Guest expert and AMCP 2024 presenter Meron Gartner, PharmD, elaborates on how pharmacists play a crucial role in addressing social determinants of health by engaging with patients, identifying barriers, and connecting them to resources for improved outcomes.

I am Meron Gartner, I am a pharmacist and I am our director of payer products at Outcomes. We used to be called OutcomesMTM, but we're Outcomes. We mainly focus on medication therapy management services but think of a broader scope of comprehensive medication reviews but also addressing adherence and we're getting into social determinants of health space as well.
I've been with the company for 10 years, so I've seen a lot of transition in the industry, a lot of transition with the company, and have just had a passion for it ever since I was in pharmacy school, very much an advocate for helping pharmacists to deliver more clinical services and help the patients and get reimbursed for it beyond just being reimbursed for dispensing medications. 

What are some common social determinants of health (SDOH)-related barriers to appropriate care that pharmacists have identified in their practice settings? 

We have a formalized social determinants of health assessment that's 9 questions and pharmacists will ask patients what barriers they have and give pointed questions about “Do you have access to food, do you have access to housing?” So they've uncovered all sorts of barriers through that assessment, one of the most common being loneliness and transportation. So if we're targeting members in like an elderly population who are homebound and not being able to see their friends very often, loneliness can creep up a lot. So that's an interesting one to find solutions for but there are community programs that can help with that.

And then transportation is a little bit easier to solve but it does come up a lot as a barrier with patients. Just being able to access the pharmacy so they can offer delivery services but then having to find transportation services also to the physician clinic as well so they can see their doctor to get their prescriptions. 

Can you describe a specific example of how engaging pharmacy teams in SDOH screening and intervention has led to improved patient outcomes? 

We have some really cool data about just holistically some of the programs we've run, and we've seen that 55% of the time the pharmacists are attempting to do the service, so it's an area that they're getting more comfortable in. And they know a lot about their patients because they see them like 35 times a year when they come in to pick up their prescriptions. So they're very familiar with the patient so asking these questions they just kind of had to get used to. So 55% of the time they're actually reaching out to members and then when they actually get those completed successfully, 74% of the time they are uncovering a barrier.

So that shows that patients [are] really comfortable opening up and being honest about their situation and sharing that information back with the pharmacist. And then over 80% of the time that pharmacist is like taking the next step and trying to help them resolve that. So could be providing education, could be providing guidance about a community resource, all sorts of things. And then we did have a patient specific example where a patient shared that they didn't have access to housing or they were losing their housing in the end of the week. And the pharmacist was able to find a local resource that we had actually queued up in our system. We provide, if the patient has a specific barrier, the pharmacist types in the zip code and we will surface some resources for them. So the pharmacist pointed a patient in the direction of a housing resource.

That patient went that day, secured housing, and then came back into the pharmacy and thanked the pharmacist for connecting them with that housing resource so they didn't lose their housing at the end of the week. It's just like a crazy example of a pharmacist engaging with a member in a pharmacy. You think about mostly medication-related things, but they helped a patient secure housing. So theres just very cool things happening out in the world. 

How can technology integration facilitate the resolution of gaps in social needs identified through SDOH screening? 

There's a lot of companies that have aggregated a list of companies that work in communities, so tapping into those databases and surfacing that information in front of the pharmacist or in front of whoever's doing the assessment could be other case managers or nurses or other cases in the health care industry. But just tapping into those and then putting those resources right in front of the pharmacist so when they're doing the assessment and engaging with that member they don't just learn that you don't have food and send them along their way that's not that doesn't feel great so actually like finding them a food resource to send them out with is really impactful. So I think that's the biggest tech thing right now is to focus on getting that linkage into the system and putting it right into the hands so it's very available for the pharmacist and the patient. 

What are some best practices for engaging patients in discussions about SDOH and addressing their social needs? 

I think it is really important to make sure that when you are doing assessments, that you have a plan to act on what you're finding. So 80% of a patient's health outcomes are related to social determinants of health. So if you're collecting the information and don't do anything about it, you can't be surprised that they have negative outcomes from that and you should have a moral feeling to help address those things if you found out someone doesn't have access to food. So the speed and having a plan of action for the collection of assessments like this is very important. And I think connection to the resources in a real time fashion is really critical.

And then how you open the conversation with the patient is really important. So first using someone who has a very trusted relationship with the patient is best practice, but also acknowledging that the assessment is going to open up into areas the patient might be uncomfortable with. So as a pharmacist you're not usually asking someone about their access to food or their access to housing. So just acknowledging it and saying like I know that these are very personal questions but I have your best interest at heart and I can actually use this information to find resources to help you. So that can make them open to the conversation a little bit easier. 

And even tying it back into other services. So pharmacists across the country are delivering comprehensive medication reviews. That's a longer form, 30-minute discussion about all of the meds a patient is on. And if you're already sitting down with that patient, you might as well also ask them about their social determinants of health, do they have access to food, housing, and transportation. It just kind of more seamlessly fits into the conversation if you're already just sitting down with them. 

In your experience, what role do pharmacists play in the overall health care team when it comes to addressing SDOH? 

I think pharmacists are underutilized as a health care provider to kind of fit into the overall health care team. They've been narrowly focused on dispensing money. in the community setting, and we've seen growth with medication therapy management and getting them involved in clinical services. And I think social determinants of health is another area where we want to make sure that they're getting engaged from the ground level, because they are seeing the patients more often than any other health care provider. That patient has to go in to pick up their prescriptions. Sometimes they're not filled in the same week, so they could be going in every single week to pick up medications. And we've seen in data that it happens that they're going to the pharmacy 35 times a year, which is a lot. That's like 10 times more often than you go to the doctor. So using that pharmacist and their interaction and engagement with the patient is a great way to get information into their hands about benefits that they could be using, collecting information about their social determinants of health, and just using that as an engagement point to take care of them more holistically. And then paying the pharmacist to engage in that way is a model that we need to figure out so that we are incentivizing them to do those things. 

How can payers effectively leverage pharmacists as part of their strategy to reach all members for SDOH screening? 

Pharmacy being a part of the SDOH plan and the health equity strategy is the best approach. It doesn't have to be the only approach. What we're trying to offer in engaging pharmacists is not that this is the only solution. But if you are doing assessments and collecting information in the physician's office and you're collecting information maybe when they're hospitalized, those can all feed into your SDOH strategy. But for those members that aren't in those settings and didn't complete assessments through the other avenues, pharmacists are a great way to do that just because they've got such extreme access to those patients. They typically have better phone numbers. They just are a great access point to close the gap especially if health plans are trying to reach high rates of social determinants of health assessments, there's a new quality measure that social needs screening and intervention where health plans will be measured on how many members are they assessing and then how many are receiving interventions for those gaps. And so health plans are going to have to have good strategies to perform on that measure and if you're not reaching members, pharmacy is a great solution to kind of fit into the model.