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Social Determinants, The Causes of the Causes

The social determinants of health are the conditions in which people are born, grow, live, work and age.1 You’ve probably seen or read the term in headlines, presented at conferences, or discussed at roundtables and meeting, but how are social determinants of health (SDoH) relevant to pharma?

Sachin Jain MD, MBA, Former CMIO of Merck explains it this way, “Every brand needs to take a precision approach to addressing social determinants, biopharma has a huge opportunity and imperative. You can produce medicines that will change lives, but if you don’t have the living conditions to support effective use of those medicines, we’re missing an opportunity to improve human health.”

Determinants, or drivers of health, are not a novel concept, yet there has been explosion of interest across the healthcare value chain. In fact, the “aha” moment was when healthcare stakeholders realized that in order to achieve optimal health outcomes AND value for healthcare services, determinants need to be addressed. 

Why?

In the shift from volume to value, understanding the complexity of patients’ lives is re-shaping drug development and commercialization. Only by analyzing data collected in routine medical care, and eventually from patients’ day-to-day lives, can pharma align with providers, payers, and regulators to design digital or traditional therapeutic interventions that will not fail in the face of complex real life.2

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Studies show that there are correlations to how patients live their lives and how effective drugs are. Coupling this with arguably one of the most important determinants, health literacy, pharma has an incentive and an opportunity to address SDoH in a variety of ways. Patients from traditionally disadvantaged social groups, limited education, or income levels have struggled with medication management. Rarely does a patient not want to be healthy, yet there are other obstacles keeping them from medication adherence.Patients don’t wake up in the morning and think “I’m not going to follow what my doctor told me to do today.”

There are a variety of societal challenges that keep patients from taking their medications such as high out of pocket costs, mobility, inability to get to the pharmacy, limited educational attainment, and health literacy. Pharma can work with local communities to promote health by offering free transportation to and from pharmacies and doctor appointments, or working with health systems to improve health literacy in underserved communities. Prescriptions, at times, can be too difficult to access due to lack of insurance coverage, and although pharma offers substantial patient support programs, there is still systematic policy issues around coinsurance and who pays for the healthcare services and drugs used. 

Social determinants such as food insecurity, transportation, job training, education, housing, and health literacy can impact clinical outcomes substantially. So who’s responsibility is it anyway to address these determinants? Well as lines of responsibility become blurred in today’s healthcare consumer-centric era, stakeholders need to work together, and take responsibility for the patient.  Going beyond the pill to bundle drugs with lightweight services, whether it’s a screening, a referral or some financial assistance, are some ways pharma can address social determinants of health.

Of the determinants listed previously, many are the underlying symptoms that can lead to low rates of medication adherence. Medication adherence is and always has been a significant issue for pharma, and employing digital technologies such as apps and smart pill bottles are helping to solve this complex puzzle . Only by going a layer deeper, by learning about the true needs of the patients they are serving, will pharma truly solve this issue and improve outcomes. 

1https://www.who.int/social_determinants/sdh_definition/en/

2https://www.aetion.com/post/addressing-the-determinants-of-health-what-is-pharmas-role

3 https://patientengagementhit.com/features/using-social-determinants-of-health-to-drive-medication-adherence

4 https://www.mmm-online.com/home/channel/features/why-every-drug-should-have-a-social-care-strategy-but-most-dont/


Finding the right partner: Pharma and Digital Health

Digital health is all the buzz these days, but how do you know which digital health opportunity is the best one to pursue for your brand or organization? 

Pharma and digital health companies can both benefit from an effective and meaningful partnership. 

Pharma will benefit from working with a nimbler partner, with the talent and experience to build technology solutions quickly, allowing them to bring innovation into a larger, typically slower moving organization. Digital health companies often have access to more and better data on healthcare stakeholders, allowing pharma to gain deeper insights into their customers. 

Digital health companies who may lack the depth of experience in selling and marketing products to healthcare stakeholders, can benefit from pharma’s experience and established processes and infrastructure for getting a product to market.

Once you’ve identified that working with a digital health partner is an area of interest, finding and fostering the right partnership can be challenging. Based on our experience working with our life science clients to partner and execute digital health programs, here are a few considerations for a successful partnership:

1.    ALIGNED GOALS AND ROADMAP

As with any partnership, having aligned goals from the start is key. Goals can include, goals for your customers (patients, providers, payers), goals for your company, or goals specific to the program/partnership. It’s important to discuss all the potential goals you may have and ensure that both partners are aligned. 

 Having an aligned roadmap is less obvious, but we have seen many partnerships fail because their long-term objectives were not aligned. As a result, the partnership dissolved because they were moving in two different directions. Most digital health companies have limited resources and need to focus on their priorities. Ensure that their priorities are aligned with yours so that you are building towards a common future.

2.    CULTURAL FIT

 Another important factor for a successful partnership is the cultural fit. How quickly does the partner want to move? How nimble and flexible are they with new ideas or changes in direction? Do their strengths and weaknesses complement your organizations? One of the most common dissatisfaction in a partnership is when the partner is expected to perform a task (e.g. user research, UX design) that may not be aligned to their strength, and as result, pharma is unhappy with the end product. Exploring each partner’s values and capabilities and ensuring alignment at the beginning of the relationship will help avoid conflicts down the road.

3.    LEADERSHIP SUPPORT

Although many brand teams and organizations within a life science company may dabble in innovation, innovation doesn’t stick unless there is investment in time and resource at the executive level. Not only from our experience, but from speaking with other pharma innovation leaders, the digital health initiatives that were most successful were the ones where leadership saw the value and was personally involved in ensuring that the partnership was a success. This included meeting regularly with the partner as well as supporting the development of innovation goals and capabilities at the organization level. Before spending too much time developing a partnership, it would be worth doing a business case and selling it in internally to ensure that you have the right support to successfully launch your innovation project with your digital health partner.

Finding the right partner is not always an easy task, but well worth the effort and investment long term. 

What other recommendations would you have for life science companies looking to find a digital health partner? From your experience, what are some key factors that made your partnerships a success? 


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