Polypharmacy and medication adherence are common problems among the Medicare patient population, and this article addresses how Medicare Advantage plans can address these challenges and improve patient outcomes.
Medication nonadherence is a $500 billion problem for health plans, providers, and consumers, leading to approximately 40% of avoidable readmissions and around 150,000 preventable deaths each year. If you simply believe medicine works, then the health care industry needs to focus on innovative solutions to improve poor outcomes, which represent 16% of the nation’s annual health care spend.
Individuals with multiple prescriptions are most affected by these challenges, because they are burdened with coordinating prescribers, making frequent trips to the pharmacy, and parsing through complicated orders to take medications as prescribed every day. Polypharmacy is most common among the medically complex Medicare population. Statistics show as many as 4 in 10 older adults take 5 or more prescriptions. Nearly 20% take 10 drugs or more, which can lead to a higher risk for adverse reactions and drug interactions.
Managing multiple medications can be difficult, particularly for vulnerable patients who are homebound or living in rural areas. Fortunately, innovative digital technologies are helping address the necessary support needed for medication adherence, providing everything high-risk members with multiple prescriptions may need to stay safe and adherent—all from the comfort of their own homes.
Sobering Statistics Around Medication Adherence
Despite growing attention to the medication adherence journey, too many individuals continue to experience diminishing returns when they are sent home from the doctor’s office, emergency department, rehabilitation facility or hospital.
The statistics tell the story. For every 100 prescriptions written, just 50 to 70 are ever picked up at the pharmacy. Once a patient leaves the pharmacy, a mere 25% of the medications are taken as directed at home. And then just a fraction—15% to 20%—are then refilled. All of this leads to higher unnecessary utilization and medical costs.
Older adults struggle most with adherence, as they are disproportionately affected by chronic conditions, such as diabetes, arthritis, and heart disease, and therefore more likely to be on multiple prescriptions. Nearly 50% of people with a prescription for a chronic condition, such as cardiovascular disease, stop taking it within the first year. As the Star Ratings continue to zero in on medication adherence, Medicare Advantage (MA) plans will need to quickly adapt their strategies to meet the needs of this challenging population.
Remembering to take each medication properly, sometimes 3 or more times a day, can be taxing for anyone, let alone the growing number of seniors now struggling with dementia and Alzheimer disease. What’s more, statistics show the typical Medicare beneficiary saw a median of 7 physicians per year, highlighting the need for more coordinated, multifaceted strategies. Getting to the pharmacy to pick up a multitude of drugs that likely have differing refill dates throughout the month is a hardship.
Then there are the unwanted medication-related adverse effects, anxieties of understanding what to do after missing a dose, or purposely not taking a maintenance medication if they’re feeling fine—and don’t understand that healthy feeling is likely due to medication adherence.
As a result of these challenges, medication adherence achievement is frightening. While almost 70% of Americans have at least 1 prescription medication, 50% of Americans simply do not take them as prescribed.
Addressing the Patient-Provider Disconnect
Providers play a key role in helping patients understand their medication regimens and addressing barriers that may have an impact on adherence. Unfortunately, it’s extremely difficult for providers to gain visibility into what is happening with their patients’ medication management outside clinic walls.
Although 68% of physicians are interested in receiving notices if patients become nonadherent, few actually have access to data indicating whether a patient has filled their prescription or whether they are adherent. The traditional health care system puts all these burdens squarely on the individual’s shoulders, with little to no support when things go wrong.
As the nation’s population is getting older and increasingly more care is transitioned to the home, health care stakeholders need to take a different approach. We need to create a holistic framework of support for these patients, particularly the growing Medicare population. With the right tools in place, each individual can be fully equipped to become and remain adherent.
Moving Health Care From the Hospital to the Home
This proactive, comprehensive care will become even more important as services continue to shift from the hospital to the home.
Home care is expected to increase nearly 4-fold by 2025, according to McKinsey & Co, comprising up to $265 billion in care services, which represents a quarter of the total cost of care for Medicare fee-for-service and MA members. Care delivered in the home—instead of in the acute care setting or skilled nursing facilities—offers lower costs for Medicare, a better patient experience, and critical relief for many underresourced inpatient and residential care sites.
However, home-based care can also exponentially increase existing challenges of medication adherence. Without a clinician delivering the correct medications to patients exactly when they need them, members and their caregivers will have to take on even more responsibility for medication management.
To realize the value that home-based care is supposed to bring to the system, we must provide proactive assistance with multiple touchpoints and intuitive technologies that ensure members stay on track with their prescriptions.
Developing New Strategies for Improving Medication Adherence: Technology’s Role
A combination of advanced predictive analytics tools, patient-centered strategies, and innovative home-based technologies can help us address the nation’s massive medication adherence shortfalls.
First, health plans need to leverage advanced predictive analytics to identify their higher-risk members, including those with 7 or more prescriptions, known socioeconomic challenges, and recent hospitalizations or emergency department visits. These individuals will likely struggle more with medication adherence and may benefit from modern digital pharmacy support, such as medication synchronization and comprehensive medication reviews.
For example, anchoring all patient prescription fills on the same day every month with medication synchronization can avoid the need for multiple pharmacy trips. Digital pharmacies equipped with advanced analytics can also mitigate the risk of dangerous drug interactions by automatically connecting payer data with the most up-to-date diagnosis to determine the proper medications without a clinician visit.
Next, health plans must help patients maintain medication adherence at home. Using technology to organize pills, create a routine, and enable provider awareness when something starts going wrong is vital for long-term success. This is where smart pill dispensers come into play. Once medications are synchronized to be filled on the same day each month, these devices can further simplify complex medication regimens for high-risk, chronically ill patients by automatically sorting and dispensing medications according to the individual’s recommended care plan. Smart dispensers that include a connected app that automatically tracks dosage compliance in real time, sending alerts to providers, care teams, and caregivers when a patient misses their dose would be supportive to improving outcomes.
The ability to monitor real-time medication adherence remotely—capturing data from patients and relaying it automatically to clinicians and family members—will ultimately improve compliance and materially drive down overall health care costs.
A Promising Way Forward Into the Era of the Hospital-at-Home
As home health becomes more popular and viable for a greater number of members, integrating a technology-driven digital pharmacy that integrates with an advanced in-home care platform is an essential piece of the puzzle.
Medication adherence is a huge part of MA Star Ratings and it is so deeply connected to members’ overall habits and barriers to engaging with the health care system. If you can help these higher-risk members, with triple-weighted adherence measures and quadruple-weighted Consumer Assessment of Healthcare Providers and Systems patient experience measures, the results will boost the overall Star Rating for health plans.
With the right mix of analytics, engagement, and in-home smart dispensers, plans can bolster adherence rates, improve medication safety, and help members stay on the path to better outcomes. Implementing a proactive, data-driven approach to medication adherence can bring more value and better experiences to members while incurring fewer costs for health plans by reducing the need for expensive acute and long-term care.
Jason Z. Rose, MHSA, is CEO of AdhereHealth.