Reports of cases of coronavirus disease 2019 (

 (shingles) co-infections are beginning to emerge in medical literature. Given the nature of shingles—a latent infection caused by the varicella zoster virus (

) whose reemergence is most commonly linked to stress—more co-infection cases are likely to follow.

 in May 2020, reports on a previously healthy 39‐year‐old man admitted to a Brazilian emergency room in late March. He presented with left orofacial herpes zoster (HZ) involving the left 3 trigeminal divisions, with intraoral mucosal lesions. The patient had chickenpox as a child. He reported having been fatigued and experiencing bouts of diarrhea during the preceding 10 days.

The patient’s medical history included 2 possible exposures to COVID-19 during the month of March: a cruise and the arrival of a friend from the United States. A subsequent COVID-19 test was positive.

Intravenous acyclovir was initiated to treat his shingles, and clinical improvement was seen within 24 hours. The progression of HZ lesions ceased by the fifth day, and the patient was also free of fever and respiratory symptoms.

“COVID‐19 might have fostered retrograde reactivation of VZV from the nasal cavity, where ophthalmic and maxillary branches of the trigeminal nerve are harboured,” the researchers concluded. “Hence, COVID‐19 might also entail this rare presentation of HZ.”

) in 4 COVID-19 patients in Egypt. The patients ranged in age from 7 to 42, and all reported a previous episode of chickenpox.

The patients were all immunocompetent and had mild-to-moderate COVID-19 at the onset of HZO, but did not require hospitalization. The mean time between the onset of COVID-19 and the HZO diagnosis was 4.5 days.

The treating physicians noted that the usual 

 for reactivation of VZV—advanced age, immunocompromised conditions like autoimmune diseases, and chronic diseases like diabetes—were not present in any of the patients.

“It seems that COVID‐19 infection, as an acute illness with its associated physical and emotional stress, might represent the triggering factor for the development of HZO in our patients,” they wrote.

All 4 patients were treated with systemic and topical acyclovir and topical prednisolone acetate eye drops. No ocular complications or postherpetic neuralgia (

“In conclusion, cutaneous manifestations of COVID‐19 disease are continuously emerging,” the physicians wrote. “HZO might be a complication to or an indicator of COVID‐19 infection, particularly in young, immunocompetent patients.”

Given the ongoing COVID-19 pandemic, individuals at highest risk should consider vaccination against shingles. “Ensuring that routine vaccination is maintained or reinitiated during the COVID-19 pandemic is essential for protecting individuals and communities from vaccine-preventable diseases and outbreaks,” states the 

 expands on that advice, telling health care providers, “If you have an opportunity to vaccinate a patient age 50 years or older who is due for dose 1 or dose 2 of Shingrix, proceed with vaccination as usual.”

 has been approved by the FDA since 2017 for use in the United States. Its efficacy rate has been established at over 90% across all age groups tested.

1. Ferreira ACA de F. Romão TT. Macedo YS. Pupe C, Nascimento OJM. COVID-19 and herpes zoster co-infection presenting with trigeminal neuropathy. 

2. Nofal A, Fawzy MM, Sharaf EL Deen SM, El-Hawary EE. Herpes zoster ophthalmicus in COVID-19 patients. 2020. 

3. CDC. Interim Guidance for Routine and Influenza Immunization Services During the COVID-19 Pandemic. Last updated October 20, 2020. Accessed December 1, 2020. 

https://www.cdc.gov/vaccines/pandemic-guidance/index.html

4. Immunization Action Coalition. COVID-19 and Routine Vaccination. Last updated October 22, 2020. Accessed December 1, 2020. 

https://www.immunize.org/askexperts/experts_covid19.asp

Articles

Reports of cases of coronavirus disease 2019 (COVID-19) and herpes zoster co-infections are beginning to emerge in medical literature. 

COVID-19 and Herpes Zoster Co-infections Identified	

A recent study reported a link between social isolation as a result of the coronavirus disease 2019 (COVID-19) pandemic and high blood pressure, according to investigators.

Presented virtually at the 46th Argentine Congress of Cardiology (SAC), results of the study showed that “admission to the emergency department during the mandatory social isolation period was linked with a 37% increase in the odds of having high blood pressure, even after taking into account age, gender, month, day and time of consultation, and whether or not the patient arrived by ambulance," said study author Dr. Matías Fosco of Favaloro Foundation University Hospital, Buenos Aires.

Mandatory quarantine commenced on March 20, 2020 in Argentina, which was the location of the study. Like many other countries responding to the pandemic during the initial global surge in March, apart from essential workers, Argentinians were told to stay home unless they needed to buy food or other necessities, or to pick up their prescriptions.

Investigators examined 98.2% of patients who entered the emergency department at Favaloro Foundation University Hospital between March 21, 2019 and June 25, 2020. Because blood pressure is routinely assessed in hospitals, nearly all patients admitted to the emergency department were included in the study.

A total of 12,241 patients of an average age of 57 participated in the study, 1643 of whom were admitted to the emergency room between late March 21 and June 25 of this year. Of those patients, 391, or 23.8%, had high blood pressure, which proved to be significantly higher compared with March-June 2019 (17.5%). January to March of 2020 also reported that 15.4% of patients presented with high blood pressure. Investigators noted that reasons for admission among this population were similar among the study periods.

Dr Fosco hypothesized that high blood pressure in patients amid COVID-19 may have been due to increased psychological tension in response to travel restrictions, police controls, and apprehension in regard to COVID-19 infection. Not only that, but early COVID-19 warnings, which were later proved false and dismissed, suggested that high blood pressure medications could spur adverse effects on COVID-19 outcomes, Fosco explained.

Increased prevalence in blood pressure among emergency department patients may point to a larger issue surrounding heart health. Dr Hector Deschle, scientific program chair of SAC 2020 pointed out that, “this study illustrates the collateral damage generated by isolation. There has been a significant decrease in heart disease consultations, which inevitably leads to avoidable complications. But I would like to emphasize the psychological damage pointed out by the authors, which we perceive daily in consultations and which is expressed as fear, hopelessness, irritability, and difficulty concentrating. This affects interpersonal relationships and physical health. This study puts the spotlight on the concomitant consequences of the outbreak and the restrictions used to struggle against it."

SAC 2020 was held virtually November 19 to 21, 2020.

1. Social isolation during COVID-19 pandemic linked with high blood pressure. News Release. European Society of Cardiology; November 19, 2020. Accessed November 30, 2020. https://www.escardio.org/The-ESC/Press-Office/Press-releases/social-isolation-during-covid-19-pandemic-linked-with-high-blood-pressure

Increased prevalence of high blood pressure may be among the “collateral damage” from isolation as a result of the COVID-19 pandemic, investigators said.


Study Suggests Link Between Social Isolation Amid Pandemic and High Blood Pressure 

drugs.png

Tune in to Over the Counter episode 12, the pilot episode in our McKesson partnership podcast series. Heather Cusick, RPh, director of product management for clinical services at McKesson, discusses how pharmacies can streamline vaccination programs and prepare for patient surges amid the coronavirus disease 2019 pandemic.

Cody Clifton, PharmD, clinical pharmacist at Moose Pharmacy and coordinator of Quality Assurance and Best Practices at CPESN, discusses how the company’s integrated network on community pharmacies have worked to prepare for administering the coronavirus disease 2019 (COVID-19) vaccines once available.

Don’t miss the latest news from Drug Topics.

Here’s a preview of the featured content to watch for this week on Drug Topics®.

This Week on Drug Topics: November 30 to December 4

Moderna announced its plan to apply today for emergency FDA authorization for its coronavirus disease 2019 (COVID-19) vaccine candidate, the company said in a press release.

Moderna also reported that the primary efficacy analysis of its phase 3 COVE study of mRNA-1273 demonstrated a high efficacy rate of 94.1%, with a 100% efficacy rate against severe COVID-19. A total of 196 cases of COVID-19, including 30 severe cases, among 30,000 participants were included in the analysis.

Vaccine efficacy was initially reported at the first interim analysis with a total of 95 cases based on pre-specified success criteria on efficacy. Today’s primary analysis was based on the 195 cases, of which 185 cases were observed in the placebo group versus 11 cases in the mRNA-1273 group. The primary end point is based on the analysis of COVID-19 cases confirmed and adjudicated starting 2 weeks following the second dose of the vaccine.

Based on prior analysis, the vaccine is generally well tolerated, with the most common adverse reactions including injection site pain, fatigue, myalgia, arthralgia, headache and erythema/redness at the injection site. Adverse effects increased in severity and frequency after the second dose of mRNA-1273.

According to Moderna, the trial will continue to accrue additional data even after the emergency use authorization (EUA) is submitted.

“This positive primary analysis confirms the ability of our vaccine to prevent COVID-19 disease with 94.1% efficacy and importantly, the ability to prevent severe COVID-19 disease,” Stéphane Bancel, chief executive officer of Moderna, said in a statement. “We believe that our vaccine will provide a new and powerful tool that may change the course of this pandemic and help prevent severe disease, hospitalizations, and death.”

Moderna is working with the CDC, Operation Warp Speed, and McKesson to prepare for distribution of mRNA-1273 in the event that it receives EUA from the FDA.

1. Moderna Announces Primary Efficacy Analysis in Phase 3 COVE Study for Its COVID-19 Vaccine Candidate and Filing Today with US FDA for Emergency Use Authorization. News release. Moderna; November 30, 2020. Accessed November 30, 2020. 

https://investors.modernatx.com/news-releases/news-release-details/moderna-announces-primary-efficacy-analysis-phase-3-cove-study

Moderna reported an efficacy rate of 94.1% for its COVID-19 vaccine based on the primary efficacy analysis. 

Moderna to Request Emergency FDA Authorization for COVID-19 Vaccine

Results of a recent study published in the 

 showed that an alarming number of young adult respondents reported significant loneliness, depressive symptoms, and moderate-to-severe anxiety during the coronavirus disease 2019 (COVID-19) pandemic.

Researchers used a national survey to evaluate the effect the coronavirus disease 2019 (COVID-19) pandemic is having on young adults. In light of coinciding loneliness and addiction epidemics in the United States, the survey has revealed concerning trends in this demographic related to mental health and substance use amid the pandemic.

“Even before imposed COVID-19 social restrictions, loneliness had been gaining attention as a public health crisis,” the researchers wrote in the study. However, few studies have focused on documenting and understanding loneliness and issues related to mental health wellbeing in young adults.

Investigators employed a web-based survey, approved by the University of Miami Institutional Review Board, that recruited participants on social media and networking sites—Instagram, Facebook, LinkedIn, and Twitter—via an anonymous link to the Qualtrics 2020 survey. Respondents also gained access through US college and university newsletters and student association Facebook pages.

Between April 22 and May 11, 2020, 1008 respondents 18 to 35 years of age completed the survey, which evaluated mental health through various mechanisms. Investigators determined loneliness through the UCLA Loneliness Scale; substance use behaviors through the WHO’s Alcohol Use Disorder Identification Test (AUDIT) and the Drug Abuse Screening Test (DAST-10); and anxiety and depression through the Generalized Anxiety Disorder (GAD-7) Questionnaire and the Center for Epidemiologic Studies Depression scale (CES-D-10).

Demographic analysis showed a median age of 28 years, with 86% of respondents older than 23 years. Ninety-one percent were not enrolled in school, with 63% living with 2 or 3 people at the time of the survey. The majority of respondents reported their race as white (76%); 10% were Black, and 24% were Hispanic.

The mean score on the UCLA Loneliness Scale was 49.54. Forty-nine percent of participants reported scores above 50 in the 20-80 scale. AUDIT ranks respondents according to a 0-40 scale, where a score higher than 15 is likely to indicate high-risk drinking and alcohol dependence. Thirty percent of respondents reported a score above 16 and 19% reported binge drinking at least weekly.

Of the 22% of young adults included in the study who reported using drugs, 38% showed scores indicating substantial or severe drug use. Sixty-two percent of respondents ranked as showing either moderate (45%) or severe (19%) anxiety. Seventy-nine percent indicated the presence of significant depressive symptoms, according to the CES-D analysis.

Analyses showed that most participants who reported an increase in feeling lonely also reported more alcohol use (58%), drug use (56%), anxiety (76%), and depression (78%).

“These results reveal heightened levels compared to previously documented prevalence of loneliness, anxiety, and depression,” the study authors wrote.

Findings reiterate the demand for attention to the loneliness epidemic in the US and underscore the importance of prevention and intervention on young adults,” investigators added.

1. Horigian VE, Schmidt RD, Feaster DJ. Loneliness, mental health, and substance use among US young adults during COVID-19. 

https://doi.org/10.1080/02791072.2020.1836435

A recent study showed “alarming” rates of reported loneliness, anxiety, depression, and substance use in young adults during COVID-19. 

Mental Health Conditions, Substance Use Heightened in Young Adults Amid COVID-19 Pandemic

Impel NeuroPharma recently announced its submission of a New Drug Application (NDA) to the FDA for dihydroergotamine mesylate, or DHE, (INP104) for the acute treatment of migraine headaches in adults with or without aura.

DHE utilizes NeuroPharma’s proprietary and novel delivery system called Precision Olfactory Delivery (POD) technology. It is designed to target the vascular rich upper nasal space in order to maximize consistent absorption of DHE.

Migraine is a common and often debilitating severe head pain affecting an estimated 39 million individuals in the United States; however, the disease is underdiagnosed, and of the 19 million patients with diagnosed migraine, only 4 million have been prescribed medication. The neurological disease is associated with symptoms such as nausea, vomiting, and sensitivity to light and sound.

DHE is designed to deliver a lower dose of the drug compared with FDA-approved and investigational products, according to the news release.

The NDA is based on the phase 3, multicenter STOP 301 study. The study included 360 patients at 36 trial sites in the US. Patients were included based on their documented diagnosis of migraine with or without aura who experienced a minimum of 2 attacks each month for the last 6 months at the time of the study. Investigators evaluated patients either under a 24-week or 52-week study period.

Study investigators treated over 5650 migraine attacks during the study and met the primary objectives, with no new safety signals reported. The most frequently reported treatment-emergent adverse events (TEAEs) were mild and brief and included nasal congestion (16.7%), nausea (7.9%), nasal discomfort (5.4%), and abnormal taste (5.1%).

Overall, 66.3% of patients reported pain relief, 38% reported pain freedom, and 52% reported freedom from their most bothersome migraine symptom (MBS) within 2 hours of the first dose of DHE. A total of 16.3% of patients experienced relief from their migraine in as early as 15 minutes, with improvements over time.

The STOP 301 study is among the largest longitudinal studies of DHE, according to the news release. 

Impel Neuropharma Announces FDA Submission of New Drug Application For INP104 For the Acute Treatment of Migraine. News Release. Impel Neuropharma; October 26, 2020. Accessed November 17, 2020. 

https://impelnp.com/2020/11/09/impel-neuropharma-announces-fda-submission-of-new-drug-application-for-inp104-for-the-acute-treatment-of-migraine/

The pharmaceutical company has submitted a New Drug Application for dihydroergotamine mesylate for fast and lasting whole migraine relief in adults with and without aura. 

Impel NeuroPharma Announces NDA Submission for Acute Migraine Treatment

According to the COVID Tracking Project, the latest totals for coronavirus disease 2019 (COVID-19) in the US have surpassed 12 million cases, with approximately 250,925 deaths, as of November 24. Additionally, approximately 88,000 individuals are currently hospitalized with COVID-19 in the US, reaching a new all-time high for the 15th consecutive day.

This week, AstraZeneca reported interim data on efficacy for its COVID-19 vaccine candidate, AZD1222, and the Infectious Disease Society of America led a webcast on currently available treatment options.

Here’s a roundup of the latest coronavirus-related news:

AstraZeneca Reports COVID-19 Vaccine Met Primary Efficacy End Point

One vaccine dosing regimen for AZD1222 showed 90% efficacy, according to investigators at the University of Oxford.

Infectious Disease Society of America Webcast Discusses Available COVID-19 Treatments

Infectious Disease Society of America offered a look at the current treatment options for COVID-19 and stressed the need to maintain precautions to keep people safe.

MJH COVID-19 Coalition Surveyed on Mask Mandates, Vaccines, and More

As COVID-19 cases rise across the country, members of the MJH Life Sciences COVID-19 Coalition shared their perspectives on pandemic containment efforts.

Looking at the Epidemiology of COVID-19 in Pediatrics

A new study examines the epidemiology of pediatric COVID-19 cases in a large cohort, 

1. The COVID Tracking Project. Data. November 24, 2020. Accessed November 25, 2020. 

Here’s a roundup of this week’s coronavirus-related news. 

Coronavirus News Roundup: AstraZeneca Reports Vaccine Data, Webcast Discusses Current Treatments

Results of an ongoing study has demonstrated an association in coronavirus disease 2019 (COVID-19) patients between the presence of hypertension and diabetes and a higher risk of neurological complications.

The study, which will be presented at the Radiological Society of North America (RSNA) annual meeting held virtually this year, reported that neurological complications can be fatal when it comes to COVID-19 infection and that these manifestations are more common in patients with hypertension and type 2 diabetes mellitus, according to Colbey W. Freeman, MD, chief resident in the department of Radiology at Penn Medicine in Philadelphia, Pennsylvania.

“These populations may be at higher risk for neurologic complications and should be monitored closely,” Freeman added.

Investigators in the Perelman School of Medicine at the University of Pennsylvania evaluated 81 COVID-19 patients through head CT and/or MRI brain scans; the most common reasons for a brain scan were altered mental state and focal neurologic deficits, such as speech and vision problems. Eighteen patients showed emergency or critical neurologic complications, including strokes, brain bleeds, and blocked blood vessels, according to investigators.

The study also demonstrated that Black patients with COVID-19 should also be closely monitored, as two-thirds of patients who showed critical results were Black.

In addition to evaluating neurological complication incidence in COVID-19 patients with hypertension and type 2 diabetes, the study also aims to understand these complications on patients receiving extracorporeal membrane oxygenation (ECMO).

“We have plans to initiate a larger prospective study evaluating delayed, long-term and chronic neurologic manifestations that may not be known in this early period in the pandemic,” Freeman said.

1. Diabetes, hypertension may increase risk of COVID-19 brain complications. News Release. Radiological Society of America; November 18, 2020. Accessed November 24, 2020. 

http://press.rsna.org/timssnet/media/pressreleases/14_pr_target.cfm?ID=2226

A study to be presented at the annual meeting of the Radiological Society of North America reported that COVID-19 patients with diabetes and hypertension may have a higher risk for neurologic complications.

Study: Diabetes, Hypertension May Increase Risk of COVID-19 Brain Complications

You can't fix what you don't track. Technology will help you identify potential reimbursement problems before they trigger reduced payments or claims audits.

Understanding pharmacy reimbursement is a tall order, even for owners who've been in business for decades. Pharmacy benefit managers (PBMs) structure their contracts with broad rights to initiate claims audits, which can lead to recoupment of entire reimbursement amounts plus potential audit fees. What's worse, an audit uncovering systemic errors could void profits on hundreds of claims.

So, any approach to maximizing community pharmacy reimbursement should include an active triage component, supplemented by ongoing use of pre-and post-edit and pharmacy claims reconciliation software.

Let's say, in the normal course of business, your pharmacy receives a prescription for an existing patient. Your counter technician enters the script into the pharmacy system based on patient name and other identifiers. The script goes into a queue, then makes its way to the filling tech. Once filled, the pharmacist verifies that everything on the written prescription matches up with what's in the medication bottle.

Any discrepancies would need to be resolved by either the prescribing physician or the patient's insurance company. Here are some common problems that typically occur.

Prescription lacks legally required information, such as prescriber's signature, drug quantity, date, or proper patient identifiers

Invalid DEA/NPI/prescriber identification number

When your pharmacy deems the script ready to submit for adjudication, you transmit it over a digital bridge to the PBM. In turn, the PBM examines the patient's insurance coverage, the specific drug dispensed and the contract payment rate compared to the actual claim amount submitted. If everything lines up correctly, the PBM processes the claim for payment, which can take anywhere from a week to 90 days (depending on whether insurance is government-sponsored or commercial). At the same time, claims submitted at prices less than contracted amounts would be reimbursed at the lower level.

As you can see, the process involves a lot of variables. Realistically, you can't expect to handle pharmacy claims data analysis for all your transactions manually. Many independent pharmacies use pre-and post-edit software from a third-party company to follow claims through adjudication. A pre-and post-edit platform automatically tracks, for example, prescription fill dates, drugs dispensed, and prices charged. Primarily, this type of software ensures claims are submitted correctly. In addition, many pharmacies run a reconciliation platform in tandem to make sure claims are also paid correctly. Reconciliation allows you to concisely see which claims have been paid and if the amount the store submitted for payment was the amount actually paid. Reconciliation software also provides a breakdown of claims aged up to 30 days, 60 days, 90 days, or 90 days plus.

Your action item here: Appoint a trusted team member to take charge of reviewing the reconciliation reports. Your claims “captain" should run the reports at regular intervals, ideally weekly. Any claims that haven't been paid as anticipated should prompt a call from your captain to the corresponding insurance company asking why proper reimbursement hasn't been issued.

Independent pharmacy revenue leakage can also happen outside the parameters of reconciliation.

For instance, a pharmacy's computer system typically uses an algorithm to set prices for dispensed drugs. The algorithm generates a measure of cost multiplied by a markup plus a dispensing fee. When you fill a prescription, it's tied to the pricing formula—or it's overridden to establish a discretionary price. Overrides cause inconsistency in pricing, which can raise audit flags with PBMs. Be sure your store has protocols and clear guidance to technicians and pharmacists regarding when an override may be used.

 to watch is the National Drug Code (NDC) number—the universal product identifier tied to every prescription. The NDC submitted on a claim must be an exact match to the NDC on the product dispensed to the patient. In the case of generic drugs with multiple manufacturers, NDCs differ for each strength and bottle count. It's not uncommon to have old inventory on the shelf, along with bottles of the same drug in new sizes or strengths. To avoid NDC mix-ups, consider software that monitors NDCs and will issue a “hard stop" at the pickup window when attempting to adjudicate an outdated NDC.

Similarly, “dispense as written" (DAW) codes can cause problems if not properly triaged. This comes into play when a brand-name drug isn't covered by the PBM, but the prescriber specifies a branded product. The DAW code on the claim must match the instructions on the prescription. If the script doesn't include a DAW tag for a particular brand and you sell the branded product while having the generic equivalent on your shelf, an insurance audit would dictate that you only receive payment at the generic rate. Again, claims editing software would catch such an instance before it becomes a financial liability.

Finally, it's essential to have a current average wholesale price (AWP) file incorporated into your claims processing system. Drug manufacturers publish AWPs, which establish the basis for wholesale drug prices and PBM reimbursements. Be sure your AWPs are updated at least weekly; even better, run those updates daily, if available. An outdated AWP file could fail to translate drug price increases, which would result in a loss of income. When investigating claims editing software, ask if it automatically corrects for the latest AWP information.

The overarching theme in maximizing community pharmacy reimbursement is that you can't remedy what you don't measure. In other words, if you don't have the optics to understand potential problems, you won't be able to solve them. Appoint a trusted staffer to oversee pharmacy claims data analysis and continually monitor the claims process. When your pharmacy gets to the root of any problems, metrics will verify over time whether they've been permanently fixed.

Fully understanding pharmacy reimbursement is hard enough as it is, but, for even the most seasoned independent pharmacy, revenue leakage is an ever-present threat that requires constant attention. A 

business coach can serve as a second set of eyes on your business, performing pharmacy claims data analysis and identifying anything that results in reimbursement that’s less than it should be. Your coach will help you optimize the way you reconcile claims and plug leaks along the way to make sure you’re maximizing your reimbursement at every turn.

Technology will help you identify potential reimbursement problems before they trigger reduced payments or claims audits.

Using Data to Put a Stop to Your Pharmacy's Profit Leakage

 and today I'll be speaking with Tim Suther, senior vice president of data solutions at Change Healthcare, about the company's new Social Determinants of Health (SDOH) Analytics, and its application in the pharmacy setting.

First, here's the latest news from DrugTopics.com. Results of an interim analysis for AstraZeneca’s coronavirus disease 2019 (COVID-19) vaccine, AZD1222, demonstrated that the vaccine candidate met the primary efficacy end point of preventing COVID-19 infection.

The United Kingdom-based study evaluated 2 dosing regimens. The first, in which the vaccine is administered as a half dose followed by a full dose at least 1 month later, showed 90% efficacy; the other regimen – 2 full doses at least 1 month apart – demonstrated 62% efficacy. Overall, investigators reported an average vaccine efficacy of 70%, with all results deemed statistically significant.

And that's the latest news from DrugTopics.com. Now, here's my interview with Tim Suther.

 So to get us started on the topic today, what are SDOH and what are some of the ways that they inform health disparities in the United States?

 It's a great question. I'm delighted to be with you here this afternoon and hope you and yours are safe and healthy in these challenging times. So social determinants are, frankly, life circumstances. So much of healthcare is about the care that is rendered by your doctor or the prescription that your pharmacy provides to you. But the reality is that 80% of your health and wellness, in fact, people's health and wellness, is determined by these life circumstances.

That is what happens outside the doctor's office, what happens outside the pharmacy, and they include things like our health, literacy, our income, our wealth, our access to care, whether or not we are caring for a loved one, or whether or not we're a single parent – all those things affect our health and wellbeing.

And the challenge is that healthcare overall does not really do a great job of collecting that information. And that's the problem we set out to solve, how do we connect what happens in the doctor's office to life circumstances, which is what happens to us when we're out living our lives. I look forward to talking to you about it today.

 Now with these disparities are also showing themselves with the COVID-19 infection rates and outcomes, can you talk about that a little bit more?

 Indeed, so when the pandemic was first declared in March, we began immediately isolating COVID encounters. So today, we see about 40% of the positive COVID diagnoses in America the day after a clinician makes that diagnosis. So we see tests, we see diagnoses, we see when people are admitted into the hospital, we see their discharge status.

And in March, we made a decision. It’s said that if you want to go fast, go alone. If you want to go far, go together. And we elected to go together with the brightest health care minds in America. And we began making it available to academic medical centers. And right now over 70 academic medical centers are using our data to better understand COVID: how the disease progresses, whether interventions work and the impacts on the overall healthcare system.

And the reality is that each of us experience healthcare differently. And in this time, also of social unrest, most of the research and our data supports, it indicates that People of Color, whether African American or Latinx, they are experiencing COVID on a per capita rate far more intense than those that are Caucasian and those that are Asian, Asian American. And if you want to do something about that, you got to have data to understand it. And that's been our role.

 So you touched upon why Change Healthcare decided to create this resource. How does current practice utilize SDOH in treating patients now? Is there a widespread understanding of the critical need for addressing SDOH in creating more equitable health outcomes?

 Well, sadly, the health care system does not do a great job of capturing that information organically. There's just too much friction in the process.

I spent a lot of my career in financial services and in the advertising world. And when I got into the health care business about 4 years ago, I was shocked to find out that information that was so crucial in determining our health outcomes just was not available in the health care system.

We set out about a year ago to begin to identify the best sources for that data, and then to integrate it with our claims data. And that actually was harder to do than you might imagine. I felt like Thomas Edison. I’d found all 10,000 ways not to invent the light bulb, until we did.

So today, we've got this great data set that links deidentified claims with the most important SDOH. And then we make it available to payers and providers alike in a portrait service that allows them to understand for their local area, what SDOH matter most for their at risk population. And then we offer the ability to supply needed SDOH to providersand payers and pharmacies. And likewise, we've created a unique analytic environment for those that have data scientists to be able to do really rich, deep compliant analytics.

So we're serious about making a dent here.

 So can you take us a little bit step by step of how SDOH Analytics works?

The first thing is that you have to understand, for your patient population, or if you're a health plan your members, which social determinants matter most. Oftentimes, social determinants feels like an abstract concept and there are so many choices. So how do you choose?

Well, the first thing that we do is we offer a portrait service. So give us a population that matters to you and we will go do the analysis for you. We’ll tell you whether it's health care literacy, or access to health care, food vulnerabilities. Whether it's broken down by ethnic disparities, no matter what the life circumstance is, we’ll go identify it for you.

And then armed with that, you can prioritize your initiatives to do something about it. So we think that's the initial gateway service. And oftentimes that can lead to, “Oh, great, I understand that it's really healthcare literacy that matters most.” So we can supply that information to a payer or provider to be able to fill that information gap that they have about their patients or members.

And then for certain customers who have the necessary analytic expertise, and they want to do their own unique analysis, we have a secure compliant environment exactly for that purpose.

 And then in pharmacy specifically, how can pharmacies that are expanding into corporate retail clinics utilize this resource?

 The pharmacies that are doing that are making a strong statement about the importance of population health. And understanding the totality of your customers life beyond the perceptions that he or she picks up is vitally important.

Having the ability to connect to other information about that customer, whether that be information that is from a clinical experience, or information that is about as social determinant of health, just provides a vital information platform for those who want to have a population health oriented mentality to their customers.

 And are there other resources like this currently out there?

 I don't really think so. There are certainly data sets that are available, there are geo demographic data sets. But the hard part of this is actually taking it and linking it to HIPAA regulated data. It’s my Thomas Edison example again. That is really hard to do. And to be able to connect what happens in a clinical setting with life circumstances reliably at scale is a serious technological challenge.

And we've solved that. The second part is, generally we're dealing with deidentified data. And 1 of the things that you need to be careful with is that when you take clinical data that has been deidentified and you start to add other descriptive information about those customers, you can very easily late end up reidentifying people. And that's a really bad outcome.

So we built this secure, always on compliance environment for those who want to do advanced analytics. And they can do that knowing that the system will be checking every query, every output, to make sure that you remain on side with that with HIPAA. Because the last thing you want, as you're trying to do something that is really impressive progressive in serving customers, last thing you want to do is to create an environment, a situation where you accidentally reidentify someone. That would be not a good outcome.

 And what does Change Healthcare hope that this resource will lead to?

 Well, our country right now spends about twice per capita on health care of any other developed country. We ranked number 43 in the world in life expectancy.

So we're spending a lot of money and are not getting our money's worth. So what do I hope it comes to? I want our health care system to be more affordable for Americans, I want our loved ones to live healthier lives, and longer with us. Our mission at change health care is to inspire a better health care system. And we hope that this service will enable payers and providers alike to do exactly that.

 And what do you see as the key takeaways on this topic?

 It's the ability to convert SDOH from an abstract concept into specific steps that you can take to do something about it. That's what the portrait analysis will do.

It will help you remove the abstraction of social determines, the confusion of social determinants, and to prioritize which of them actually had the most significant impact on your patients, your members, your customers.

And armed with that, then you can prioritize the programs that are likely to make a difference. And where you have information gaps, we can help you fill those, and where you have desires to do advanced analytics in the social determinants space, we can help you do that as well.

 Tim, thank you so much for taking the time to speak with me today. Really appreciate it.

 Gabrielle, I'm so happy that we've spent time together and we look forward to the success of this program across health care in America, so thank you.

Expert Interviews

Tim Suther, senior vice president of data solutions at Change Healthcare, discusses a new Social Determinants of Health Analytics resource.