Introduction
Poor medication adherence is a common issue in the United States. Lack of adherence to medications caused approximately 125,000 deaths, at least 10% of hospitalizations, and cost the U.S. health care system $289 billion in 2009.1,2 The Centers for Medicare and Medicaid Services (CMS) through Medicare Advantage plans and the CMS Star Rating program offer incentives to optimize medication adherence. These incentives are particularly advantageous for participants in value-based programs. Currently, there are limited studies outlining the best way to approach patients with nonadherence.
Population Health Approach
Given the lack of published data, UCHealth Coordinated Care Colorado (C3) has been working on a multidisciplinary workflow, utilizing population health specialists, clinical pharmacists and nurses to improve the process for identifying and outreaching patients who are identified by value-based programs as nonadherent to their medications.
A pilot program was completed October 2020 through December 2020. During this time, approximately 150 patients in a Medicare Advantage value-based program were identified as nonadherent to an antihypertensive, an oral antidiabetic or a statin medication. The medical records for these patients were reviewed and outreach was completed when appropriate. The majority of patients who were reached by phone were not able to identify a cause for missing their medication. Some patients described difficulty affording medication, and some described choosing to only pay for medication deemed essential. Some patients were hoping to synchronize their medication refills to limit the number of trips to the pharmacy, and had therefore delayed filling all prescriptions.
Challenges to completing outreach in a timely and effective manner were identified. Patients frequently wanted to discuss additional health concerns besides medication nonadherence; it was often difficult to get ahold of patients even after two attempts by phone; and despite having access to claims data through the electronic health record, there were still gaps in available refill data.
The pilot program provided important findings to improve future medication adherence outreach. Starting in 2021, C3 will begin outreaching patients who were nonadherent during the 2020 plan year, as these patients are at high risk for nonadherence again.
What You Can Do to Improve Medication Adherence
Prescribing a 90-day supply of medication for chronic disease control is one of the most important strategies to reduce nonadherence. This increases the amount of medication patients have on hand and limits the number of trips patients need to take to the pharmacy.
A 2012 systematic review identified additional evidence-based strategies to improve medication adherence.2 Several of these strategies are outlined in Table 1.
| Table 1: Evidence-based strategies to optimize medication adherence2 | |
| Hypertension | Blister packing, involving case management, and education with behavioral support |
| Heart failure | Reminder calls, pharmacist-led multicomponent interventions, education with behavioral management, and case management involvement |
| Depression | Case management involvement and collaborative care |
| Asthma | Self-management and shared decision-making |
| Diabetes | Care coordination and collaborative care |
Conclusion
Medication nonadherence can result in increased hospitalizations, morbidity, and mortality, as well as increased costs to the health care system. C3 is currently working on improving the medication adherence process through a multidisciplinary process. Providers can improve medication adherence through multiple medication interventions, and most importantly, by prescribing a 90-day supply for medications used to treat chronic diseases.
References:
- National Community Pharmacists Association. Medication Adherence in America: A National Report 2013. Alexandria, VA; National Community Pharmacists Association; 2013. Available from: ncpanet.org/pdf/reportcard/adherencereportcard_abridged.pdf. Accessed December 11, 2013.
- Viswanathan M., Golin C.E., Jones C.D., et al. Interventions to improve adherence to self-administered medications for chronic diseases in the United States: a systematic review. Ann Intern Med. 2012 Dec. 4;157(11):785-95.