Polypharmacy and medication adherence are common issues in the Medicare patient population, and this article addresses how Medicare Advantage plans can address these challenges and improve patient outcomes.
Medication non-compliance is a $500 billion problem for health plans, providers and consumers, resulting in approximately 40% of preventable readmissions and approximately 150,000 preventable deaths each year. If you simply believe medicine works, then the healthcare industry needs to focus on innovative solutions to improve poor outcomes, which account for 16% of the country’s annual healthcare spending.
Individuals with multiple prescriptions are most affected by these challenges as they are burdened with coordinating the prescribing physicians, frequent visits to the pharmacy, and analyzing complicated instructions on how to take the prescribed medications on a daily basis. Polypharmacy is most prevalent in the medically complex Medicare population. Statistics show that up to 4 in 10 older adults take 5 or more prescriptions. Almost 20% take 10 medications or more, which can lead to a higher risk of side effects and interactions.
Managing multiple medications can be difficult, especially for vulnerable patients who are housebound or live in rural areas. Fortunately, innovative digital technologies are helping to provide the necessary support for medication compliance by providing everything high-risk, multi-prescription members need to stay safe and comply—all from the comfort of their own home.
Sobering statistics around medication compliance
Despite growing attention to the drug delivery route, too many people continue to experience diminishing returns when they are sent home from the doctor’s office, emergency room, rehabilitation facility, or hospital.
The statistics tell the story. Out of 100 prescriptions, only 50 to 70 are picked up at the pharmacy. As soon as a patient leaves the pharmacy, only 25% of the medication is taken at home as directed. And then only a fraction – 15% to 20% – is refilled. All of this leads to higher unnecessary utilization and medical costs.
Older adults struggle the most with compliance as they are disproportionately affected by chronic conditions such as diabetes, arthritis and heart disease and are therefore more likely to receive multiple prescriptions. Almost 50% of people with a prescription for a chronic condition, such as cardiovascular disease, stop taking it within the first year. As star ratings continue to target medication adherence, Medicare Advantage (MA) plans must quickly adjust their strategies to meet the needs of this challenging demographic.
Remembering to take every medication correctly, sometimes three or more times a day, can be exhausting for anyone, not to mention the growing number of seniors now struggling with dementia and Alzheimer’s. Additionally, statistics show that the typical Medicare beneficiary sees an average of 7 physicians per year, underscoring the need for coordinated, multifaceted strategies. Getting to the pharmacy to pick up a variety of medications that likely have different refill dates throughout the month is a difficulty.
Then there are the unwanted drug-related side effects, the fear of understanding what to do after a dose is missed, or intentionally not taking maintenance medication when they’re feeling well – and not understanding that feeling healthy is likely down to sticking to it medication is due.
As a result of these challenges, the performance of medication adherence is appalling. While nearly 70% of Americans have at least 1 prescription drug, 50% of Americans are simply not taking it as directed.
Dealing with the disconnect between patient and provider
Providers play a key role in helping patients understand their medication regimens and removing barriers that can impact adherence. Unfortunately, it is extremely difficult for providers to gain insight into their patients’ medication management outside of the hospital walls.
Although 68% of physicians are interested in receiving notifications when patients are off therapy, few have access to data that indicates whether a patient has filled their prescription or is on therapy. The traditional healthcare system places all of these burdens squarely on the shoulders of individuals, with little to no support when things go wrong.
As the country’s population ages and more care is shifted to the home, healthcare stakeholders need to take a different approach. We need to create a holistic framework to support these patients, especially the growing Medicare population. With the right tools, each individual can be fully equipped to become and remain faithful.
Shifting healthcare from the hospital to the home
This proactive, comprehensive care becomes even more important as services continue to shift from the hospital to the home.
According to McKinsey & Co, home care is expected to nearly quadruple by 2025 and up to $265 billion. Care at home — rather than in acute care or skilled nursing facilities — offers lower Medicare costs, a better patient experience, and crucial relief for many underfunded inpatients and inpatient care facilities.
However, home care can also exponentially increase existing medication adherence challenges. Without a physician to get patients the right medications exactly when they need them, members and their caregivers must assume even greater responsibility for medication management.
To recognize the value home care is meant to bring to the system, we need to provide proactive support with multiple touch points and intuitive technologies that ensure members stay on track with their prescriptions.
Developing new strategies to improve medication adherence: The role of technology
A combination of advanced predictive analytics tools, patient-centric strategies, and innovative home technologies can help us address the nation’s massive medication compliance deficits.
First, healthcare plans must use advanced predictive analytics to identify their higher-risk members, including those with 7 or more prescriptions, known socioeconomic challenges, and recent hospitalizations or emergency room visits. These individuals are likely to struggle more with medication adherence and can benefit from modern digital pharmacy support, such as B. Medication synchronization and comprehensive medication reviews.
For example, anchoring all patient prescription fills on the same day each month with medication synchronization can eliminate the need for multiple pharmacy visits. Digital pharmacies, armed with advanced analytics, can also mitigate the risk of dangerous drug interactions by automatically linking payer data with the most up-to-date diagnosis to determine the right medications without a doctor’s visit.
Next, health plans need to help patients maintain medication adherence at home. Using technology to organize pills, create a routine, and educate the provider when things go wrong is vital to long-term success. This is where smart pill dispensers come in. Once medications are synchronized to be filled on the same day each month, these devices can further simplify complex medication schedules for high-risk chronically ill patients by automatically sorting and dispensing medications according to the person’s recommended care schedule. Smart dispensers that include a connected app that automatically tracks dosing compliance in real time and sends alerts to providers, care teams, and caregivers if a patient misses their dose would improve outcomes.
The ability to remotely monitor medication compliance in real time—capturing data from patients and automatically sharing it with physicians and family members—will ultimately improve compliance and significantly reduce overall healthcare costs.
A promising path into the era of the hospital-at-home
As home health care becomes more popular and viable for a larger number of members, the integration of a technology-driven digital pharmacy that integrates with an advanced home health care platform is an essential piece of the puzzle.
Medication compliance is a big part of MA star ratings and so closely tied to members’ general habits and barriers to engaging with the healthcare system. If you can help these higher-risk members with triple-weighted compliance measures and quadruple-weighted consumer ratings from healthcare providers and patient experience systems, the results will improve overall star ratings for healthcare plans.
With the right mix of analytics, engagement, and smart at-home dispensers, plans can increase adherence to therapy, improve drug safety, and help members stay on track for better outcomes. Implementing a proactive, data-driven approach to medication intake can bring more value and better experiences to members while reducing the cost of healthcare plans by reducing the need for expensive acute and long-term care.
Information about the author
Jason Z. Rose, MHSA, is CEO of AdhereHealth.