Addressing the determinants of health: What is pharma’s role?
Contributing writer, The Evidence Hub
As recognition grows that health care is broader than medical care, innovative partnerships are springing up across the country. Hospitals are training Meals on Wheels volunteers to do safety checks on vulnerable patients when they drop off dinner. Uber transports high-risk patients to medical appointments. Health systems are building affordable housing and opening “food pharmacies.” And both public and private payers are evolving reimbursement to remove barriers to better health in patients’ lives.
Addressing the “causes of the causes” of poor health—food insecurity, social isolation, inadequate transportation, unsafe housing, and more—requires novel partnerships among providers, payers, and communities. It’s all-hands-on-deck as the U.S. health care ecosystem seeks to improve outcomes at lower cost in a value-based landscape.
Rarely mentioned in coverage of this united effort, however, is one of the biggest players in the ecosystem. Is addressing social determinants of health within the scope of the pharmaceutical industry?
“Biopharma is going through its own evolution and transformation,” says Christopher Boone, vice president and lead for Global Medical Epidemiology and Big Data Analysis at Pfizer, speaking at the 5th Annual d.Health Summit Aging Innovation Conference on June 11, 2019. “There is not only a moral obligation, but also a professional responsibility for pharma to care about all the things that impede a patient’s care.”
There is not only a moral obligation, but also a professional responsibility for pharma to care about all the things that impede a patient’s care.
In the shift from volume to value, understanding the complexity of patients’ lives is re-shaping drug development and commercialization. “As the world moves to a value-based system,” says Boone, “clinical outcomes are paramount.”
As treatment regimens broaden to meet patients where they are, pharma is turning to real-world data to understand the complexities of patients’ lives. “We know that most of the data we care about is going to be captured and generated outside the walls of provider organizations,” says Boone. “I care a lot about the contextual information that gives us a better insight in that overall patient experience.”
Identifying sub-populations of patients that would benefit most (or conversely, that would be most at risk) is essential, says Boone. As randomized controlled trials determine the effectiveness of treatments in trial participants, real-world evidence determines the value of treatments delivered in the context of people’s lives. “Once a drug is on the market, real life gets in the way,” says Carolyn Magill, CEO of Aetion. “What we saw in a clinical trial doesn’t necessarily manifest in the same way for patient groups who didn’t participate in the trial.”
Only by analyzing data collected in routine medical care—and eventually from patients’ day-to-day lives—with scientific rigor, can biopharma align with providers, payers, and regulators to design interventions that will not falter in the face of complex real life.
In a system long hobbled by fragmentation and silos, integrating care for the whole person begins with sharing validated data that captures their whole lives—from diagnosis to zip code. Because, says Boone, “it’s going to take all actors and all entities within the ecosystem to meet the needs of the patient.”