Improving Medication Adherence

Analysis

Improving medication adherence

Tailored approaches may boost potential for success

New data available from Deloitte’s 2015 Survey of US Health Care Consumers intends to crack the code on medication adherence—a critical component to improving patient health outcomes and provider performance on value-based care (VBC) and related quality initiatives. Explore new ideas and insights for designing adherence-related patient interventions.

Critical step toward improving patient health outcomes

Increasing medication adherence is critical to improving patient health outcomes and provider performance on value-based care (VBC) and related quality initiatives. Many of the quality measures in the Centers for Medicare and Medicaid Services’ (CMS) value purchasing programs are influenced by medication adherence, and some measures capture adherence directly. For example, controlling hypertension and blood sugar—quality measures for accountable care organizations (ACOs) and Medicare Advantage plans—improves with higher levels of medication adherence. CMS also directly measures and rewards medication adherence for three conditions (diabetes, hypertension, cholesterol) under Medicare health plans that cover both Part C and Part D benefits and standalone Part D plans.

Deloitte’s 2015 Survey of US Health Care Consumers finds that adherence is associated with consumers’ attitudes about the health care system, wellness, and engagement with digital tools. The survey also shows that individuals’ positive attitudes about the value of incentives in health plan offerings are associated with higher rates of reported adherence, and that—consistent with industry literature—lower rates of reported adherence are associated with individuals’ demographic and socioeconomic characteristics.

Many health care organizations are developing numerous strategies and tools to help patients adhere to their medication regimens. These include sophisticated programs that combine sensors to see whether people take their medications, electronic reminders, communication with family members, and innovative benefit designs. New technologies, such as Proteus’s digital pill, offer potential breakthroughs in measuring non-adherence and creating real-time strategies to address it.

Multiple touch points along the patient journey provide opportunities for health care organizations to offer support to improve medication adherence. A successful outcome should, in turn, lead to higher industry revenues, lower overall health care spending, and—most important—better patient outcomes.

Creative solutions to improve adherence

Many health care organizations are developing strategies and tools to help patients adhere to their medication regimens. These include benefit design and other incentives, disease management programs, and multifaceted programs that combine technology with behavioral economics insights.

Benefit design: Reducing or eliminating drug cost-sharing for people with chronic diseases can improve adherence rates. One trial (Post-MI FREEE) tested the effect of eliminating cost-sharing on several outcomes, including adherence, for patients discharged from the hospital following a heart attack. The trial found that patients who did not have to pay cost-sharing for drugs had adherence rates four-to-six percentage points higher, and that total spending was no higher.(15) CMS recently allowed Medicare Advantage health plans to experiment with reducing cost-sharing or supplemental benefits to improve outcomes for chronic conditions.(16) Despite interest in reducing drug cost-sharing to encourage medication adherence by people with chronic conditions, benefit design around drug coverage is often moving in the other direction, as seen in rising deductibles and cost-sharing levels for high-cost specialty drugs.

Digital tools: To counter forgetfulness as a reason for non-adherence, numerous companies are developing tools to remind people to take their medications. At the beginning of 2014, one health care industry expert found around 100 companies in this space.(17) Many of these tools have not yet been formally evaluated, but one study in the UK examined the effect of sending text messages to remind patients to take their medications; the study saw a significant drop in the share of patients who were the most non-adherent.(18)

Multifaceted programs: Some adherence programs combine disease management, incentives, and digital technologies. For example, researchers at several academic institutions have received funding to apply lessons from behavioral economics to the challenge of improving adherence, including reminders and incentive programs.(19)

15 Niteesh K. Choudhry, M. P. (2011). Full Coverage for Preventive Medications after Myocardial Infarction. The New England Journal of Medicine, 2088-2097.

16 Centers for Medicare and Medicaid Services. (2015). www.cms.gov. Retrieved from https://innovation.cms.gov/initiatives/vbid/.

17 Antwerp, G. V. (2014). Retrieved from http://georgevanantwerp.com/2014/01/23/ listing-of-medication-adherence-solutions-2/.

18 David S. Wald, J. P. (2014). Randomised Trial of Text Messaging on Adherence to Cardiovascular Preventive Treatment (INTERACT Trial). PLoS ONE , e114268.

19 Bernstein, L. (2015). Researchers are trying again to help you take your medicine. Washington Post, https://www.washingtonpost.com/national/health-science/ researchers-are-trying-again-to-help-you-take-your-medicine/2015/09/05/6f26d896- 525d-11e5-9812-92d5948a40f8_story.html.

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