A health system can make remarkable strides in patient safety and quality only to see those results squandered when patients fail to properly adhere to a medication regimen. A recent study by the Council for Affordable Healthcare Coverage found that a shocking two-thirds of patients in the United States do not adhere to their medication treatment plans. It's a problem that's costing the nation's healthcare system an estimated $100 billion annually.
At this year's Health:Further conference, two innovators shared their thoughts on how technology can help solve this vexing problem.
Bruce Greenstein, former CMS chief technology officer and now an executive at The LHC Group, urged providers to prioritize outreach efforts to the top 5 percent of health system utilizers who account for 50 percent of all spending. "The top 5 percent of Medicare utilizers spend an average $43,000 each annually, while those in the bottom 50 percent only spend an average of $234 each," he said. "It's really important to focus our resources where they'll have the most impact."
Greenstein added that about one-third of patients who go to a skilled nursing facility (SNF) following hospital discharge could instead go home, providing they had someone there to assist with medication adherence. He noted that even at SNFs, medication adherence isn't always handled properly. "SNFs have star ratings for excellence, but a lot of low-quality SNFs are still getting referrals," he said.
"Cost and health literacy remain two distinct barriers to improving the outlook on medication adherence," said Miriam Paramore, president of OptimizeRx. "There is a significant opportunity to positively impact medication adherence rates by embedding cost savings opportunities, education materials and refill transparency directly into EHR workflows."
OptimizeRx makes it much easier for physicians to monitor medication adherence. "This direct line of communication allows physicians to access key information on patient follow-through," said Paramore. "For instance, once an order for a medication is made with an e-prescribing workflow, data is sent back to the physician regarding whether the patient has picked up the medication from a retail pharmacy. Information on refill follow-through is also available. Armed with this important insight into patient activity, physicians can then get ahead of the medication non-adherence problem by proactively reaching out to patients to determine the reasons for non-compliance."
The high cost of medications remains one of the principal reasons why people quit taking prescribed drugs. A recent report from the National Center for Health Statistics found that about 8 percent of adult Americans don't take their medications as prescribed because they can't afford them. For those with incomes below the federal poverty level, that percentage rises to almost 14 percent.
OptimizeRx aims to reduce those percentages by automatically alerting patients to savings they might otherwise not know about. "As physicians conduct a patient encounter, available co-pay coupons and vouchers appear within their existing EHR workflow and can be immediately printed, texted or emailed to help bridge the knowledge gap regarding patient savings opportunities," explained Paramore. "Physicians simply search for a brand name drug within the EHR, and in real-time, they're alerted to available offerings for a specific patient. The patient can then present the coupon or voucher to a retail pharmacy provider. By improving medication affordability, ongoing adherence and desired clinical outcomes are more likely to be sustained."
Digital Alerts On The Rise
A recent Pew Research study revealed that more than 90 percent of Americans now own a cell phone - and 64 percent of them are smart devices. Providers are increasingly texting medication reminders because patients are accustomed to receiving information that way.
Nearly 40 percent of these digital reminders actually go to caregivers, not the patients themselves. Getting a timely text helps them ensure that the medication schedule is being followed.
Even when drug costs and provider communication aren't an issue, medication adherence can still be challenging. Here are some factors that add to the complexity:
- CMS estimates that 75 percent of Medicare-age patients have multiple chronic conditions that require multiple medications throughout the day.
- Many patients still try to "be their own doctor," quitting a medication when they either feel better or don't like the side effects.
- The severity of the condition doesn't always ensure medication adherence. One study showed that fewer than half of the patients who survived a major heart attack were adherent to their medication plans in the months following the attack.
Technology tools like OptimizeRx are providing timely education to combat these misconceptions and scheduling issues. "We can engage patients more fully and help them achieve better outcomes," said Paramore.