDOH initiatives. For example, a pharma company that wants to focus on a particular therapy area should find a partner that sees the value in addressing that area. Partnerships may extend to health plans based on the channels where priorities align with the partnership initiator. Sometimes those partnerships may include a Medicaid program with a homogenous population in a state or region where a key membership population resides.
- Invest in organizational resources that understand population health. Organizational sophistication plays a key role in successfully designing, implementing and operating a SDOH program. It’s important to understand population health as a concept before trying to address something like SDOH.
- Form an organizational commitment to support SDOH initiatives. This may seem self-evident. But considering the importance of partnerships to properly address SDOH, the need for leadership buy-in and support is essential.
Organizational commitment can take on many shapes and forms, including dedicating roles and resources to SDOH programs and documenting SDOH efforts in company mission statements, performance reports and long- and short-term investment goals.
2. Look for strong data infrastructures
These partnerships require sophisticated data infrastructures. Strong infrastructure capabilities are needed to scale SDOH programs by optimizing key aspects such as data collection, training and marketing initiatives. Equally significant to finding the right partners is evaluating which SDOH programs to invest in based on how feasible they are to execute and scale.
Infrastructure needs can include dedicated resources, appropriate technology or extensive community reach. It’s important that the partnerships include the right data infrastructure and analytics capabilities to collect data, train personnel, increase awareness and expand initiatives. Beyond data capabilities, the organization needs to have personnel who understand the broader concept of population health and the most effective ways to address it.
3. Measure the value of your investment
The preventive nature of SDOH programs creates a challenging proposition: How to measure the value or return on an SDOH investment. There’s no standardized process to measure value, so it’s important for an organization and the partnership to develop a methodology that identifies what their desired value is. All parties should adhere to a few guiding principles, such as being transparent and flexible, throughout the course of a SDOH partnership (Figure 2).
FIGURE 2: Guiding principles of SDOH partnerships
A few of the ways that a SDOH program’s value can be defined and measured include:
- Its ability to provide financial value for providers and patients alike
- How the program supports the triple aim by lowering costs and improving the quality of healthcare through holistic interventions
- How it can serve as a gold standard for SDOH valuation
- Whether it establishes reporting methods and standards for providers and social organizations to quantify valuation
There’s no one answer for how organizations should define value, but each organization needs to ensure it has a process in place that quantifies value and can support a sustained investment.
By defining value upfront, an organization can identify partners that have the same shared vision or objectives. This alignment allows a partnership to flourish, as partners can agree on a timeframe and put the necessary processes in place to quantify a return. This requires not only collaboration but also the underlying technology and skill sets needed to perform the analytics on the SDOH data. It’s imperative to have this infrastructure in place as partnerships seek to determine the differences between an actual and projected outcome.
A real-world example of a successful SDOH program
What does it take to successfully execute a SDOH program? The first step involves the co-creation and design of the initiative. This includes decisions on which social need to address, whether it’s an individual or community need, who the target population will be, and how and when the value of the program will be measured.
Here’s one real-world example: A large health plan partnered with a rideshare service to address its members’ transportation issues. The partners piloted the program with a small subset of members in Chicago. From a data infrastructure perspective, the partners paired the health plan’s ZIP code data and technology along with the rideshare company’s services. To measure the value of their program, the partners tracked the number of missed appointments for non-emergency medical care in areas without optimal transportation alternatives.
How to scale SDOH initiatives
Once SDOH initiatives have been designed and piloted, partners can decide whether to scale the program. During this step, organizations should evaluate the ability to scale a given program nationally by establishing a framework that evaluates how effective a program could be. This includes looking at the technology needed, how localized the needs being addressed are and what resources are available. In the case of the partnership between the health plan and rideshare company, scale was achieved by expanding the pilot program to include health plan members in all 50 states.
Organizations should focus on making an impact locally and developing a framework that helps determine if programs or parts of programs can be scaled to other communities. Smaller SDOH initiatives can make a big impact on their given populations and shouldn’t be overlooked or abandoned simply due to a lack of or difficulty in scaling. To account for health disparities’ nuances, it’s often better to identify archetypes and design SDOH initiatives for a specific population rather than trying to apply a one-size-fits-all solution to several populations.
The partnership between Merck and ZS is dedicated to helping other healthcare organizations design programs that have a positive impact on SDOH and, ultimately, health inequities. In today’s world, enormous opportunities exist for healthcare organizations—specifically pharma companies—to become more invested in health equity programs that make a significant impact across the populations they serve.
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