Social determinants of health screening and referral services in community pharmacies: A payor program analysis

Community pharmacists are one of the most accessible health care providers and often interact with patients affected by social determinants of health (SDOH). By leveraging their trusting relationships with patients, pharmacists can identify and discuss SDOH barriers. An obstacle to implementation and sustainability of pharmacist-provided SDOH services is reimbursement. Contracts with payors were recently established by a clinically integrated network (CIN) of community pharmacies in Pennsylvania where community pharmacies receive payment for providing SDOH screening and referral services. However, there is limited understanding of how reimbursement impacts adoption of pharmacist-provided SDOH services.

The objectives were to (1) design and implement SDOH screening and referral services within community pharmacies as part of Pennsylvania Medicaid payor programs; and (2) evaluate the adoption of these services within a Pennsylvania community pharmacy CIN.

The Pennsylvania Pharmacists Care Network (PPCN) is a statewide network of community pharmacies made up of 200 member pharmacies. PPCN is affiliated with the national pharmacy CIN, CPESN USA.

Since 2022, the PPCN established 4 payor contracts with regional Medicaid Managed Care Organizations (MCOs) to provide SDOH screening and referrals. Pharmacists documented SDOH encounters using the Pharmacist Electronic Care Plan (PeCP). These were the first Medicaid payor programs in Pennsylvania that reimbursed pharmacy teams for SDOH services.

A retrospective quantitative analysis of deidentified PPCN Pharmacist PeCP data from August 2022 to April 2024 for all Medicaid MCO SDOH programs was conducted. Patient encounters eligible for payment were analyzed using descriptive statistics. Systemized Nomenclature of Medicine-Clinical Terms codes in the PeCP were used to quantify SDOH services provided.

A total of 15,441 reimbursed SDOH services (11,661 screenings and 3780 referrals) were provided to 5421 unique patients from August 2022 to April 2024 by 108 pharmacies. Of the 5421 patients who received at least one SDOH screening, 1375 patients (25.4%) received at least one referral. Referral categories included: food insecurity (22.4%); financial strain (18.9%); health care access/affordability (14.1%); utilities (11.6%); clothing (8.9%); housing (8.7%); transportation (8.2%); employment (5.2%); and child care (2.0%).

Payment from MCOs promoted the adoption and implementation of community pharmacy-provided SDOH services across Pennsylvania.