Across healthcare sectors, many leaders wish to change clinician behavior for many reasons, from private gain to public interest — and few have been more successful at doing so than the pharmaceutical industry. Pharmaceutical sales reps routinely visit physicians’ offices to inform and influence their prescribing. The practice has drawn substantial skepticism, but it’s hard to discount its success at changing the way physicians write prescriptions. That success is why the pharmaceutical industry spends over $5 billion a year on this practice.
At the same time, many health equity initiatives, including population health and social needs programs, have struggled to achieve lasting behavior change among frontline care teams. So it begs the question: Can teams focused on advancing equity take a page from the pharmaceutical sales playbook?
Pharmaceutical companies have drawn significant criticism for often blurring the line between pushing drugs that are truly medically necessary and drugs that are simply profitable. For that reason, pharmaceutical sales are not where most people would instinctively look for solutions to health equity. But if you separate the motive from the method, you can find important lessons that will help advance health for all populations.
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Health equity efforts can stall for several reasons. One foundational reason is that it’s hard to get busy clinicians and practices to identify eligible patients and connect them to a range of proven health interventions — from diabetes and falls prevention programs to nutrition supports. It’s harder still when those patients are already experiencing care gaps or unmet social needs, like food insecurity, that make it harder to get care or get better. Another reason is that most healthcare professionals often don’t know the people who provide these programs, especially when they’re based in the community. Clinicians tend to know other clinicians, but many don’t have working relationships with other professionals — like managers at the local YMCA or Area Agency on Aging (AAA). These nonprofits offer a range of health programs that address immediate needs as well as the upstream factors that influence up to 80% of a person’s health outcomes. But, without relationships to clinicians, these programs often struggle to get people in the door.
That’s where “detailing” can help. It’s an approach that uses brief, semi-structured, and repeat face-to-face visits with key messages tailored and delivered to fit someone’s specific needs.
The practice of detailing dates back to the 1800s, and the rise of modern pharmaceutical detailing began in the 1940s. By the 1960s it was the industry standard, with about 20,000 pharmaceutical sales reps nationwide who became known as “detail men” because of their role sharing educational details about particular drugs in one-on-one meetings with doctors.
Others have adapted this tried-and-true practice in the decades since. In the 1980s, researchers at Harvard introduced “academic detailing,” in which nurses and pharmacists helped to change prescribing behavior using unbiased research and evidence. A couple of decades later, the New York City Department of Public Health used detailing to promote essential preventive and disease management practices in the city’s highest mortality areas. Now, it’s time to apply the lessons learned from detailing to one of the industry’s biggest challenges: community health.
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Reimagining detailing for community health
The pharmaceutical industry figured out decades ago that behavior change rarely happens because someone receives more information or goes to a conference. It happens when people are supported — repeatedly and practically — in doing something differently.
What’s beautiful about the detailing approach is that it meets clinicians and care teams where they are. They are busy, time-constrained, and facing many competing priorities. That’s why brief but repeated meetings to provide useful information and approaches tailored to their needs have proven so effective.
Tailoring is important because different leaders and frontline teams are trying to solve different problems. Some are trying to close quality gaps while others are working to improve population health outcomes, address social needs, or connect patients to benefits and community resources.
In many cases, health plans, health systems, public agencies and community-based organizations have already invested in evidence-based programs designed to prevent disease and address the social conditions that harm health. Yet too often, the people who could benefit from those programs are never identified, assessed, referred or enrolled. This includes programs related to diabetes prevention, food support, transportation assistance, Medicaid re-enrollment support, falls prevention and more.
When organizations invest in programs that never reach or enroll eligible patients, it’s not just that they’re underusing vital staff time and resources, it’s a wasted opportunity to improve health. And with the broad cuts to public health programs, healthcare coverage, and nutrition benefits that we’re currently experiencing, it’s more important than ever to connect eligible patients to essential programs and ensure that existing investments and resources are being used to the fullest extent possible.
Community health detailing is an important tool that can help solve this underutilization problem and enrollment gap. The same mechanics that helped the pharmaceutical industry increase prescriptions can now help people meet new Medicaid work requirements or exemptions, increase referrals to evidence-based health interventions, and dramatically increase enrollment in vital programs that improve health outcomes and reduce inequities. The practice just looks a little different.
To adapt the detailing approach for health equity, population health, and social needs, keep these four key pillars in mind:
Focus on behavior, not just awareness. You need to define the specific actions you want a care team to take, whether that’s identifying eligible patients, asking the right questions, making referrals, helping someone enroll in a service, or something else.
Use trusted messengers. Community health workers, peer educators, community-based organizations, and people with lived experience can bring credibility, context, and practical knowledge about the barriers patients face.
Make changes small and repeatable. Busy care teams are more likely to adopt changes that fit into existing workflows. Keep the ask focused, reinforce it through brief repeat interactions, and make the desired behaviors – like “Screen, Assess, Refer” – easy to remember and repeat.
Build relationships to build referrals. Clinicians are more likely to refer when they trust the messenger and receiving organization, understand what happens after the referral, and believe patients will be cared for effectively and with dignity. A resource directory alone does not change referral patterns.
The pharmaceutical industry was extremely successful at using detailing to change prescribing behavior. Now healthcare and community leaders can use the same discipline for an arguably more important purpose — connecting people to the resources, supports, and interventions that help prevent harm before it happens.
Photo: Khanisorn Chaokla, Getty Images
Dr. Rishi Manchanda is the Founder and CEO of HealthBegins, a certified B-Corp that helps transformational healthcare leaders address the social needs and conditions that put people in harm’s way through practical strategies, training, and field-building expertise. Prior to HealthBegins, Dr. Manchanda was the founding Director of Social Medicine for a network of community health centers in South Central Los Angeles, the first lead primary care physician for homeless veterans at the Greater Los Angeles VA, and the inaugural Chief Medical Officer for a self-insured employer with a large rural agricultural workforce.
Dr. Manchanda is dual board-certified in Internal Medicine and Pediatrics and is a nationally sought-after speaker and advisor on social drivers of health, health equity, population health transformation, and upstream healthcare innovation. Based in Los Angeles, he also serves as a board member and advisor to organizations and initiatives advancing health equity, economic opportunity, and participatory democracy.
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