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PharmD Live Solution

Social Determinants of Health (SDOH) Support

Proactive care. Better outcomes. Lower costs.

Smarter SDOH solutions for better patient outcomes, stronger care coordination, and reduced healthcare costs.

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The PharmD Live® Difference

Addressing Barriers to Health
and Equity

Social determinants—such as access to food, housing, transportation and social support—have a profound impact on health outcomes. CMS is implementing a Health‑Related Social Needs (HRSN) screening tool to identify beneficiaries’ needs and reimburse providers for these assessments. Care management programs like CCM, BHI and TCM are well positioned to engage patients, screen for SDOH and coordinate resources.

HRSN Screening & Documentation
Risk Stratification
Resource Coordination
Addressing Barriers to Health and Equity
Core Capabilities

Key Features of Our SDOH Support Program

Explore the clinical, operational, and technology capabilities that work together to improve care delivery and performance.

Featured Capability

HRSN Screening & Documentation

Use standardized tools (e.g., G0136) to assess social needs and document Z‑codes for appropriate reimbursement.

Integrated Capability Network 5 connected capabilities
Risk Stratification
Resource Coordination
Multidisciplinary Team
Patient Empowerment

Risk Stratification

Incorporate SDOH data into AI models to prioritize interventions for high‑risk patients.

Resource Coordination

Connect patients to community programs (food banks, transportation, financial assistance, housing) and track referral completion.

Multidisciplinary Team

Pharmacists, social workers and care coordinators collaborate to address social barriers and medication access issues.

Patient Empowerment

Coaching and tools that help patients overcome social barriers and stay on track with their care plan.

Benefits & Impact

The Value of Addressing Social Determinants of Health

The Value of Addressing Social Determinants of Health

Improved Health Equity

Addressing social needs reduces disparities and improves outcomes for underserved populations

Quality Performance:

SDOH interventions contribute to higher quality scores in value‑based programs (Star Ratings, CAHPS, HEI) and support CMS health equity initiatives.

Reimbursement Opportunities

Billing for HRSN assessments provides additional revenue

Lower Total Cost of Care

Removing barriers enables better adherence and reduces preventable hospitalizations and ED visits

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Related PharmD Live Solutions

Why PharmD Live®

Why PharmD Live®

Our SDOH support program integrates social needs screening into routine care management workflows. Using AI‑driven risk models, we identify social barriers that impact medication adherence and disease control. Our care coordinators and social workers then connect patients with appropriate resources and monitor outcomes.

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