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Reducing Barriers to Medication Access and Adherence for ACA and Medicaid Participants: A Peer-to-Peer, Community-Based Approach

Andrea Baer, MS, and Marcia Baker, MS Ed
How peer-to-peer, community support programs can educate and empower patients to become more adherent to treatments, which will improve outcomes and reduce healthcare costs.
The patient also learns from a peer supporter who discusses topics like depression, the art of positive thinking, and the importance of taking care of themselves and adhering to the treatments and medications they are prescribed. The patient is sent home with a lot of information, including practical tools, such as a medication card (and extra copies) to fill in about their medications and when to take them.

The Mended Hearts peer supporter follows up with the patients, provides 1-on-1 support, and invites them to meetings and other community events to keep them involved. These steps have helped the hospital to be in the top 1% of cardiac care in the nation and receive a 3-star rating from the Society of Thoracic Surgeons. Scoring above average in all areas of patient satisfaction is also something that Memorial Healthcare System has achieved; in areas like access to care, follow-up care, and communication, the hospital performs higher than the state average in all areas.12 With Broward County being home to a high rate of underserved patients, it is important that this hospital takes the time to provide such outstanding patient education and support throughout their hospital stay and beyond. Embracing the total heart and total healthcare of the patient is working well in this hospital.

CaroMont Regional Medical Center in Gastonia, North Carolina, much like Memorial Regional Hospital, is a top-ranking cardiac care hospital system. US News & World Report ranks the hospital as "above average" in areas such as survival and patient services.13 An additional similarity to Memorial Regional Hospital is that CaroMont also has a strong peer support network with a Mended Hearts chapter. At this hospital, Mended Hearts has over 60 peer supporters who provide in-patient visits to patients who are recovering from cardiac events. Providing education and support to patients is so important to CaroMont that their hospital system sought out Mended Hearts and helped to get the chapter running in the hospital. Understanding that support systems are critical to their patients’ success, CaroMont provides support to the Mended Hearts chapter with in-kind services that include meeting room space, newsletter distribution, and meals for meetings.

These small things can make a big difference in the success of the local support group chapter. The chapter spreads awareness through a monthly newsletter that includes a heart-healthy recipe, a heart patient story, visiting (peer-to-peer support) reports, chapter events, and ways to get involved.14 The newsletter is distributed to each floor of the hospital and at each CaroMont facility in Gaston County.


The research shows that peer support that focuses on education and empowerment through a structured system is vital to improved outcomes in chronic disease management. With community-based programs that work closely with healthcare teams, medication adherence can be addressed in a cost-effective way. Disease-specific nonprofit organizations can be funded to execute their programs to provide peer support in a variety of settings in the community.

Support meetings and functions, 1-on-1 meetings and visits, social events, educational materials, and other support programs can be operated in the community at a fraction of the cost of healthcare professionals. Although the costs will vary depending on the community, the overriding costs can be absorbed by simple “in-kind” donations from health systems. Such items can include use of meeting space, free parking for volunteers, food and beverage for meetings and events, printing and mailing of organizational materials, and educational speakers. In return, health systems could see a reduction in readmission rates, lower healthcare costs across the spectrum, and adherence to treatments that will improve the health of the community. The cost of the programs is a minimal cost to the healthcare system and could enhance the ability of patients to truly be empowered to adhere to the treatments they prescribed.

There is a gap in notable research in medication adherence and peer-to-peer support programs, and patient reported outcomes are difficult to quantify. Creating a multicenter pilot program to follow patients over the course of a 12- to 18-month period to compare with patients who do not receive peer support services would be a valuable undertaking. In designing this study, one would need to work within that same hospital system and compare subgroups of patients within the same system to assure that the variables of care provided are controlled through the study.


For healthcare to truly be patient centered and to address the barriers of patient care that currently plague the healthcare system currently, peer support and personal empowerment of the patient are keys to success. When managing chronic disease, the socioemotional toll can be devastating on patients and their caregivers. Providing support and educational resources can provide patients with the ability to make better healthcare choices and become more adherent to treatment plans and can improve their overall emotional and physical health.

When patients are empowered and supported, barriers can be removed with critical thinking skills, lifestyle changes, and social services programs within the community. However, the first area to address must be the patient’s emotional health. Once their emotional health is cared for, patients can focus their energy on the desire to become healthy and adherent.

Reducing barriers and improving medication adherence can be done with a low-cost community strategy that focuses on patient support, education, and empowerment. These programs can help to improve the quality of the patient experience, reduce hospital readmission rates, and reduce overall healthcare costs. Investing in peer support programs in local communities could have a positive, long-term effect on the health of patients.

Author Affiliations: Mended Hearts, Inc (AB, MB), Dallas, TX.

Source of Funding: Mended Hearts, Inc.

Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (AB, MB); acquisition of data (AB); analysis and interpretation of data (AB); drafting of the manuscript (AB, MB); critical revision of the manuscript for important intellectual content (AB. MB); provision of patients or study materials (AB); obtaining funding (AB, MB); administrative, technical, or logistic support (AB).

Address Correspondence to: Andrea Baer, MS, Mended Hearts, Inc, 8150 N Central Expressway, M#2248, Dallas, TX, 75206. E-mail: Marcia Baker, MS Ed, Mended Hearts, Inc, 8150 N Central Expressway, M#2248, Dallas, TX 75206. E-mail:

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