Beyond Prescription Refills: How ActualMeds' Outreach Addressed Social Determinants of Health and Changed a Life

While measurement of medication adherence can be reduced to the task of getting a prescription refill, even that is not simple. It's often the unseen, more complex challenges that have the most significant impact on a patient's ability to obtain their medications and maintain adherence to them that is key to their well-being.

With that perspective, ActualMeds approaches a health plan’s members differently. Our Stars Medication Adherence Solution is different than other Stars solutions that rely on volume of outbound calls to drive outcomes. Our technology-enabled service uses automated, data-driven processes to precisely target high-risk beneficiaries and increase the probability of engagement.

The Challenge

Our team recently encountered a situation that demonstrates the value of our deep understanding and ability to effectively solve social determinants of health (SDOH) issues. During a call with the member to assist her with medications adherence, our member advocate identified the member was having difficulty accessing her transportation benefit. What began as a routine call to assist with transportation revealed a far more pressing issue. During the conversation, the member revealed she was facing imminent eviction due to her building being condemned by the city.

This situation highlighted several critical challenges:                                       

1. The member had been canceling Case Management visits out of embarrassment about her living conditions.
2. Unreliable transportation was causing her to miss crucial medical appointments.
3. The impending eviction threatened to destabilize her entire life, potentially derailing her physical and mental health.

This web of social and economic factors was preventing the member's ability to prioritize her health.

Taking Action

Our experienced SDoH nurse took immediate steps to help the member and resolve the larger challenges around housing and healthcare which seemed incredibly daunting to the member on her own. The SDOH nurse:

1. Provided emotional support and comfort to the distressed member.
2. Facilitated the assignment of a new Case Manager from the health plan to help address the member's unique needs.
3. Assisted the member to secure both reliable transportation and new living arrangements.
4. Arranged for her new Case Manager to visit the member's home and develop a transition plan.

Making a Difference

This intervention goes far beyond simply addressing a prescription refill need. It demonstrates the critical importance of solving SDOH barriers in healthcare:

• Removing Barriers to Care: Reliable transportation and stable housing are fundamental to consistent healthcare access and treatment adherence.
• Building Trust: By responding with empathy and practical solutions, we built trust with the member, potentially improving future healthcare interactions.
• Breaking the Cycle: By helping with both immediate needs (transportation) and long-term stability (housing), we're helping the member create a more stable foundation. Addressing these social needs now may prevent future health crises and reduce emergency care needs.

By integrating SDOH considerations into our outreach and care management processes, we're not just improving medication adherence. Our work focuses on medications, but our duties are far more expansive. We pride ourselves addressing the full spectrum of factors that influence the health and well-being for members we serve.

To learn more about how we can help your members in 2025, please contact us.