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What Role Do Social Determinants of Health Play in Market Access?

By Julia Scanlan

A patient’s journey to accessing life-saving therapies is rarely linear, and while much of that is due to factors within the healthcare system, many external influences are also at work. Social determinants of health are an example of these outside forces that play a crucial role in patient care, for better or for worse.

Social determinants of health (SDoH), as defined by the CDC, “are conditions in the places where people live, learn, work and play that affect a wide range of health risks and outcomes.” These are the non-medical factors that influence health outcomes, such as economic stability, healthcare access and quality, neighborhood and environment, and social and community context. While these factors can positively impact overall health, unhealthy housing options, unemployment, food insecurity and lack of access to quality healthcare are all unfortunate results of SDoH in which health systems have invested billions of dollars to address.

In other words, medication or therapies alone will not improve a patient’s overall quality of life. Researchers estimate that demographic, environmental and social factors contribute up to 80% in determining patient health outcomes, so mitigating the negative impact of these factors is imperative to improving both access and outcomes for individuals and lowering overall costs. For this reason, payers and providers must learn to incorporate these factors into their practices to evaluate patients holistically. 

The Role of Manufacturers, Payers and Physicians 

While there’s plenty of awareness of SDoH, determining who’s responsible for addressing these issues in healthcare is complicated. Should providers oversee alleviating lack of access to quality healthcare? Or should physicians be responsible for addressing these factors? Or is it neither and instead the burden of government programs? Addressing SDoH requires multifaceted, multi-stakeholder approaches, and the coordination of healthcare and social services to best serve those in need. This could include payers, physicians and practice managers establishing a universal standardization for capturing SDoH data, or manufacturers working in tandem with payers to share resources and implement data analytics and predictive analyses to ensure at-risk patients are getting the care they need, among many other options.

According to MMIT’s 2022 Managed Care Index report, most payers have indicated that they are aware or highly aware of social detriments of health, while around half of oncologists report that social determinants of health are top of mind. Also, most payers believe that SDoH has a very large impact on patient care and, therefore, is very important.

Some top reasons that payers indicated for why they believe patients do not maintain good health are socioeconomics, education, health literacy, and linguistics and communication, among others. Most payers believe that the biggest barrier to tackling social determinants of health is an unclear return on investment.

Looking Forward 

Many private and public institutions have already started addressing SDoH, such as state Medicaid programs, the Children’s Health Insurance Program (CHIP), and providers such as Aetna, Anthem, CareSource, Humana and Kaiser Permanente. While an encouraging start, the real challenge to helping improve a patient’s access to therapy will lie in how committed all stakeholders are to collaborating and taking action to address SDoH. We’re starting to see some manufacturers teaming up with organizations to provide food within local communities, provide services to homebound seniors, donating sums of money to support inequalities, partnering with organizations on providing housing with lower income areas, and more.

Payers and prescribers are very aware of SDoH, and they are implementing programs even though they are unsure of the return on investment. Going forward, manufacturers should consider strengthening their partnerships with payers by working on objectives around SDoH. One payer from MMIT’s Managed Care Index indicated that they are already partnering with manufacturers on social detriment of health initiatives. Specifically, the payer said that “collaboration with manufacturers on health literacy and clinical study inclusion for minorities and communities of color” is one such tactic.

While adoption of a new approach is slow in most industries—and healthcare especially—traction will build as the ROI becomes clear. As payers start initiating SDoH programs and learning what works, we could expect a rapid adoption if the data is showing a positive ROI. Having an SDoH strategy could even give manufacturers a leg up within a therapeutic area, or ensure that they aren’t left behind in a competitive marketplace.

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© 2024 MMIT
Julia Scanlan

Julia Scanlan

Julia Scanlan is an Associate Consultant at MMIT.

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