Pilot Program Targets Social Determinants Of Health Barriers for Members With MS

Recently, health insurers have begun focusing on social determinants of health (SDOH) and the role these factors play on health outcomes. Then the COVID-19 pandemic put even more of a spotlight on the issue, disproportionately affecting people of color and low-income communities. Recognizing the impact that SDOH can have, AllianceRx Walgreens Prime is partnering with Highmark Inc. to launch a pilot outreach program focused on the impact of SDOH on people with multiple sclerosis (MS).

According to the Healthy People 2030 initiative from HHS’s Office of Disease Prevention and Health Promotion, SDOH “are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” These include financial strain, transportation needs, food insecurity and housing instability.

The program will apply to Highmark members with an MS diagnosis who use AllianceRx Walgreens Prime as their specialty pharmacy. To participate, these members must be willing to take part in a 13-question, voluntary survey conducted via telephone. SDOH-trained nurses from AllianceRx Walgreens Prime are contacting eligible members by phone and offering to administer the survey. Highmark will assess the survey responses to identify how it can design a specific care plan for each member facing SDOH challenges.

The pilot will determine the success rate of a specialty pharmacy in administering the survey and the ability to address any member issues.

“Based on the self-identified needs of the member, the Highmark Social Work team will outreach to further assess the SDOH issue or barriers,” explains Amy Shannon, director of health and wellbeing integration at Highmark. “In partnership with the member, our social worker will identify available resources to assist in reducing or eliminating the barrier.”

The outreach, she says, “is the first step to help ensure members who are already facing health challenges have the support and resources they need to overcome barriers in other aspects of their lives which impact their health. By reducing or eliminating these barriers, people are free to be their best.”

“This pilot demonstrates the continual evolution of patient care and collaborative efforts between key stakeholders,” says Nebeyou Abebe, senior vice president of social determinants of health for Highmark. “Highmark recognizes that to understand and impact health, we must consider the physical, mental and social health of our members. Understanding, identifying and addressing SDOH factors that MS patients experience is a further commitment to improving their treatment journey and overall outcomes.”

“SDOH can drive up to 80% of an individual’s health outcomes,” Shannon says. “It’s imperative that we assess and provide support to members who are facing SDOH issues.”

The nurses began making phone calls on April 19. Since then, AllianceRx Walgreens Prime already has identified some SDOH barriers among Highmark members, says Rick Miller, BS.Pharm., MS.Pharm., vice president of clinical and professional services at AllianceRx Walgreens Prime.

The pilot is focusing on seven domains, he explains: “social connections, financial resource strain, health literacy, food insecurity, transportation needs, safety and housing stability. While these SDOH domains may impact any patient with a health condition, in the short time the pilot has been live, we have already identified transportation needs, housing stability and financial resource strain as concerns within the MS population.”

Miller notes that AllianceRx Walgreens Prime and Highmark have worked together on “several innovative programs to support Highmark members receiving specialty medications, focusing on improving the quality of patient care, as well as addressing the overall cost of health care. The SDOH pilot was a project on which both organizations enthusiastically aligned as an area of focus.”

According to Shannon, “since November 2019, Highmark has used a standardized SDOH survey to assess for barriers that health plan members may be facing.” More than 50,000 Highmark members have completed it.

As far as starting the program with a focus on MS, Miller says that both AllianceRx Walgreens Prime and Highmark already had
“dedicated clinical and operational teams to support the MS patient population. With that infrastructure already in place, we selected MS as the initial disease state to pilot the SDOH survey process.”

Miller explains that some metrics that will be tracked to measure the pilot’s success include:

  • The number of Highmark members eligible for outreach by AllianceRx Walgreens Prime;
  • The number of Highmark members outreached by AllianceRx Walgreens Prime and the disposition of each outreach (e.g., could not reach, left voicemail, etc.);
  • The number of completed surveys;
  • The number of Highmark members identified by AllianceRx Walgreens Prime as having an urgent member need(s) and referred to Highmark through an escalation process for immediate action; and
  • Of completed surveys with identified SDOH concerns, how many Highmark members received support services.”

While the survey is offered by telephone only at this time, Miller says that “other communication and technology options are being explored. Based upon the success of the pilot, these additional options may be considered for future development,” such as digital-based solutions.

The program will run for one year. Depending on its success, additional patient populations may be included in future phases. “We are exploring a number of specialty disease states for future expansion,” Miller tells AIS Health, a division of MMIT. “Initial expansion would focus on chronic specialty therapies, as well as specialty disease states, such as oncology and autoimmune diseases, that can be complex and challenging for patients to navigate through the health care system.”

“Both companies are optimistic about the future of this program,” says Miller. “The opportunity for improving the quality of life among people with rare and chronic conditions is why we do what we do and is professionally rewarding for all those involved. It also underscores the importance AllianceRx Walgreens Prime places on innovation and collaboration with partners like Highmark.”

Contact Abebe and Shannon through Emily Beatty at emily.beatty@highmarkhealth.org and Miller through Adrienne Foley at Adrienne.foley1@alliancerxwp.com.

This story was reprinted from AIS Health’s monthly publication RADAR on Specialty Pharmacy.

© 2024 MMIT
Angela Maas

Angela Maas

Angela has an extensive background of editing, reporting and writing for trade and consumer publications. She has written Radar on Specialty Pharmacy (formerly called Specialty Pharmacy News) since she joined AIS Health in 2005 and has broad knowledge of the various issues at play within the space. Before joining AIS Health, she was managing editor at Employee Benefit News and Employee Benefit News Canada and managing editor at HemAware (a hemophilia publication), Lupus Living and Momentum (a multiple sclerosis publication). She has a B.A. in English and an M.A. in British literature from Arizona State University.

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