The journey to wellness isn't confined to a doctor’s office or a pharmacy counter; it's greatly shaped by the conditions in which people live, work, and age. These conditions are known as social determinants of health (SDOH).
Consider a patient recently faced with a new chronic condition. Their treatment plan is clinically sound, but the reality of their life outside the healthcare system creates overwhelming barriers. They live in a community geographically distant from the local pharmacy, with inadequate access to reliable transportation.
Compounding this challenge, the complex medical instructions, full of unfamiliar terminology and protocols, are difficult to understand, reflecting a significant barrier in health literacy. For this person, the greatest threat to their adherence and long-term health isn’t the condition itself, but the systemic circumstances of their daily life. However, the right support from their community and their healthcare team can help them tackle these challenges and see positive health outcomes down the line.
What are social determinants of health?
Social determinants of health are defined by the World Health Organization as “the conditions in which people are born, grow, live, work and age, and people’s access to power, money and resources.” In other words, the non-medical factors that influence a person's health, wellness, and ability to manage their conditions.
These factors, which include economic stability, neighborhood and physical environment, and access to education, are powerful environmental and social influences that often function as the root cause of both systemic healthcare disparities and critical issues like medication non-adherence.
For health plans, SDOH represents the critical gap between providing clinical treatment and achieving true, measurable health equity. Ignoring these non-clinical hurdles makes it nearly impossible to drive long-term improvement in member outcomes, medication adherence, or quality measures like Star Ratings.
4 social determinants of health barriers impacting patient outcomes
While the healthcare system often focuses on clinical interventions, the most persistent roadblocks to patient health, adherence, and health equity lie in the non-medical factors. These barriers directly drive up costs and complicate efforts to manage chronic conditions, ultimately hindering a health plan’s ability to achieve high Star Ratings.
1. Economic stability
Financial hardship is arguably the single largest factor driving poor medication adherence. The reality is that economic stability directly impacts a member's ability to afford prescribed treatments. When members face insecurity regarding housing, food, or employment, the cost of a necessary medication becomes a secondary priority. This leads to common practices like skipping doses, cutting pills, or simply failing to fill a prescription.
The downstream result is avoidable complications, emergency room visits, and costly hospitalizations. A clinical pharmacy partner must be equipped to identify these financial challenges during a medication therapy management (MTM) consultation and collaboratively find low-cost alternatives or connect the member with relevant assistance programs.
2. Healthcare access and quality
This determinant is less about the existence of health insurance and more about the practical barriers to consistent, high-quality care. Challenges in healthcare access and quality include:
- A lack of reliable transportation
- Long travel times to clinics
- Inconvenient operating hours
These obstacles are particularly acute in rural areas, leading to significant healthcare disparities. Modern clinical pharmacy solutions overcome this by utilizing the remote pharmacist. With this model, necessary counseling and follow-up are delivered virtually, increasing accessibility and helping health plans engage members regardless of their geographical limitations.
3. Social and community context
A patient’s health journey is greatly influenced by their surrounding support system. Within their social and community context, a patient might face feelings of isolation, lack of social support, or even experiences with systemic bias or discrimination. When patients feel disconnected or lack a trusted support network, they are less likely to stay motivated, share accurate information, or follow through on complex care plans.
Effective MTM programs leverage pharmacists trained in motivational interviewing to empathetically connect with members, building the trust necessary to overcome these social considerations and foster engagement. This relational approach transforms transactional dispensing into collaborative, continuous care.
4. Education
In the context of improved patient outcomes, health literacy, the ability to obtain, process, and understand basic health information, can greatly impact a patient’s engagement and overall well-being. Low health literacy is a massive contributor to non-adherence, as patients may misunderstand complex instructions, misinterpret side effects, or fail to grasp the importance of their drug regimen, such as the need to take a blood pressure medication even when they feel well. A 2024 study highlighted this disparity, finding that among patients with low health literacy, only 32% were adherent to their medications, compared to 67% of patients with adequate health literacy who were adherent.
MTM pharmacists equipped with advanced pharmacy SaaS platforms are trained to simplify complex clinical information, use a member's preferred language, and provide culturally competent guidance, transforming confusion into clarity and giving members the confidence needed to adhere to their plan.
Why traditional pharmacy services fail to overcome social determinants of health
Traditional, volume-driven pharmacy models are fundamentally ill-equipped to address the complex, non-clinical barriers presented by social determinants of health. They were built for transactional efficiency, not for the continuous, deep engagement required to achieve health equity and drive better outcomes.
1. Limited time and transactional focus
In a traditional retail setting, the pharmacist's interaction is brief and constrained by high prescription volume. This environment prioritizes speed over comprehensive consultation.
- No time for discovery: Addressing SDOH requires probing questions about a member’s income, transportation, or social support, all of which are conversations that can’t happen effectively from behind a bustling counter. The rapid-fire exchange prevents the remote pharmacist from building the necessary trust to uncover the real barriers to adherence.
- Lack of proactive engagement: Traditional services are inherently reactive; they engage the member only when they present a new prescription or a refill. They lack the technology and infrastructure for proactive, personalized outreach, making it impossible to manage at-risk members outside of a dispensing cycle.
2. Geographic and physical constraints
The legacy model of in-person consultations limits access, creating and reinforcing existing healthcare disparities.
- Transportation challenges: For many members, especially those with mobility issues or living in rural areas, the physical journey to a pharmacy is a significant SDOH barrier. If they can’t get to the pharmacy, they cannot receive MTM or clinical counseling.
- Inflexible staffing: In-house pharmacy teams, particularly within smaller health systems, struggle with flexible staffing and fluctuating member volume. This lack of scalability often forces them to prioritize easier cases, leaving the most complex, high-risk members (who often face the most severe SDOH barriers) underserved.
3. Missing technology and data integration
Traditional models lack the sophisticated pharmacy technology necessary to operationalize SDOH insights and scale solutions.
- Inability to match: Traditional services can’t leverage data to match members with an MTM pharmacist based on shared language, cultural background, or relevant specialty. This is a key strategy for building trust and overcoming social hurdles.
- Documentation and insight: Without an integrated telepharmacy platform, documentation is often siloed or cumbersome. The valuable insights a pharmacist gains about a member's SDOH barriers are often lost, preventing health plans from effectively closing care gaps or reporting on critical measures.
The pharmacy industry today places a high emphasis on outcomes, not just services provided, as part of a comprehensive value-based care model. Because traditional pharmacy fails to effectively mitigate SDOH barriers, it directly undermines adherence, increases avoidable medical spend, and stalls progress toward achieving high-quality measures like Star Ratings. Addressing SDOH requires a dedicated, technology-enabled partner that can deliver high-quality, personalized care virtually.
Addressing social determinants of health with scalable pharmacy solutions
Achieving health equity is far from a sprint to the finish line, but with the right strategies and a steady pace, improvements in overall quality of care for patients everywhere can be made. This fundamental shift in how health plans engage members is powered by combining the empathy of the remote pharmacist with purpose-built pharmacy technology.
However, the effectiveness of an MTM program hinges on member engagement, which is impossible without trust and relevance. Aspen RxHealth’s multiple care delivery models address this through:
- Customized engagement: Our platform leverages data to match members with an MTM pharmacist based on clinical specialty, preferred language (pharmacists in our network speak over 28 languages), and even social factors. This clinical and cultural matching is the critical step in overcoming SDOH barriers like low health literacy and social isolation, ensuring the member feels understood and respected.
- Accessible expertise: The remote pharmacist model removes geographic and transportation issues, directly solving one of the primary SDOH access issues. This flexible, digital approach allows for deeper, more meaningful conversations where the pharmacist can screen for financial, housing, and social concerns that impact adherence while providing personalized resources to help patients understand their conditions and be active in their care plans.
To deliver this personalized care at the required scale, health plans need a robust pharmacy SaaS solution. The engine that powers our nationwide community of pharmacists is BeWell with Aspen RxHealth. It integrates member data, guides consultations to ensure compliance and SDOH screening, and automates reporting. This clinical intelligence allows pharmacists to focus their time on empathetic consultation and intervention, delivering the highest quality of care possible.
For health plans with existing in-house clinical teams, Alliance by Aspen RxHealth offers the same powerful BeWell technology as a configurable SaaS solution. This is the ultimate tool for strategic efficiency: internal teams gain best-in-class workflows, while the platform provides the flexibility to seamlessly scale operations by leveraging the Aspen RxHealth pharmacist community during peak volume or for complex, SDOH-challenged populations.
By effectively mitigating SDOH barriers through a technology-enabled, pharmacist-led approach, health plans realize tangible results, ranging from improved medication adherence to reduced total cost of care. The future of healthcare equity demands a clinical partner that seamlessly blends pharmacy technology with genuine human connection.
To see how our scalable, pharmacist-led solutions can address SDOH barriers, drive measurable health equity, and boost your Star Ratings, schedule a demo of the Aspen RxHealth platform today.
