Achieving medication adherence: creativity, consultation and community
Improving rates of medication adherence in the patient population has long remained an area of focus among pharmacists. Patients who regularly take their medications as prescribed demonstrate better clinical outcomes. Moreover, adherence results impact the retail pharmacy financially. Even though pharmacies aren’t scored for HEDIS or Star measures directly, they are incentivized through risk-based contracts and other programs to help improve these ratings because they impact health plans’ ratings. CMS now measures adherence to statin, blood pressure, and diabetes medications as part of its Medicare Part C and D star ratings, representing 11% of the ratings portfolio. These Star ratings impact a health plan’s profitability and a provider and pharmacy organization’s value-based care incentives.
In the push toward value-based care, providers treating and serving vulnerable populations, like the chronically ill, must consider implementing various strategies to generate successful healthcare outcomes, and especially reduce the likelihood of hospitalizations. Medication adherence plays a significant part in this effort as it is lowest among patients with chronic illnesses, and poor adherence results in 33 to 69 percent of medication-related U.S. hospital admissions, at an estimated cost of $100 billion annually.
As pharmacists seek to take a more active role on the patient care team, perform more valuable and, consequently, profitable services, and execute a successful pharmacy business model, they can improve on these statistics by implementing new data analytics tools and strategies for better patient service and increased medication adherence.
Taking a broader view of each patient
While pharmacies have had some success with medication synchronization, custom packaging, customer reminders, and coupon programs for years, the industry needs to advance past these fundamental strategies. Each patient is an individual and has complex challenges that contribute to medication nonadherence. To better understand each patient, pharmacists should take a broader view than their script provides. From a socioeconomic standpoint, what can data about this patient predict about health outcomes and specifically medication adherence? Not knowing what is driving a patient’s non-adherence is a missed opportunity for improving that patient’s outcomes and the pharmacy’s adherence metrics.
Developed with attributes predictive of healthcare outcomes, an adherence score can help pharmacists understand the likelihood of patient follow-through with medication. With an adherence score, the pharmacist will have both an understanding and a call to action for specific patient challenges such as address mobility, education, community engagement, access to transportation, and social support. Retailers can implement corporate-wide programs that can enable individual interactions between the pharmacy staff and the patient. These interactions can have a direct impact on patient outcomes and adherence and may qualify for reimbursable consultations. Retailers can also take on a more active role in their communities to help with broader issues, such as housing, connecting patients with social groups, or encouraging patients to become involved in their communities.
The key benefit of harnessing analytic data is the pharmacists’ ability to broaden their perspective on how they can help patients. The extra help can be as simple as the right conversation with a patient or as complex as a retailer is willing to take on. The goal of medication adherence is the goal of better health. Let’s get to work.
Brian Eidex is Director, Relationship Management at LexisNexis – Health Care.