In a clear signal to the health care community that it needs to confront patient compliance, a report from the New England Healthcare Institute estimates that additional care for non-adherent patients places a $290 billion cost burden on the health care industry. With health reform initiatives focused on three clear goals—better health, better care and improved costs—there is strong incentive for education around medication adherence and persistence.
The scale of the problem is vast. Following an electronic prescription from a physician, up to 22 percent of patients do not obtain the medication prescribed (or an appropriate alternative) within an acceptable period of time. Reasons for primary non-adherence vary based on patients’ individual barriers, such as poor understanding of an illness or the importance of a medication, low motivation, or affordability. This is a particular concern with chronic diseases, which, if not managed effectively, can take a heavy toll on the patient both physically and financially.
Certainly, in the case of accountable care organizations (ACOs), adherence seems to be a priority. The Centers for Medicare & Medicaid Services (CMS) has adopted rules for objective assessment of ACOs, including a list of 33 quality measures. One measure requires Medicare patients to self-report medication adherence after an inpatient facility discharge. Though working to ensure accuracy and patient safety is a positive step, relying on patients to compare medications at home against their discharge orders may not be enough to improve overall medication adherence rates, says Craig Schilling, PharmD, vice president, patient programs for OptumInsight’s life sciences business.
The Connected Patient
ACOs and other private-sector models, such as the patient-centered medical home, have established multiple touchpoints for patients, which include not only doctors but also nurses, pharmacists, case managers, health coaches and other allied health care professionals, Schilling says. It stands to reason, then, that the greater the teamwork and health care support, the better the opportunity for improved health outcomes.
These multi-participant health care models are better positioned to provide unbiased educational material to help patients change their behavior around medication use, says Lou Brooks, vice president of marketing analytics for the life sciences division of OptumInsight.
“The current health care organization is fairly disjointed, with various parties pushing and pulling in slightly different directions,” he says. “The concept of the ACO is to mitigate the counter strategies that each of these different entities have and get them working collaboratively to improve not only the outcome for the patient but the overall balance that exists in the health care system.” Moreover, because patients today often turn to the Web when seeking health information, ACOs and similar organizations already have an eager audience.
Jerry Hester, national account manager at Forest Pharmaceuticals, a prescription product manufacturer and distributor based in St. Louis, agrees that it will take a group effort to make new health care models work long term. “Health care providers, pharma companies included, can all do a better job in communicating the value of adherence by disease state, along with the consequences of non-adherence,” he says.
The Role of Pharma
There is a growing awareness among many health care participants that adherence requires a multifaceted response and that the one-size-fits-all approach is less effective. Furthermore, there are practical and perceptual barriers to compliance, and these differ among patients as well as from one disease to the next. As the health care industry deals with these challenges, there is a role for pharmaceutical companies in all of this, regardless of their lack of direct access to patients. Where pharmaceutical companies can have impact, Schilling says, is in helping payers and providers understand the value of their medication by conducting comparative effectiveness research trials with specific products within therapeutic categories.