Hot Takes from ‘Hotlanta’ – ISPOR Annual 2024

ISPOR Annual 2024 was held in Atlanta this year and as always, the Congress did not disappoint. Echoes of the 1996 Olympics were in the air while walking into the Georgia World Convention Center through the Olympic Centennial Park, which remains a jewel in that part of the city, complete with Atlanta’s Ferris Wheel take on that of Navy Pier in Chicago or the London Eye. The Olympic campus has morphed into a sports campus for all things pro sports ATL: the Falcons (NFL), the United FC (ML Soccer) and the Hawks (NBA) play here. The College Football Hall of Fame is even next door.  Still, this  Panalgo reporter could not help but be struck by the number of persons in that part of the city who are obviously homeless, in mental health distress, and not just marginalized but presumably invisible to the healthcare system.

Why mention Atlanta’s homeless in my reflections on ISPOR Annual 2024? The title of Monday’s opening plenary was “Advancing Whole Health: How Do We Know When We’re Succeeding?” with social determinants and social constructs of health front and center during the session both figuratively and literally. The panel included Denise Webb, a local college student who is a Senior Youth Staffer for The Partnership for Southern Equity and a powerful storyteller of her own experiences with homelessness, food insecurity, and a complete lack of access to healthcare for many of her formative years.

The plenary was moderated by CDC’s Charlene Wong, MD MSHP, Senior Advisor for Health to the Director, a logical assignment given that the CDC is headquartered in Atlanta. Having a CDC staffer involved was brilliant, as well, because it signals an evolution in the HEOR community: the growing importance of public health services and public health data to advancing whole health.

Whole health is not a new concept among healthcare providers, especially to those who work in primary or preventative care. But for those of us who work in biopharmaceutical and medical device research, the shift from ‘patient’-centered care to ‘person’-centered care is novel. As shared in the plenary, the focus should not be solely on the person’s disease or the treatment, but on how access (or lack of access) to healthy food, reliable transportation, and stable housing influences everything from diagnosis to outcome. Healthcare providers need to tailor treatment to a person’s socioeconomic circumstances and while they are at it: build a relationship based on empathy and trust. One of the panelists – Seth Berkowitz, MD MPH from UNC Chapel Hill – gave the example of a primary care practice providing food bags to their more resource-challenged clients to take home from a visit. Healthy food is medicine, after all.

To be able to address the whole person’s health and analyze the impact of treatments on health, you need not just clinical data, but social determinants of health (SDoH) data that are structured and retrievable. (The most effective medicines for type 2 diabetes won’t stand up to a diet that consists of highly processed foods that are lacking in protein, fiber, vitamins, and minerals, for example.) HEOR researchers are accustomed to analyzing  clinical and economic data but are less experienced with SDoH data, in part because they are hard to come by. There are data sources such as open or closed administrative claims that purport to contain SDoH data, but that claim (pun intended) is often based simply on race and ethnicity and perhaps census-tract information. These limited indicators are too crude to be informative and risk the introduction of bias because we assume a person’s color determines their socioeconomic circumstances and health status. Moreover, race and ethnicity are often missing from claims and/or health records so that researchers must supplement their data with a linked SDoH-only data source that covers only a fraction of the patients in the master dataset.

Enter public health data, qualitative and quantitative; federal, state, county and community sourced. These assessments of a person’s access to resources are not at the person-level but are so rich in context and so highly dimensional that you can make a highly educated guess as to a person’s access to resources based on where they live.

So how can HEOR researchers make use of these public health data to inform whole person analytics? CDC announced during the Plenary that in the Summer of 2024, granular SDoH data will be made available to the public via the CDC ‘Places’ initiative. CDC is attempting to curate a number of measures that characterize SDoH status at a county or city level which include, among other things, five key domains: social context (e.g., age, race/ethnicity, veteran status), economic context (e.g., income, unemployment rate), education, physical infrastructure (e.g., housing, crime, transportation), and health care context (e.g., health insurance). These data can be used to derive a score that can be assigned to a person to factor their SDoH value into the equation that predicts treatment outcomes. Indices like this are not new to CDC who created the social vulnerability index (SVI) used during Hurricane Katrina to identify subgroups most of in need of post-disaster assistance. The Places Score and the SVI percentile are what an epidemiologist would call ‘ecologic’ measures because they relate to communities and not to persons. But they provide contextual information which is invaluable.

When asked what types of data Denise Webb found most informative, she didn’t hesitate to say: stories and storytelling. Entering a resource-constrained community, building trust among its residents, capturing with empathy that with which the inhabitants cope every day — Ms. Webb believes that these personal, qualitative, ‘survey’ data could be structured and linked with community-level ecologic data (like the Places data) and with traditional (quantitative) patient-level clinical data to profile a person’s whole health. Panelists mentioned several times making invisible persons visible, and getting everyone the resources they need to improve their health status. It’s an audacious goal, and we are not there yet. But we are closer than we have ever been.

Panalgo, a Norstella company, is your partner on the healthcare data analytics journey. In addition to our industry-leading analytics platform, Instant Health Data (IHD), Panalgo provides streamlined access to real-world data of all kinds – qualitative and quantitative, community-level and person-level, healthcare-focused and public health-focused. By linking these data sources and making them available for analysis in IHD, we provide a unique solution that allows our clients to see the whole patient and more holistically view their journey through the healthcare system.

Interested in learning more about how you can leverage Panalgo’s platform and partner data assets? Contact us today.