Aligning Patient-Centered Goals to Improve Quality of Care, Address Health Inequities

As health care organizations develop strategies to address health equity and disproportionate patient outcomes, the process of pairing patients with the right therapy or care plan warrants communication between the patient, health plan, and care provider.

During a session at the 2021 Pharmacy Quality Alliance (PQA) Annual Meeting, panelist and patient advocate Aberdeen Allen, a research chemist from New Jersey, spoke about the challenges he initially encountered before being diagnosed with rheumatoid arthritis (RA) more than 15 years ago, which included being suspected of drug seeking during an emergency department visit, being perceived as healthy by physicians, and lacking a true relationship with his care team.

“I’ve had to go through several doctors, work really hard, and become my own advocate because of the issues that I experienced while getting the proper treatment that I needed for my RA,” said Allen.

Finally being diagnosed with RA after 3 years, Allen’s first visit with a rheumatologist led to the prescription of several unsuccessful medications to address his condition, with the physician being dismissive toward his increasing pain.

“When I sat down with a new rheumatologist I expected the same treatment and to my surprise...she stopped and asked me: how are you doing emotionally? And that just blew my mind because no doctor had ever asked that,” said Allen. “This was the first time I really felt that I had a doctor that cared.”

Although Allen eventually created his own “dream team” of care physicians who listened and continue to assist him in his care journey, his experience is not a rare instance in the health care system, noted panelist Lori Hall, director of Global Health Literacy at Eli Lilly and Company (Lilly), who highlighted the disproportionate lack of understanding, or health literacy, of underserved groups at-risk for several health outcomes, such as RA or cancer.

With over 30 years of health care experience in the clinical setting, Hall’s work at Lilly focuses on advocating for the needs of patients and prioritizing health literacy.

“If patients can’t access our medicines, don’t understand what our medicines are for, or don’t take them as prescribed–they can’t experience the full potential of what that medicine can offer to manage their condition or make their life better,” said Hall.

With social determinants of health accounting for 80%-90% of health outcomes, Hall said that Lilly has began to educate their patient support, education, and assistance program teams, as well as payers and providers, on aspects such as HHS CLAS standards and even active listening to improve health literacy of culturally appropriate care and reduce health disparities.

Building on the conversation regarding adverse patient experiences and the importance of improving health literacy, panelist Sharon Jhawar, chief pharmacy officer of SCAN Health Plan, discussed the journey of her organization in addressing health equity, as well as disparities in medication adherence.

Serving approximately 220,000 Medicare beneficiaries, Jhawar noted that when SCAN took a look at its star ratings of its health plan, its 4.5 star overall rating was not uniformly met across each race, which spurred dialogue within the company on how to address these disparities.

“One of the things that jumped out to us is that among our Black and Latinx members, medication adherence was 3% lower,” said Jhawar. “We all know that if you take your medications as you should and routinely, it does lead to better health and management of chronic conditions.”

Focusing on medication adherence issues in these 2 groups, SCAN made it a corporate incentive goal tied to every employee this year to reduce these rates by 25%.

Although cost of medication is typically perceived as the main driver of medication non-adherence, SCAN’s benefit design is structured to where 90% of medications for its older adult beneficiaries has a $0 copay, indicating that cost was not the root cause.

Seeking feedback from patients, providers, employees, and other health plans, SCAN gained insight into several issues impacting its care value, which included connecting with members of the community that they served, building personal health literacy among Latinx and Black beneficiaries to provide a level of knowledge of their care, and connecting/educating on mail-order utilization, particularly among Latinx groups.

Integrating interventions to better address these issues, such as cultural humility training and pairing members with care teams by language or race, Jhawar acknowledged that SCAN is currently in the beginning of its journey and will continue to innovate and improve to reduce medication adherence issues and other disparities that are observed in quality measures.

“Our plan is to make refinements, have new interventions, and as we put things into motion and we find out what is working, we’re going to thinking though how to expand and scale those things,” said Jhawar. “It does take a village to tackle this so we’re thinking about how we can partner with our medical groups, retail pharmacies, as well as our pharmacy benefit manager.”