It’s broadly recognized that the majority of health outcomes in a population are driven by behavioral, social, economic, and environmental factors outside of the four walls of the clinic; these social determinants of health drive 80% of health outcomes for a given population.
To illustrate the interplay between Clinical & SDoH perspectives, here’s a summary of a recent conversation we had with a clinic leader:
- My patient is comorbid w/diabetes, clinical obesity, dyslipidemia, hypertension → My patient lives in a food desert and the nearest grocery store closed down a year ago. Now my patient can’t get fresh groceries without spending an extra hour and a half on the bus and it has become much, much harder to stay on a healthy nutrition plan.
- My patient isn’t adherent to her medication → It’s not that she doesn’t want to be compliant, but my patient’s neighborhood pharmacy closed down last month. Now she has the same issues as her grocery store problem and lives in a pharmacy desert. On top of that, her health plan’s PBM restricts her medications to its own pharmacies far from where she lives. And they insist on sending her HIV medications by mail through its PBM-owned pharmacies. She doesn’t have a stable address, having moved three times in the past year, and doesn’t want her HIV medications in the mail to protect her privacy.
- My patient missed her appointments → My patient doesn’t have a car, works two jobs, and her time is at the highest premium. Everything has to go right in her life, and she couldn’t take off work in the middle of the day to make her clinic appointment yesterday. My next available appointment isn’t for another three weeks, and will probably lead to another missed appointment given it’s in the middle of the day.
For 340B Covered Entities, this is nothing new: SDoH is an intuitive and lived experience every day, with native understanding of the barriers their patients face every day to access care.
How to address SDoH barriers effectively, however, is a much harder question to answer. While there are growing Medicaid Section 1115 waiver programs supporting & acknowledging these barriers from a reimbursement perspective, these programs are not everywhere and still in ‘pilot’ phase. Meanwhile, patient need persists every day, in all states, regardless of whether there’s a billing code to address these needs or not.
Your in-house pharmacy is your most accessible site of care
Fortunately, as a 340B Covered Entity closest to the ground and closest to community need, the answer to how to integrate SDoH & community health related services is hidden in plain sight: through your in-house pharmacy program.
When you as a 340B Covered Entity sets up an in-house pharmacy, you establish a brand new site of care with unique characteristics:
- In-house pharmacy is the most accessible site of care for your patients, with immediate availability vs. provider appointments scheduled days, weeks, or even months out at the clinic
- In-house pharmacy is the most frequent site of care, with the most encounters/touchpoints with your patients - whether it’s medications refills, MTM, or clinical services established through collaborative practice agreements (CPAs)
- In-house pharmacy holds a cost-effective, upskillable / cross-skillable labor force, whether through these same CPAs to augment your existing provider team, or expanding the scope of the pharm techs managing your pharmacy to support broader operations at your CE
- In-house pharmacy is powered by 340B savings, a flexible revenue engine that is uniquely suited to fund and sustain innovative programs to close care gaps for your community. This funding source is exclusive to you, and trusting in you to solve these hard problems and ensure you can cover what no one else will cover, cares about, or does – services insurance may not reimburse, but you as the provider know makes all the difference between whether a patient can navigate & access care to a positive outcome or not.
Leveraging these characteristics, your in-house pharmacy is your new tool to address SDoH barriers for your community now. Think of your in-house pharmacy - what we call at Alchemy the ‘physical layer’ of your pharmacy program - as your launchpad to extend a robust ‘clinical layer’ of services beyond the four walls of your clinic and meet SDoH head on.
How Alchemy partners with you to expand your in-house pharmacy beyond the four walls
At Alchemy, we partner with you to design & deploy your pharmacy service to meet the totality of your community’s needs. We start with the physical ‘table stakes’ of setting up and launching your in-house pharmacy to stabilize your 340B program revenues, which is the engine for the services you provide for your population.
But from there, we bring all of what we’ve collectively learned on the frontlines, designing and deploying clinical, technology & product experiences for patients to stay deeply connected to care – and partner with your team to deliver measurable, reportable health outcomes for your population, with significant bottom line financial results to ensure you can sustain their care for the long-term. The majority of our founding team comes from non-profits and the grant-funded healthcare world. We were trained at the largest HIV clinic in the world and understand how crucial it is to secure stable, ongoing funding to build trust within the community and keep them engaged with their care.
But once this funding is stabilized with the in-house pharmacy, the opportunity is in how we flex this new asset to address all access barriers beyond the four walls of your clinic. In the background, we layer in insurance enrollment programs, find new grants & revenue opportunities for your CE, handle all PAs for your providers, and cross-train your new on-site pharmacy team to better meet patients where they are. Now, your new pharm tech and logistics personnel are also your community health workers. Your pharmacists are now an extension of your provider team. And we design this in a way with you that is both mission and margin accretive at every step.
Take our most recent case study, where we partnered with STD Clinic leadership to link a historically difficult population to care: intravenous drug users – a population with disproportionately high risk, incidence, and prevalence of HIV and Hep C infection. They’re significantly impacted by behavioral determinants, compounded by transient shelter, social shame and isolation.
Once our in-house pharmacy was established, we immediately launched an expanded mobile clinic and community outreach service to find patients where they are, away from clinical services and brought care to them. For some patients, this literally meant couriering their medications in-person at the McDonald’s parking lot where they spend their daytime hours. For others, it was having a cross-trained community health worker & mobile clinic technician share her own story overcoming addiction to know they have a care team who understands them without judgment.
The results have been extremely impactful for the Covered Entity, both from a public health and financial standpoint. Combining best practices in product and service design with public health frameworks developed at the largest HIV clinic in the world, where we were trained and what informs our perspective and our DNA, we build this clinical layer in lockstep with your leadership team’s vision and specific to your community’s needs.
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