Contributor: From Outreach to Outcomes—4 Steps to Stronger Medication Adherence

As the prevalence of chronic diseases continues to rise, the hidden costs of poor medication adherence are no longer hidden. Research has repeatedly shown that nearly half of US adults with chronic conditions don’t take their medications as prescribed, leading to 125,000 preventable deaths and more than $500 billion in avoidable costs each year.

The impact of widespread shortfalls in medication adherence is also becoming more and more apparent for health plans. Not only do payors end up shouldering many of those avoidable costs, but many plans are also seeing their Star Ratings take a hit, limiting incentive opportunities and quality scores. And once adherence scores slip, recovery can take years, with bonus eligibility lost along the way.

Although Star Ratings policies and policymakers change, 1 factor remains constant: focus on medication adherence is a strong path forward for health plans. Since adherence directly influences health outcomes, hospitalization rates, and avoidance of associated health care costs, disengagement today risks compounding cost pressure tomorrow. Instead of viewing the recent change in measure weighting as a reason to take their foot off the gas, health plans should instead take this opportunity to double down on sustainable, member-centered adherence strategies that strengthen outcomes and drive success across every measure, no matter what happens with short-term adjustments to the scoring rubric and long-term changes to the measures themselves.

The framework for success begins with 4 data-driven strategies that focus on holistic, proactive, personalized member engagement to build and maintain the community of care that supports ongoing medication adherence.

Step 1: Leveraging data-driven targeting to reach the right members at the right moment

Medication nonadherence has many causes, especially for the 4 in 10 older adults who take 5 or more prescriptions. In fact, most drivers of nonadherence are not directly clinical in nature. Socioeconomic barriers, including lack of transportation to increasingly inaccessible pharmacies, unsustainably high drug costs, and low health literacy contribute significantly to variable adherence rates.

Addressing these issues at the source is essential for getting members on the right track to ongoing adherence. Having the right data to target high-risk individuals before they start failing measures—and the right platform in place to push effective nudges that influence behavior—is the best way for plans to improve performance and control avoidable spending.

By adopting digital tools that layer clinical condition data, refill history, engagement patterns, and social risk factors into advanced targeting algorithms, plans can see the whole story behind each member’s adherence journey, evolving in near–real-time as models adapt to support outreach activities exactly when they matter most.

Plans will need to consider how to use predictive analytics to identify rising-risk and high-risk members; segment members not just by clinical need but also by behavioral readiness and social risk; and blend claims, pharmacy, and clinical outreach data for a 360-degree view of populations and their risk levels.

Step 2: Incorporating omnichannel outreach to meet members “where they are”

Adherence success is a cumulative, continuous process, built one conversation, one refill, and one dose at a time. True success means treating adherence as a living, breathing journey that requires consistency, creativity, choice, and care.

Successful adherence programs meet members on their terms, mixing digital and analog methods while adjusting in real time to changing preferences. When health plans have multiple ways to connect with their members during that journey, engagement soars.

To make it happen, plans should start by offering true outreach flexibility, including live calls, mail, SMS, and digital options. They must let response data drive the next step (eg, text after a missed refill) to avoid friction with members and use simple, encouraging, trust-building language to authentically connect with each individual.

Step 3: Infusing behavioral science into outreach activities

By weaving together omnichannel outreach options with proven communication techniques rooted in behavioral science, intervention shifts from transactional to relational.

Conversations that create change start with pharmacists, nurses, and care navigators trained in motivational interviewing and behavioral insights, which can transform member hesitation into confidence. By addressing the practical socioeconomic and behavioral barriers of medication adherence, they can build trust and transform advice into action.

It helps when clinical outreach staff utilize strong “soft skills,” such as the ability to express genuine empathy and create authentic connections, in addition to robust clinical credentials. These staff members should be encouraged to speak like a human rather than from a script from a handbook, with clear, supportive, and focused attention on what’s possible for each member.

Behavioral science isn’t just about better conversations—it’s economics in motion. When motivational interviewing helps a member refill on time, the plan avoids the exponentially higher costs of deterioration, hospitalization, and disengagement. This set of outcomes will encourage staff and members to collaboratively identify and resolve barriers early and often through personalized problem-solving that reduces costs and supports better outcomes.

Step 4: Activating the whole team to expand the circle of engagement

Collaboration builds consistency and prevents costly errors or oversights from propagating through the care process. Programs that integrate provider alerts, electronic health record messaging, and pharmacy interventions ensure everyone has the same information at the same time, enhancing the team’s ability to prevent delays, reduce member confusion, and avoid high-cost adverse events.

Plans will need to work with providers, retail and mail-order pharmacies, community-based organizations, and other members of the broader care team to build strong networks, create seamless feedback loops, and effectively coordinate around medication regimens. Keeping communication aligned and comprehensive can ensure members hear 1 clear, unified message they can trust.

Coordinated communication also prevents duplicative outreach, prior-authorization delays, and refill gaps that quietly drain budgets. A unified network minimizes both member confusion and operational waste—creating financial resilience alongside clinical stability.

Conclusion

Even as regulatory priorities evolve, medication adherence should remain a top priority for health plans seeking to maximize Star Ratings scores tied to Quality Bonus Payments, rebates, and total cost containment. Plans that invest in technology, staff, and strategies required to prioritize member engagement, access, and support will see the short- and long-term rewards in both health outcomes and financial stability.