As adherence incentives expand, pharmacies weigh point-of-care options

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As adherence incentives expand, pharmacies weigh point-of-care options

By Dr. Anton Berisha, LexisNexis - 05/02/2018
Medication nonadherence is a major problem that results in significant consequences to our healthcare system. Between $100 and $300 billion of avoidable healthcare costs have been attributed to non-adherence annually. This represents 3-to-10% of total U.S. healthcare cost in the forms of increased service utilization, preventable hospitalization, and development of comorbidities.

Payers and PBMs have grasped this drain to the system, responding with incentives for medication adherence. Just last month [April 2018], Express Scripts announced a pilot program that rewards retail pharmacies that fill prescriptions and demonstrate an improvement in members’ medication adherence for such conditions as diabetes, high blood pressure and asthma.

These performance-based pharmacy incentives for better outcomes — which often include withholding payments, too — surely have your attention by now. Hopefully you are also paying close attention to the data that supports the use of medication adherence risk scores to segment member cohorts expected to have costly outcomes resulting from non-adherence.

Success of using SDOH

Studies show that social determinants of health (SDOH) — the conditions in which we are born, live, work and age, according to the World Health Organization — account for as much as 50% of health outcomes. This information provides insights into the social, economic, and environmental factors that influence health.

Med Care study looked at how SDOH impact diabetes patients. Researchers found that cost-related nonadherence was prevalent in people with diabetes—half of adults with the disease perceived financial stress, and 20% reported financial insecurity with healthcare and food. Nonadherence in these chronically ill patients brings significant complications much faster than if the disease was naturally progressing in coordination with treatment recommendations.

If the pharmacist could know his patient’s financial stress, perhaps, when filling the medications, he could go back to the physician asking about lower-cost options or discuss strategies for adherence with the patient. Screening to identify challenges is imperative for better communication as the pharmacist’s role on the patient care team continues to grow. Consider that the pharmacist sees these chronically ill patients monthly and can leverage the benefits of both frequency and ease of access. Since patients can walk right up to the counter, they may be more willing and likely to communicate with their pharmacist than with any other provider.

In another case, LexisNexis matched data attributes to SDOH categories identifying correlations with healthcare outcomes. Through public records data on individuals’ court records—including felonies, misdemeanors, liens, judgments, bankruptcies, and evictions—higher numbers of crimes or financial issues were associated with lower medication adherence. Other SDOH data, such as proximity to relatives and education level, can also be used with advanced analytics to provide additional information that could impact future outcomes.

Scores at the point of care

The SDOH information can be used to determine medication adherence risk scores, in the format of a numbered scale or color-coded system such as “red, yellow, green” indicating severe, moderate or low risk. Risk scores trend in the same direction with several outcomes dependent on medication adherence. LexisNexis found those expected to be nonadherent to have a three-fold increase in ER visits. On the other hand, those predicted most adherent were twice more likely to follow up with office visits two weeks after an acute event. These follow-up visits also reduce the likelihood of readmissions, decreasing overall costs.

These types of predictions and the associated scoring will be available at the pharmacy counter soon enough. Realistically, physicians and insurance companies do not have the bandwidth to follow up with every patient individually to remind them about taking their medication and determine if there are additional challenges coming into play. By identifying patients who may be at risk for nonadherence, pharmacists can easily grant them some added attention and communication that reinforces the importance of their medication regimen. As the frontline point-of-contact, pharmacists can help patients understand their condition and how and why the medicine helps them.

Already, we’ve seen through medication therapy management programs that pharmacists are expected to fulfill this role: From adherence to synchronization to reconciliation of medications, it’s the pharmacist’s responsibility to make sure that medications are working to improve health.

With just the click of a mouse, the pharmacist has the medication adherence score, as well as key information about the patient’s socioeconomic environment that enables him to quickly and easily determine what may be driving challenging behaviors and putting that patient (and his health) at risk. At the point of care, the pharmacist has better understanding about the patient’s risk and, therefore, what level of engagement would be optimal.

This all can integrate right into the pharmacy workflow at the point of care.  An example is the real-time prescriber verification solution VerifyRx that is used by the majority of retail pharmacies.

The future of healthcare demands an insightful understanding of patient challenges and the provision of accompanying solutions. For example, in March 2018, Allscripts and Lyft, a rideshare provider, partnered to provide non-emergency transportation for patients to get to medical appointments5.

What do our pharmacy patients need for support? If the adherence risk data indicates transportation is a challenge for a patient, could we seamlessly schedule a ride share for them in one month when their next prescription refill needs to be picked up?

Consider the potential of solving our patients’ biggest challenges with a synthesis of data, technology and the personal communication skills that got you into the business!

Dr. Anton Berisha is senior director of clinical analytics and innovation, health care, at LexisNexis.