The Value of Medication Adherence
By Phyllis Houston, MSOL |
It might be the cost, the unexpected side effects, a lack of continuing symptoms, feelings of malaise or depression, too many pills to keep track of or a simple misunderstanding regarding the need for the medication. Whatever the reason, medication non-adherence is a serious issue. And it's one, according to the National Community Pharmacists Association (NCPA), that is costing the healthcare industry hundreds of billions of dollars in avoidable healthcare costs each year.2
To combat these losses, the Centers for Medicare and Medicaid Services (CMS) have created specific adherence measures in their quality Star Ratings for diabetes, hypertension and cholesterol medications, as well as completion rates for medication therapy management (MTM) programs.3 In the CMS 2018 National Impact Assessment Report, the agency revealed that healthcare organizations that undertook measures to improve medication adherence saw significant savings — an estimated $4.2 billion to $26.9 billion in avoided costs between 2011-2015.4 This estimate includes potential savings to provider organizations that have avoided costly hospital admissions and reduced overall claims by striving to enhance patient quality of life in the face of chronic conditions through better medication adherence.
The pharmacy opportunity
While emphasizing medication adherence can reduce the overall cost of providing care, it also presents an opportunity for pharmacies to bolster their own profit margins — in the form of more filled prescriptions and in the kind of stellar CMS Star ratings that keep health plans eager to partner with them.
But such savings extend far beyond dollars. A lack of medication adherence can also affect the core of the patient-pharmacist relationship, negatively impacting patient health both now and in the future. Pharmacists who aren't doing all they can to drive adherence are missing out on opportunities to build the kind of strong relationships that ensure the best in patient care and well-being. The CMS report highlights the 670,000 patients with improved blood pressure, the 510,000 diabetic patients exhibiting better blood sugar control and the 12,000 fewer deaths following hospitalization after a heart attack. Those numbers represent actual lives, with improved health outcomes, thanks to an increased focus on medication adherence.
Where to start
So how can today's independent pharmacies better equip themselves to improve medication adherence? It starts with having the right technologies and tools to identify non-adherent patients. It's often said that medication adherence is a barometer for a pharmacy's success. Pharmacists can drive adherence, and their business, with an understanding of why a patient isn't adherent to their medication regimen.
Independent pharmacists first need to identify which of their patients may not be taking their medications as prescribed. To do so, pharmacists can turn to industry tools that use pharmacy data to deliver patient and prescription insights. Platforms like EQuIPP? and the Prescribe Wellness Patient Engagement Center can be leveraged to quickly highlight patients who are not adhering to one or more of their medications for chronic conditions. Such tools can help you find the patients who need the most help.
As pharmacists typically see their patients more often than a provider, they can get to the true root of the problem by taking a holistic view of all of a patient's medications — and that starts with a conversation. A pharmacist shouldn't assume that even their most loyal patients are filling all of their prescriptions at their pharmacy alone. Engaging patients in this way puts the pharmacist in an optimal position to address any issues or barriers and find the right strategy to keep those patients on their medication regimens.
In addition, an experienced business coach can offer expert guidance to further pinpoint opportunities for pharmacies to drive medication adherence efforts. Tools and resources available through a third party, such as a medication synchronization program, can help independent pharmacists target specific groups. Such tools can also facilitate pharmacists in scheduling and conducting the kind of conversations that have the greatest impact on patient health — and the health of the business.
Proactive strategies highlight which patients to focus extra attention on and enable pharmacies to shift workflow and create more time to connect with these patients in a more meaningful way at the pick-up counter. In this way, pharmacists can arrange their schedule to carve out the time needed to engage with patients and transform the patient experience.
It all starts with a conversation. And these kinds of conversations matter. They strengthen the pharmacist-patient relationship, encourage greater medication adherence, improve patient satisfaction, increase CMS Star ratings and promote healthier patient outcomes. And, in doing so, enhance the business.
That's value beyond measure.
1. 8 Reasons Patients Don't Take Their Medication. October 16, 2015. AMA Wire. https://wire.ama-assn.org/practice-management/8-reasons-patients-dont-take-their-medications
2. NCPA 2016 Digest. NCPA. https://s3.amazonaws.com/external_clips/attachments/1829149/original/NCPA_2016_Annual_Digest.pdf?1524268372
3. 2018 Part C & D Star Ratings Measures. CMS.gov. https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/Downloads/2018MeasureList.pdf
4. 2018 National Impact Assessment of the Centers for Medicare and Medicaid Services (CMS) Quality Measures Report. CMS.gov. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/Downloads/2018-Impact-Assessment-Report.pdf