Electronic Health Reporter

By Jason Rose, CEO, AdhereHealth.

More than a year after scientists identified the first cases of COVID-19, infection rates continue to rise in regions across the United States.

The virus has been particularly devastating for those who can afford it least: the elderly, underserved communities, low-income families, and people of all ages with chronic conditions.

COVID-19 infection, hospitalization, and death rates for these groups are dramatically higher than for other populations.

According to the CDC, eight out of ten reported COVID-19 deaths in the US are among individuals 65 or older.  And data from the COVID Tracking Project reveals that Black or African American individuals are up to 1.5 times more likely to die from COVID-19 than white patients.

Patients with multiple chronic diseases are also at elevated risk.  The CDC cites chronic kidney disease, COPD, obesity, and heart conditions as known contributors to poor outcomes from COVID-19, while Medicare statistics show extremely high rates of hypertension and hyperlipidemia, diabetes, and chronic kidney disease among hospitalized beneficiaries.

All these groups have another major risk factor in common.  They are the populations that most often struggle to cope with the social determinants of health (SDOH), such as food security, social isolation, and access to healthcare, living wage employment, and transportation.

In the current economic environment, many of these individuals are even facing the hard choice of prioritizing food and shelter over the expenses of necessary healthcare and medications, despite the knowledge that avoiding care may increase their vulnerability to their preexisting conditions – and subsequently raise their chances of experiencing a worse outcome if they contract COVID-19.

Even with the prospect of mass vaccination on the horizon, it’s more important than ever for healthcare providers and health plans to understand and address the social determinants of health, starting with ensuring pharmacy access and medication adherence.

The role of medication adherence in population health management

Population health management focuses on staying one step ahead of the clinical and non-clinical factors that may lead to poor outcomes in targeted patient groups.  For the six in ten Americans with at least one chronic disease, medication adherence is a critical component of maintaining good health.

Suboptimal medication adherence has significant impacts on chronic disease management and overall wellbeing. Incorrect use of medications contributes to tens of thousands of preventable deaths and half a trillion dollars in healthcare waste every year.

The reasons behind medication adherence issues are varied and challenging.  Some patients experience undesirable side effects and change their doses without consulting their physicians, while others struggle to understand the importance of their prescriptions or fit their medications into their daily routines.

For patients with socioeconomic difficulties, the problem gets even more complex.  Out-of-pocket drug costs are skyrocketing, leading large percentages of patients to abandon their medications unwillingly.

Elderly and medically fragile individuals often lack transportation to the pharmacy and may not be able to manage multiple prescriptions on their own.  As social distancing and quarantine requirements make it more difficult for family and friends to provide direct support, these patients risk falling out of adherence with one or more of their medication regimens.

In order for providers and health plans to close gaps in care and succeed with population health management – and the financial incentives increasingly attached to these strategies – medication adherence must take center stage.

Encouraging medication adherence during a pandemic

Collecting accurate, comprehensive data about the social determinants of health is an ongoing issue for many health plans and providers.  SDOH information is often difficult to gather, standardize, and share through existing health IT systems.

With the right technologies and predictive analytics capabilities, however, healthcare stakeholders can use pharmacy data, claims data, clinical histories, and other patient information to generate important insights into patients who may be experiencing medication adherence concerns due to socioeconomic challenges.

By working with these data sets and creating automated processes to identify chronic disease patients falling behind with their prescriptions, providers and health plans can effectively target population health management interventions to individuals with known risks.

These interventions may include medication reconciliation reviews, personalized conversations about barriers to prescription access, or enrollment in case management programs.

Patients may also benefit from access to customized medication blister packs, assembled by pharmacists, that include all their medications organized by time of day or other dosing requirements.

Providers and health plans can use these conversational opportunities to share education about staying safe and healthy during COVID-19.  They may also connect vulnerable patients with food pantries, financial assistance groups, and behavioral health organizations in their communities to help them cope with socioeconomic concerns related to the pandemic.

Combining clinical interventions with community-based support can boost medication adherence rates, which can in turn give patients a better chance of maintaining their health and avoiding the worst outcomes from COVID-19.

Staying connected with patients during and after a COVID-19 illness

Unfortunately, there will be patients who cannot evade COVID-19.  Older and medically complex individuals who are hospitalized for the disease may be discharged with complicated instructions, changes or additions to their medications, and new limitations on their daily functioning as they recover.

Providers and health plans can help patients adapt to their situation and potentially avoid readmissions by engaging in transitions of care (TOC) activities, including speedy follow-up after discharge and a thorough medication reconciliation review.

Patients with multiple chronic conditions and SDOH challenges may also benefit from additional services like medication delivery arrangements, access to prepared meal services, home care aides, or safety inspections of the living environment to ensure they can reintegrate into their homes.

Ensuring that COVID-19 patients have the tools and resources they need to continue managing their underlying conditions is essential for helping them regain their health and return to normal life.

As the United States continues to battle the clinical and social effects of COVID-19, healthcare stakeholders will need to keep SDOH-focused population health management as a top priority.

Providers and health plans that integrate data-driven, proactive medication adherence into their population health programs can equip their patients with the knowledge and support they need to overcome socioeconomic issues and remain healthier throughout the course of the pandemic.