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Poor medication adherence is widely recognized as being one of the largest controllable costs in the U.S. healthcare system, to the tune of somewhere between $100 billion and $289 billion per year, according to the Centers for Disease Control and Prevention.
“Adherence is important and we should take steps to combat the reasons patients remain nonadherent, but it’s more important to know when there is no adherence,” says Asif Khan, CEO of Caremerge, a communication and care coordination network for the senior care industry. “Often, nobody knows when adherence is off—until it’s too late.”
Reasons for nonadherence are myriad, today however, Managed Healthcare Executive focuses on 10 solutions that come together to provide a multifaceted approach to the problem.
#1. Connect the dots of fragmented care
“Increasingly, the entire healthcare system is low on time and high on high-need, high-risk patients,” says Khan.
Paper charts, incomplete electronic health records (EHRs) that focus on ailments but not psychological behaviors that could potentially be barriers to adherence are not enough to combat the growing problem, he says. “Instead, technology is being created to fill the current gaps, optimize workflows and empower all staff—not just the physicians—to provide better care more efficiently.”
Chronic care management SaaS solutions, created to aid physicians in billing for CPT code 99490 (for non-face-to-face care coordination services furnished to Medicare beneficiaries with multiple chronic conditions), is a good example of connecting the dots of fragmented care.
“Physicians should look for interoperable systems that can easily integrate—or already are—with their EHR,” Khan says. “Using these solutions allows physicians to become hubs for patient-centered care—coordinating care with specialists, referrals, caregivers, tracking all communication and interactions so in-office visits are more effective while also focusing on educating the patient, and their caregivers, to combat potential slip-ups between visits.
“Chronic care management solutions and tech aids made in a similar vein, are effective, not just for chronically ill patients but for any patient experiencing difficulty adhering to mutually agreed upon care plans,” Khan adds. “They provide physicians and patients with a stronger foundation to build a more communicative, fully fleshed out relationship.”
#2. Recognize that medication adherence is a critical “healthy behavior”
“This, along with others such as smoking cessation, weight control, healthy eating, and exercise, significantly impacts clinical outcomes,” says Katrina Firlik, MD, chief medical officer and cofounder at HealthPrize Technologies, a patient engagement and medication adherence solutions company.
Find out what patients actually want in an adherence solution, not only what you think they need, Kirlik advises.
In an Accenture report regarding what patients wanted in terms of pharma services, the number one most-requested service was rewards.
#3. Make the regimen simple
Complex regimens will affect adherence, according to Michael J. Sax, PharmD, president, The Pharmacy Group LLC.
“By reducing the drug regimen in frequency, for example, taking one pill per day versus multiple pills, has been shown to affect adherence,” Sax says. “Also, the use of simple instructions to ensure proper understanding will also increase adherence. Many times patients do not understand the instructions they have been given and will forget what their physician has told them.”
#4. Don’t overlook the capability specialty pharmacy partners
“Engagement with specialty pharmacy partners with proven MTM programs has shown to add measurable value, improve adherence, patient outcomes and reduce overall healthcare costs,” according to Marc O’Connor, COO with medication management provider Curant Health.
For example, a study conducted by Curant Health showed that in a cohort of HIV patients on highly active antiretroviral therapy (HAART), MTM with consistent patient outreach and customized prescription packaging improved adherence by 28%. The study also found that the number of patients demonstrating 95% adherence improved 69%.
#5. Educate patients
Many patients have difficulty understanding health information given to them by their physician during their 7.8 to 17.6 minute appointments. Furthermore, nearly 85% of patients want access to their digital health records and care plans, according to the National Health Council.
“Providing patients digital access, alongside education on their condition, their medications as well as the ability to check-in with their primary provider could dramatically increase the number of patients becoming active agents in their own care,” Khan says.
Establishing a consequence, such as educational web courses patients must attend if they are found to be nonadherent, also can aid in greater personal accountability, according to Khan.
“Studies have shown that an understanding of the patient’s condition and treatment is related to adherence,” says Sax. “an explanation in simple, everyday language is essential … Communication should be tailored to each patient and involving family members is key and has a positive affect on adherence.”
#6. Educate caregivers
Caregivers are a booming demographic; approximately one-third of Americans are informal caregivers putting in 1.2 billion hours per week, according to an article published in Population and Development Review.
“In addition to working full-time jobs and taking care of children, these caregivers step in to aid their loved ones and things fall through the cracks,” Khan says. “Emphasizing coaching and caregiver education is a no-brainer, especially if it can be done by bringing all the informal—and formal—caregivers onto one platform and then checking in with them in-between visits to build relationships and push adherence.”
#7. Put measures in place to track adherence closely
Determine which patients don’t fill prescriptions; are always late to fill; or quit refilling over time.
“Offer adherence solutions to those who need it,” Firlik says.
#8. Conduct in-between visit care
Chronically ill patients spend just a few hours in their doctors’ offices annually, but they spend about 5,000 more waking hours living out their lives, according to an article in the New England Journal of Medicine.
“In-between visit care [the time that passes between each scheduled vist] provides another outlet for physicians and staff to connect care, educate patients and their caregivers,” Khan says. "They don't have to wait for each scheduled visit to provide care and education to the patient."
In chronic care management, for example, an LPN will call to check-in with a program participant and go through the care plan to gain a better understanding of whether or not they're following the outline—taking medication (or need refills), participating in exercise, answer any questions of concerns, etc.
This goes beyond telephonic check-ins, patient portals, pushing out educational material via email, or reminders via text, so the patient can be engaged between visits and active in their care, Khan says.
#9. Don’t rely on only one intervention
“Some patients who are already motivated to fill and refill, but may skip an occasional dose, may simply need reminders,” says Firlik. “Others may require motivation, which could require rewards, gamification, discounts, or compelling forms of education.”
#10. Keep a close eye on the prior authorization process
Ensure the process doesn’t serve as a costly, unintended barrier to access for much-needed therapy, says O’Connor.
“It is not surprising that as the number of specialty drugs increases, so do requirements for prior authorizations; fiscal responsibility on the part of payer and PBMs dictates that this, in fact, be the case,” he says. “However, the administrative burden of completing these forms frequently falls on overworked providers and their staff. No one in the healthcare ecosystem benefits when clinicians are forced to decide between time spent caring for additional patients or time spent fulfilling the administrative burden imposed by prior authorization forms.”
Executives need to take a close look at their overall processes to ensure the correct balance is struck between fair evaluation of a therapy’s necessity and timely medication access for patients, he adds.
“For example, we have seen some hepatitis C patients have their prescriptions authorized and filled for the first month of a known 12- or 24-month regimen, only to have the same patients faced with monthly prior authorization approval from their PBM or payer for subsequent fills,” O’Connor says. “This process creates an unnecessary burden to access and puts the patient, now dependent on securing multiple prior authorization approvals, at risk for developing resistance to therapy if those authorizations aren’t repeatedly approved in a timely manner.”
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