How Can Employers Address Social Determinants of Health Exacerbated by COVID-19?

As the coronavirus disease 2019 (COVID-19) pandemic exposes and exacerbates social determinants of health (SDOH) in at-risk communities, services such as clinical trials and personalized care can prove effective interventions for employers in providing access to vital health services.

As explained by the CDC, SDOH are the conditions in the places where people live, learn, work, and play that affect a wide range of health risks and outcomes. These influences have played a distinct role in certain populations ravaged by COVID-19, particularly African Americans and Hispanics who are at greater risk of underlying conditions such as obesity, diabetes, and hypertension.

Although the CDC has yet to provide data on the association of race and COVID-19 mortality, the nation’s top infectious disease expert Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, has noted the stark disparities, stating, “It really does have, ultimately, shined a very bright light on some of the real weaknesses and foibles in our society.”

So what can employers do to assist employees affected by SDOH during the pandemic?

In the National Alliance of Healthcare Purchaser Coalitions’ webinar “Employer Town Hall: Social Determinants in the Face of COVID-19,” panelists discussed efforts to address the wide range of issues contributing to SDOH. Elizabeth Colyer, senior vice president (SVP) of Community Well-Being Index at ShareCare, indicated that stress, which was shown to occur regularly in 38% of individuals before the pandemic, has ballooned to 92% based on a survey of over 100,000 participants conducted by her organization. Furthermore, the survey highlighted that 15% are lonely, 21% are experiencing severe stress or anxiety, and 56% are watching or reading more news, which can be from a potentially unreliable source.

“What we’ve done at ShareCare to ensure that we can address mental well-being, social isolation, and all of the social determinants spawned from that is set up a net new anxiety offering to ensure that people can engage with providers—to ensure that people can engage with a program that is going to support reducing that anxiety at its core,” said Colyer.

As telehealth services grow in use to address behavioral health issues that arise during the pandemic, many individuals, especially those in rural communities, still require the necessary care that has been made available in the past through clinical trials. In an interview with The American Journal of Managed Care^® (AJMC^®), 3 experts from Precision for Medicine, Gerald Messerschmidt, MD, FACP, hematologist/oncologist and chief medical officer; Megan Liles, executive director of Operational Strategy & Feasibility for Clinical Trials; and Al Blunt, MD, SVP of Oncology & Rare Disease, discussed challenges that their organization has faced amid the pandemic and what strategies they developed to optimize availability of their services.

AJMC^®: Patient participation in clinical trials has been noted as an issue, especially among minority populations. Can you discuss the initial challenges of transitioning clinical trials to a virtual format?

Messerschmidt: The COVID-19 pandemic has certainly made patient enrollment more challenging. As we deploy methods that allow for remote access to patients, it’s important to ensure that this is not a barrier to trial participation. This means collecting patient information that we don’t typically collect. For example, it’s important to discuss each patient’s access to tools such as internet access, video conferencing capability, and their ability to find a location to engage in private interactions with medical staff. It may also be relevant to inquire about the option of visits to their home to perform tests when appropriate.

AJMC^®: Can you explain how strategies such as telehealth and remote monitoring have assisted researchers in providing access to these potentially life-saving therapies during the COVID-19 pandemic?

Liles: We have to allow patient access to treatment and collect enough data, because patient safety remains of utmost importance. We’re using remote tools for interaction between patients and study sites, including telephone calls, video teleconferences, patient diaries, and home nursing visits. In the setting of oncology trials, some drugs have to be administered intravenously, in which case patient visits can be limited to drug administration days. Access to patient data is critical, but limited across countries and even sites. With this in mind, we have developed remote monitoring plans focusing on review of [electronic data capure], trend analysis, and protocol deviations.

AJMC^®: As patients with debilitating diseases such as cancer continue to have surgeries or therapies postponed due to the pandemic, how can clinical trials help bridge this gap of unmet patient needs?

Blunt: We must balance the need to deliver treatment and collect data with the need to reduce infection exposure in a hospital or clinic. We achieve this goal by identifying priorities around visits and data collection. Patients can take advantage of the fact that many clinical trial assessments can be performed remotely. Only critical site visits will be maintained. When face-to-face interaction is required, each study site has to create an environment that is safe for cancer patients. The FDA has provided guidance that allows study sponsors to make these adaptations as long as they’re well documented.