“Conditions in the places where people live, learn, work, and play affect a wide range of health risks and outcomes. These conditions are known as social determinants of health (SDOH).” – CDC

With all that’s happening in the Medicare space, one theme rises to the top: social determinants of health (SDOH). It’s not hard to understand why SDOH have become a hot topic. A growing population – a growing older population – and mounting research show us how important it is to develop healthcare that treats more than physical health. This drives us to establish what the CDC refers to as “health equity,” and for Medicare Part D programs, it’s critical.

How SDOH and Adherence are Intertwined

SDOH include the conditions of a person’s life which impact their ability to care for themselves emotionally, mentally, and physically. We know from our own research – you can see some of it here and here – that the primary barriers to adherence are:

  • Forgetfulness
  • Poor or no understanding of the condition being treated.
  • Lack of education related to prescriptions and side effects.

Translation: when it comes to taking or not taking medications as directed, SDOH are actually the primary driver for many members.

“The relationship between care coordinators and patients must be cultivated over time to lead to a more assertive, more effective approach. This creates stronger patient accountability and greater adherence.” – 6 Things Health Plans Need to Create Successful Medication Adherence Programs

What Adherence Programs Must Include to Address SDOH

Part D adherence programs rely on the power of interventions, and the effectiveness of those interventions, to drive better health, better quality care, and better Star Ratings bonuses. Successfully achieving this goal must tackle SDOH factors with these three tactics:

  • Proper intervention mix. This means establishing the right mix of intervention channels and risk stratification analytics to drive expensive interventions (e.g., live calls) to higher risk members.
  • Useful engagement tools. High-risk members will only change behaviors when presented with quality conversation and the right level of contextual information.
  • Dual-powered outreach strategies. Near-real time reporting on intervention deployment, reach, and receptivity rates, must be used to both analyze and predict.

Real-Life Examples of Health Plans Maximizing Strategies to Include SDOH

So what do these “tactics” actually look like in practice across a health plan’s diverse member base? We can show you – check out these examples of how real regional and national health plans apply this approach in their Star Ratings initiatives:

Activating Retail Pharmacies to Improve Medication Adherence in the MA Population

This health plan worked to activate local retail pharmacies as key engagement points for members. The live-calls from pharmacists lead to conversations with members that improved more than just medication adherence.

Empowering the Provider

This health plan treated care providers as a resource, deploying “provider-facing associates” to enable their physician network to engage members. The change allowed better, more tailored advice and information to be communicated to members from a trusted source, driving better member adherence across all measures, and then some.

Bringing SDOH to the Forefront of Medication Adherence Programs

MAPD plans can use all the tactics at their disposal to change medication adherence, but none of them will sway Star Ratings without strong, intentional relationships between callers (i.e., the pharmacist, provider, or otherwise) and members. We know firsthand that person-to-person interactions allow callers to provide high-risk members customized information and assistance. They also allow callers to gather data on non-adherence, informing future strategies at an enterprise-wide level for MAPD plans.

The future of medication adherence strategies includes approaches that enable and empower members to change their behaviors by delivering the right context at the right time and in the right way. For MAPD plans, that means using proper management and reporting tools to refine interventions as powerful instruments that address SDOH.


Are You Missing SDOH in Your MAPD Strategic Initiatives?

We have lots of tools you can use to support your strategies. Alternatively, request a consultation, demonstration, or person-to-person conversation. Here’s where you can find us.