Providers, pharmacies, insurers, patients and families all agree that better medication adherence can improve care and reduce costs. The numbers are striking:
- Non-adherence can account for up to 50% of treatment failures, around 125,000 deaths, and up to 25% of hospitalizations each year in the United States contributing $100 billion in preventable costs1,2
- Despite existing efforts, adherence rates lag around 50% when it is broadly recognized that 80% adherence is considered clinically important.
With a mutual commitment to innovation and teamwork, everyone in the healthcare ecosystem can enjoy the financial, safety and quality of life benefits that will result from improved medication adherence.
In the transition to value-based care, the importance of treating chronically ill patients safely in their homes becomes critical. Providers, Pharmacies, Insurers, and Patients all have much to gain by improving home medication management.
Physicians and other Providers
In our healthcare system, no group or entity has direct responsibility for addressing adherence. So while physicians, nurses and pharmacists have long recognized the value of medication adherence to successful treatment, they have consistently looked to the patient and family to take responsibility. In fairness, providers have had limited visibility to their patient’s home care and end up relying on a few minutes of engagement during appointments. Yet most physicians say they would want to know if their patients were non-adherent. Giving providers access to home medication adherence information and other benefits of telehealth would extend the provider’s role in the patient's success, and enable counseling with options for programs, products and services for patients at risk.
A critical stakeholder in medication management, pharmacies offer safety and medication discipline to the medication use process while distributing medications and providing clinical insight. Many pharmacists desire a deeper engagement in adherence programs, but the lack of reimbursement for assistive technology and many clinical services makes it difficult to take a more active role. Currently, innovative pharmacies and Pharmacy Benefit Managers (PBMs) are exploring home medication adherence tools including automatic pill dispensers as a way to extend value and establish loyal relationships with high need patients.
While payers recognize the value of increased attention to adherence, the complexity of the problem doesn’t lend itself to a “one size fits all” solution. Increasingly, payers are engaging care management teams and digital relationship management tools to engage and support high risk, high cost patients. Some programs show promise, though they are often expensive, utilizing nursing and clinical support staff to engage with patients to assess and coach them to better behaviors. It is becoming clear that patient needs are different, and a patchwork of programs and services is needed to help both patients and caregivers. Insurers may have the most to gain from improved adherence and should be exploring medication adherence tools that provide daily medication support for patients, and timely clinical visibility into patient behavior for care teams.
Patients and Families
For many, the responsibility for adhering to complex medication regimens remains entirely with the patient, and subsequently their families. Not surprisingly, patients and family caregivers can quickly become overwhelmed with safe medication management (including ordering, filling and sorting multiple medications, administering medications safely at multiple dosing times, and remaining diligent over an extended period of time). Working to avoid costly home nursing services or expensive facilities, patients and families are looking for safe, affordable medication adherence tools. Busy family caregivers and patients are investing in innovative technologies like reminder apps and automated pill dispensers to help safely manage medications in their homes, with hopes that insurers will soon recognize the value with reimbursement.
Why has home medication adherence become everyone’s business? Because its good business for everyone! Providers, pharmacies, payers and patients and families all have something significant to gain by exploring new ways to improve home medication management. With a mutual commitment to innovation and teamwork, everyone in the healthcare ecosystem can enjoy the financial, safety and quality of life benefits that will result from improved adherence.
- Sabaté E. Adherence to long-term therapies: evidence for action. Geneva: World Health Organization. 2003. www.who.int/chp/knowledge/publications/adherence_report/en/. Accessed June 10, 2017.
- DiMatteo MR, Giordani PJ, Lepper HS, et al. Patient adherence and medical treatment outcomes: a meta-analysis. Med Care. 2002;40(9):794-811.