By Kim Huynh and Esther Ketelaars, health and life sciences experts, PA Consulting.
Studies unanimously show the negative effects medication non-adherence has on clinical outcomes and healthcare costs. Adherence is critical to ensure that medications work properly and important for pharmaceutical companies because it helps keep their drugs covered under health plans. Healthcare insurers want to ensure their covered drugs are treating their members effectively and are seeking to prevent more costly health care.
So, while traditionally medical adherence solutions have been paid for and promoted by pharma and payors, a new player has a chance to enter the scene and challenge the status quo. Now is the time for providers to proactively address medication adherence as they start to bear more financial risk through value-based care models.
How can providers play a larger role?
Provider organizations who focus on medication nonadherence have a great opportunity to improve patient outcomes and support their value-based care models. According to the Center for Disease Control medication nonadherence results in 10% of hospitalizations and 125,000 preventable deaths in the U.S. each year. Likewise, low medication adherence leads to treatment failures between 30% and 50% of the time.1 These negative impacts become even more relevant to providers as patient outcomes continue to be more closely tied to reimbursement and payment incentives.
Pharmaceutical companies, payors, some providers, other consumer-focused companies in the healthcare value chain, and even governments have tried to address nonadherence. With the recent growth of digital health solutions especially, many have focused on leveraging novel technologies. However, there are a myriad of reasons for patients not compliant with their medication and adopting a single tool or technology has rarely been effective in reducing nonadherence.
A one-size-fits-all approach will often only address a single issue for a limited number of patients. With their direct access to patients, providers have a better chance of addressing the complex mix of reasons for nonadherence and design medication adherence programs customized to each patient. Personalized intervention plans invite a direct solution to each patient’s reasons for nonadherence with the appropriate tools that address the underlying cause for that individual.
Developing such a program requires factoring in root causes and reasons for nonadherence, using predictive analytics to identify high-risk patients, and gathering a diverse set of interventions to address those root causes. The position and shared decision-making power between providers and consumers indicate that providers can address medication adherence for more patients, improve patient outcomes, and reinforce value-based care.
Designing a patient-centered medication adherence program
Many of the tried and tested programs have been designed based on an assumption of the underlying reason for nonadherence. However, for these programs to be truly effective provider organizations need to understand and diagnose the patient’s reasons for nonadherence and tailor their intervention with the right tools.
Understand the reasons for medication nonadherence
Exploring the factors contributing to nonadherence allows organizations to understand the inherent complexity of nonadherence. Most interventions fail to produce the desired results because they don’t consider the many contributing factors. The reasons for nonadherence go beyond simple forgetfulness. Only 30% of patients cite forgetfulness as the cause of their nonadherence.