What’s Required in Order to Fight Medication Use Quality Disparities

A patient advocate, an entrepreneur, and representatives from pharma and a pharmacy benefit manager shared how their organizations are working to identify medication use quality disparities during a panel at the Pharmacy Quality Alliance 2022 Annual Meeting this week in Baltimore, Maryland.

The session, which was moderated by Melissa Castora-Binkley, PhD, PQA’ s senior director of research, also delved into issues around leadership, culture, and trust. Panelists included:

• Alan Balch, PhD, CEO, Patient Advocate Foundation
• Kristi Mitchell, MPH, CEO, Health Equity Outcomes, Inc.
• Alan Ryan, RPh, MBA, head of medical engagements and partnerships at Novartis
• Harry Travis, MBA, senior vice president, member services operations at CVS Caremark at CVS Health

Castora-Binkley asked for examples of how organizations are working to identify and prioritize disparities, as well as addressing any unintended consequences that might arise as a result of such findings.

At CVS Health, Travis said disparities in heart health between Black and White Americans are a focus for the company overall, as well as the company’s new chief health equity officer, Joneigh Khaldun, MD, MPH, FACEP who was previously Michigan’s chief medical executive and chief deputy director of health for the state’s Department of Health and Human Services.

Mitchell, who before forming her own firm was a vice president at Avalere, cited a few potential unintended consequences of examining disparities. In one, she described a multiyear project developing performance measures for CMS around heart failure, heart attacks, and hypertension. Despite the fact that thousands of measures were developed, only a small subset were used and an even small number dealt with accountability. In volume-driven programs, despite data showing where the gaps are, there might never be follow up.

In another potential example, the information gathered on certain vulnerable populations or regarding certain local areas through the use of artificial intelligence and advanced data analytics has the potential to negatively impact decision-making.

“Can we risk adjust them out?" Mitchell posited. "It sounds sneaky, but guess what, it can happen.”

And implementing social determinant of health screening tools without the right education can worsen the high levels of distrust that marginalized communities already have towards the medical profession.

If a patient is “so inclined to answer whether or not I'm food insecure and then you provide no direction to resources for me to actually close that gap, you've done nothing but increase the level of distrust and mistrust around me giving you that information,” she pointed out.

Balch agreed about not inadvertently creating situations that cause a patient to be more distrusting of health care. “I think the solution part is to introduce these ideas and conversations really, into a person's health care experience, not just waiting until it's a problem.”

People want to feel respected and listened to, and to feel like the care they received was personalized.

Castora-Binkley asked for examples of how the concept of health equity can be made actionable and practical.

“It's something that you need to drive across every service line, business line,” Balch said. “And that means focusing not just on what you're doing, but how you're doing it, and what's happening within your own building, and how are you addressing all that? Disparities within your own workforce, within your board, within your staff.”

When it comes to making equity improvements and successes sustainable, leadership from the top levels are required, and that means finding champions who are bold, open to collaboration, and willing to explore new partnerships with an open mind, the panel agreed.

As organizations find successes—or “wins”— in this area, continually tying these to organizational values will help embed the process and make it authentic, Ryan said. “It's not just we're doing it because it's good to do, right? We're doing it because it's good for us… So then, it becomes more of a ongoing sustaining WIIFM [what’s in it for me] activity,” he said.