The healthcare system has a $300 billion dollar problem – medication adherence. More than 131 million adults in the United States – which amounts to 66% of people in the country – use prescription drugs. Even though so many people take prescription medication, around 50% of them don’t actually take them as prescribed.
While the damage to the patient’s health is clear, the cost to health plans often goes unseen. Last year alone, failure to take prescribed medications led to over $100 billion in costs associated with avoidable hospitalization.
With the introduction of the 5-Star rating system introduced by the Affordable Care Act, it’s never been more important for health plans to modernize their Medication Therapy Management (MTM).
Why Medication Adherence is Important
A lack of proper adherence can hinder one’s ability to treat serious diseases. That, of course, leads to more medical complications down the line and lower life quality for the patient.
The negative impact isn’t only on the patient. For health plans, lack of adherence leads to increased costs and poorer health outcomes – which ultimately leads to a dip in quality scores (HEDIS/Stars).
Of the 53 key quality measures in the Medicare Stars rating system, 17 are prescription drug-specific. In addition, these factors have a weighting of 1.5x to 3x making them a highly important component for the overall plan rating.
With Star Ratings bonus payments expected to exceed $2 billion for the large, public Managed Care Organizations (MCOs) in 2015 alone, MTM should be a top priority for MCOs.
Let’s dive deeper into the impact on both patients and health plans.
Non-Adherence Impact on Health
When a patient struggles to obtain and use medication appropriately, it limits the drug’s effectiveness. Non-adherence can lead to a number of unwanted side effects. One study discovered that seniors taking statin-reducing medications can increase the risk of dying of a heart attack by 25% if they suddenly quit them.
Non-Adherence Impact on Mortality
Each year, more than 125,00 preventable deaths occur in the US due to medication adherence. These deaths could be easily avoided if healthcare professionals could explain to the patients that dying from non-adherence to medication is ten times greater than dying of homicide.
Non-Adherence Healthcare System Costs
As people age, their need to medically manage multiple diseases increases. Financial experts estimate that between $100 and $300 billion in annual healthcare costs are easily avoidable. To put this into perspective, consider that these costs represent between 3% and 10% of the U.S. total healthcare costs on an annual basis
Improving Medication Adherence
Providing patients with enough information, keeping a blame-free environment, and providing positive feedback for medication adherence is key to a trusting provider-patient relationship.
Health is a very personal topic. Because of this, addressing the issue of medication adherence needs to take a more personal approach.
Provider-Patient Relationship Adherence Barriers
For some patients, non-adherence simply happens due to lack of access and forgetfulness.
- Time management and forgetfulness are responsible for 47% of cases
- For 11% of people aren’t adherent due to a lack of knowledge and understanding
- 8% of patients report that trust and communication issues lead to non-adherence
But quite frequently, the largest barrier is created when the relationship between patient and provider is seen as purely clinical. There’s a difference between a qualified provider and the right provider.
For example, “right provider” might mean matching patients to clinical pharmacists based on criteria like native language, geography, specialty, etc.
While making this connection might seem overwhelming, there are already healthcare technology companies specializing in this sort of matchmaking.
Encourage Long Term Pharmacist-Patient Relationships
Assessing medication-taking can be done through self-reporting. Simply by talking to the patient at scheduled intervals, one can learn a lot about their habits. Studies show that some patients overestimate adherence by a staggering 200%.
In turn, these 1-to-1 long-term relationships enable pharmacists to understand which patients are at higher risk for non-adherence and employ tactics to limit lapses.
Ensure That Patients Understand the Benefits
Lastly, increased trust improves the likelihood of patients attending their scheduled meetings with their providers. The patient needs to actually show up for a provider to educate their patient on what the medication does, how it helps them, and how much it improves the quality of their life.
Here are a few strategies used by the Reliant Medical Group from Massachusetts to improve patient adherence to blood pressure medicine:
- Trying to help patients improve their health literacy on hypertension
- Pharmacist-led calls with patients about medication timing and dosing
- Giving their patients lower-cost, generic medication substitutions
- Pharmacist-led medication reconciliation and monitoring of medication treatment plan
Predictors of Non-Adherence
Understanding the scope of the problem is the first step in reaching better medication adherence rates. Next, you need to understand why so many people fail to follow fairly simple instructions. For many, fear of experiencing negative side effects is the number one reason.
In a recent poll conducted by Health Dialog, people were asked to say which side effects would make them stop taking their medications. These are the results:
- 38% sudden weight gain
- 34% feeling of nausea
- 19% fatigue and dizziness
- 9% visible skin irritations
At the surface level, some might chalk up non-adherence to these simple fears. However, fear and misunderstanding are symptoms. The larger issue is the lack of proactive education, intervention, and a dedicated MTM program resource.
One study found that patients with chronic diseases who were enrolled in an appointment-based medication synchronization program were 3.4 to 6.1 times more likely to be adherent than patients who didn’t have synchronized medication refills.
The final step in non-adherence prevention is to create a system of accountability for the patient. And in many cases, this begins with the simple step of creating scheduled, pharmacist-led, clinical consultations.
Leveraging Large-Scale Data Collection
In one study that focused on collecting large amounts of data on patient behavior, clinicians at Sichuan Provincial People’s Hospital were able to successfully evaluate peoples’ adherence status. By recording demographics, disease, treatment, diet, exercise, and mental status information, researchers found out that 21.2% of the patients were susceptible to poor adherence.
Medications Associated With Non-Adherence
In another study, the average non-adherence rate across all diseases is roughly 25% according to a meta-analysis of more than 500 studies. However, certain medications were more associated with non-adherence than others. Adherence is highest in patients with arthritis, gastrointestinal disorders, and most surprisingly, cancer.
Non-Adherence in the Value-Based Care Model Era
The ‘value-based care models that align reimbursement with the delivery of higher quality and more cost-effective care are not going away. These models have a profound impact on how MTM services are utilized.
More importantly, an effective MTM program that utilizes clinical pharmacists can dramatically improve adherence and patient health through regimented chronic condition management, eliminate the fear of medication-related side-effects through patient education, proactively identify medication adherence gaps, and drive appropriate interventions.
The main takeaway is that non-adherence is one of the biggest costs and fatality drivers in healthcare today. It also represents one of the biggest opportunities. Through healthcare technology and accessibility to high-quality clinical pharmacists, the quality of resources available to implement effective MTM programs has never been higher. And that’s great news for patients and health plans alike.