Why Payers Need Robust Medication Adherence Strategies to Stay Competitive

5 min read
Why Payers Need Robust Medication Adherence Strategies to Stay Competitive

Medication adherence is complex, with many moving parts to ensure medications are being taken appropriately by patients. Non-adherence leads to many issues, often resulting in increased morbidity and mortality, greater use of emergency healthcare services, hospitalization and poorer long-term health outcomes. 

Medication non-adherence is preventable. However, based on recent data, current strategies employed by health plans are not fully achieving desired goals. In order to increase adherence to therapies, lower healthcare costs and improve patient health outcomes, plans need to work strategically with healthcare teams such as pharmacies by leveraging patient-specific data that addresses their unique adherence challenges. 

We sat down with Matthew Simmons, Product Manager at Outcomes®, to discuss the issue of nonadherence and what payers can do to improve these numbers and help more patients. 

Understanding causes of medication nonadherence 

Medication non-adherence is not a clear-cut issue. The social determinants of health (SDOH)—factors such as food, housing and transportation issues—along with other individual concerns—such as cultural and language barriers, race, age, gender and health literacy—significantly influence adherence. Social determinants influence chronic disease prevalence and people's ability to manage their own conditions. For example, a study published in the International Journal of Environmental Research and Public Health found food insecurity, poverty and weak social support systems increased non-adherence among Medicare patients with hypertension. 

If a payer doesn't know the underlying cause of non-adherence or is offering generalized adherence solutions that don't address individual patient barriers, the solution is unlikely to convince a patient to take their medication as prescribed. Conversely, pinpointing the exact cause of non-adherence can enable health plans to develop patient-centric solutions that deliver the right message at the right time to positively influence adherence. 

Patient non-adherence is also connected to provider and health system challenges. Lack of access to healthcare providers, fragmented care coordination, provider time constraints and ineffective communication by providers regarding treatment plans all impact adherence negatively. 

As Matthew Simmons says, "plans regularly use a one to many approach to achieve their adherence goals. This means identifying one solution with proven value and applying it to as many patients to realize their adherence goals." And data shows these types of solutions do work, though this strategy alone can leave gaps. "In today's competitive payer landscape, plans need to utilize patient-specific one-to-one strategies that support the patient on their health journey and yield consistently high four- and five-star performance ratings," says Simmons. 

The Outcomes suite of payer-based solutions offers multiple pathways through pharmacy network partnerships to help health plans achieve their performance and quality goals. By utilizing Outcomes payer solutions, plans can realize cost savings and develop strategies to strengthen patient-focused adherence targets that incorporate targeted interventions to achieve their desired Star Ratings goals. 

Benefits of partnerships to improve medication adherence 

Pharmacists have distinct advantages in offering medication-related education and positive adherence messaging in today's changing healthcare environment. Their increased visibility and easy access have highlighted their value as trusted participants in patients' health and wellness journeys. Pharmacist-led interventions such through medication therapy management (MTM) have proven benefits in raising disease awareness and improving medication adherence. Pharmacists are a perfect health partner for payers to achieve their adherence targets. 

Payer-pharmacy collaborative alliances are also essential for optimizing patient care, lowering healthcare costs and improving outcomes. Pharmacists have 10 times more interactions with patients than any other healthcare provider. This allows them greater opportunities to answer patient questions about their medications and customize education to reduce barriers while empowering them to stick with their therapy. 

For example, when a patient new to hypertension therapy may not fully understand the benefits of their medication, may have anxieties about side effects, or if they've had limited interaction with their doctor, this is an ideal time for a pharmacist to engage the patient. The pharmacist can discuss their condition, offer adherence tips and ask about their interest in joining an adherence monitoring program to proactively avert non-adherence long term. Outcomes data indicates that direct communication between pharmacists and patients ensures 91% of patients new to a medication regimen pick up their first prescription. In the end, payers benefit, too. 

Value of Outcomes solutions 

The Outcomes Adherence Monitoring Program has demonstrated improvement in payer adherence rates by implementing both short-term and long-term strategies to help plans achieve annual performance ratings goals. The program has delivered an average increase of 11% in adherence rates. More specifically, use of the program increased diabetes adherence rates by nearly 18%, hypertension by 21% and statin therapy by over 16%. 

"These results are powered by Outcomes’ clinical platform, OutcomesOne (formerly Connect™), where the goal is for programs to offer clinicians specific information about a patient's adherence journey when they engage patients one on one. It prompts them to initiate a conversation with the patient while allowing them to use their clinical judgment to address specific patient concerns to ensure adherence goals are achievable." When a plan works with the Outcomes adherence solution and any proposed interventions are complete, the plan will achieve the chosen TIP net-effective rate. In turn, they'll realize improved the adherence star ratings as well. 

Payers that utilize the Outcomes network of pharmacies can leverage proprietary clinical algorithms to harness patient-specific data to select and deliver actionable strategies that are relevant to addressing root causes of non-adherence. This robust interactive partnership between Outcomes and the pharmacy network helps plans achieve high-performance ratings. In 2020, for example, the Outcomes programs provided $738 million of healthcare savings, achieved 4.5 million interventions to lower adherence barriers and addressed 437,000 medication treatment concerns. 

Partnering with Outcomes enables health plans to recognize root causes for non-adherence and select targeted interventions that improve medication regimen adherence while advancing plan quality and performance goals. CMS has signaled continued prioritization of the three adherence Star ratings, making this a continued area of focus for health plans for the next several years. Outcomes is ready to support quality and performance goals every step of the way.


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