Expert Panel Offers Insight Into Multifaceted Approach to Addressing Health Care Disparities

Disparities in health care can be addressed in a multitude of fashions, including by addressing prior authorization challenges, implementing physician incentives, improving medication management, and tackling barriers to higher COVID-19 vaccination rates, according to a panel of experts at the Academy of Managed Care Pharmacy’s 2021 Nexus meeting.

The panel explained what interventions their organizations have implemented to address health care disparities and how they have improved conditions. They also offered recommendations on how to best apply these interventions and advice on how to develop them further.

Aimee Loucks, PharmD, manager of specialty clinical pharmacy and formulary at Kaiser Permanente, shared her organization’s strategy for addressing the impact that rejections for prior authorization claims have on Hispanic and Latinx patients, who were found to be less likely to fill a requested drug after a claim was rejected for utilization management edits than White patients (31% vs 44%).

Kaiser Permanente (KP) launched a project aimed at creating a patient-centered solution, where it hosted a focus group of Hispanic and Latinx patients to gauge whether they knew why these disparities existed. KP found that not only were the patients highly aware of how prior authorizations contribute to disparities, but they also were frustrated with the system and felt that health plans didn’t care. Loucks suggested that plans examine the contributions of utilization management to outcome disparities and to ensure that a solution is designed in partnership with patients if disparities are identified.

Kat Wolf Khachatourian, PharmD, MBA, clinical executive of MHS Employee Health Plan at MultiCare Connected Care, offered a glimpse into how health risks impact households that make less than $50,000, who experience a 9% greater risk of chronic disease, including diabetes, due to socioeconomics of zip code residence. Khachatourian’s organization used a step approach that involved multistakeholder workgroups, which were conducted over Microsoft Teams because of the COVID-19 pandemic.

Results of the approach showed that observing increased pharmacy costs justifies the real-world application of clinical trial data and that aligning stakeholder goals, expectations, and incentives can be accomplished without stakeholders meeting in person. Khachatourian said that she would like to see an expansion of these processes to other disease states and broader stakeholder groups.

Edward Jai, PharmD, senior director and chief pharmacist at Inland Empire Health Plan, examined how to best address social determinants of health (SDOH) that impact health outcomes for Medicare and Medicaid beneficiaries. Jai talked about how medication management programs around SDOH and telephone-based medication reconciliation programs can lead to decreased hospital readmissions and significant reductions in additive adverse effects, drug-drug interactions, emergency department visits, and medication costs.

Finally, to address COVID-19 vaccination disparities, Sharon K Jhawar, PharmD, MBA, BCGP, chief vice president and chief pharmacy officer at SCAN Health Plan, dived into the reasons behind why some people are not getting vaccinated, including that people don’t trust that the vaccines are safe and effective, don’t know where to get them, or lack the savvy needed to use digital navigation and scheduling tools.

Jhawar talked about SCAN’s goal to vaccinate 70% of their members, which it achieved at the end of July 2021 by creating a health equity–based outreach team, a COVID-19–specific vaccine hotline, an in-home mobile vaccination program, a COVID-19 provider task force, and a robust communication plan.

Using data and reaching out to patients, stakeholders, and providers, this panel was able to show the various ways health disparities can manifest, the multidimensional approaches that are needed to address them, and the all-hands-on-deck approach that is required for efforts to be successful over time.