Quality Forum Review: Introducing the PQA SDOH Resource Guide

The PQA Quality Forum Webinar is a regular, recurring series on healthcare quality topics with a focus on medication use and medication services. It is a forum for educating and engaging with PQA members and quality-focused healthcare professionals. 

PQA’s January 27, 2022, Quality Forum welcomed Arpana Mathur, MD, MBA, Executive Medical Director, Medical Affairs at CVS Health, and RJ Briscione, Senior Director, SDOH Strategy and Execution at CVS Health to speak alongside PQA’s Executive Fellow Alexis Caronis to introduce the PQA Social Determinants of Health (SDOH) Resource Guide. 

The SDOH Resource Guide documents real-world SDOH services that are promising for improving the quality and safety of medication use. Caronis has overseen the identification and documentation of initiatives, as well as the design and launch of the guide.  

The first edition focuses primarily on the cost of medications, cultural or literacy barriers and screening for unmet needs. These barriers were identified by PQA members during the 2020 Leadership Summit as areas pharmacists or pharmacies can impact, as well as areas where PQA members are currently screening, referring or intervening.  

The examples featured in the guide address at least one of seven SDOH barriers:  

  • SDOH Areas Address graph: Cost of Medications; Cultural or Literacy; Decent, Safe and Affordable Housing; Food Security; Screening for Unmet Needs; Social Isolation; TransportationCost of Medications 
  • Cultural or Literacy Barriers 
  • Decent, Safe and Affordable Housing 
  • Food Security 
  • Screening for Unmet Needs 
  • Social Isolation 
  • Transportation 

As PQA identified examples, most initiatives address multiple barriers, as individuals who struggle with SDOH commonly face challenges in multiple areas. The most common were cultural or literacy barriers, screening for unmet needs and transportation.  

Many of the initiatives feature multiple approaches to addressing SDOH. In the examples we’ve catalogued, screening and referral are the most common services, but often they are paired with each other or interventions. 

Half of the initiatives included have been implemented in a community pharmacy setting, followed by health systems and health plans 

Additionally, 50% of the initiatives were conducted at the local level, followed by 25% at the national level and 20% at the state level. 

We recognize that health care professionals working to address SDOH have specific needs and interests that track to their practice and the populations they serve. 

The appendix documents a host of characteristics and subcategories for the initiatives.  

After Caronis introduced the guide, Mathur outlined CVS Health’s commitment to social justice and equity through their colleagues, communities and public policy. Specific to SDOH, CVS Health is focused on health access, food access, employment, economic condition, education and health infrastructure. 

Our focus on achieving health equity; CVS Principles; champion education and awareness; increase community testing and screening; simplify access to care; optimize treatment interventions with dataMathur detailed CVS Health’s four principles for achieving health equity: 

  • Awareness and Educational Resources  
  • Testing and screening 
  • Access to health services; and 
  • Treatment optimization interventions. 

Part of CVS Health’s commitment includes pharmacy based unique lifestyle management programs designed for Medicaid members. These programs include automated text messaging, personalized calls to patients, face-to-face interactions and action plans and educational materials that patients can easily reference.  

To give insight to the specific CVS Health HealthTag Initiative, Briscione discussed CVS Health’s partnership with Unite Us. Unite Us is an organization that forms a network of community-based organizations unique to geographic locations. Then Unite Us provides these community-based organizations with a software system to use free of charge, which allows pharmacists and pharmacies to provide referrals to the organizations directly. By utilizing this software platform, participating organizations create a closed loop communication which allows CVS Health access to data and outcomes. 

Unite Us HealthTag Message image of prescription labelThe HealthTag Initiative was implemented in various pharmacies in Louisiana and West Virginia. Eligible Aetna Medicaid members received the example message on their patient prescription handout. The message provided a call to action to call a dedicated number to be connected to community-based organizations that can address various SDOH barriers.

The guide is publicly available, and PQA encourages you to share it with anyone.  

PQA will continue to expand the guide and plans to issue a second edition within a year that features additional examples, plus updates for some of the projects already featured, as many of them are in progress and will have results in the future. Adding to the guide’s depth is a priority. 

PQA would love to hear specifically how people are using the guide. Please provide PQA feedback via email. Also, to provide PQA an update to an initiative included in the guide, please email PQA 

If you are working on an SDOH initiative that PQA can consider for inclusion, please fill out this form. Anyone can submit SDOH interventions for consideration. 

You can share the guide with your colleagues and networks through a social media toolkit. The toolkit features a special social media image for those organizations that have an intervention featured in the guide.  

This activity was supported by an independent medical education grant from Merck & Co. and by Humana, whose mission is to help people achieve lifelong wellbeing. 

You can listen to the full recording of this Quality Forum Webinar, a one-hour presentation with audience Q&A, on PQA’s YouTube channel. PQA members can access the presentation slides in the Member Resources Library. 


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