When patients don't take their medication as prescribed, it can lead to adverse health outcomes and increased costs. Alarmingly, 50% of patients are nonadherent at any given time causing up to $300 billion in waste per year.1 Up to 69% of hospital readmissions are due to nonadherence and approximately 125,000 deaths are linked to it each year.2
Clearly, this is a pervasive problem with complex social and behavioral causes, but most cases have one thing in common: Most medication nonadherence is a conscious choice patients make to not follow their doctor’s advice or take their medications appropriately. Their decisions are based upon a few common reasons including3:
- Fear of side effects.
- Not Understanding the purpose of the medication.
- Out-of-pocket costs.
- Too many medications.
- Mistrust of the doctor’s motives.
And often, patients do not open up to their doctor about their concerns with the treatment plan.3
When plans can identify patients who are most at risk for nonadherence, they can work to proactively engage the patient and pre-empt nonadherence. This is where a partner with advanced analytics capabilities and deep expertise in pharmacy claims data can contribute substantial value and insights.
A strong adherence program provides enhanced analytics to enable the largest return with a minimal amount of dedicated resources. Data-driven analysis can include clinical data, behavioral observations and direct reports from the patient. When evaluating a potential partner’s medication nonadherence program, consider the following:
- Do they have the technology and know-how to identify at-risk patients at the moment when engaging them could drive behavior change?
- Does the program identify patients at risk for nonadherence by linking prescription claims data with behavioral factors?
- Does the program prioritize patient interventions by focusing on targeted behaviors like multiple medications, use of antidepressants, etc.?
Our program integrates the Johns Hopkins ACG® System with our powerful claims adjudication system, RxNova, to improve adherence and reduce the total cost of care while increasing ROI. We target patients who have one of eight chronic conditions and help plans track these patients and their adherence scores over time. Data analytics and insights help identify opportunities to reduce therapy drop-off at the right time. Let us show you how we can help you make the most of the resources you have for the best possible outcomes.
1 Overcoming Barriers to Medication Adherence for Chronic Diseases, CDC Public Health Grand Rounds. February 21, 2017., https://www.cdc.gov/grand-rounds/pp/2017/20170221-medication-adherence.html
2 Annals of Internal Medicine. December 4, 2012. http://annals.org/aim/fullarticle/1357338/interventions-improve-adherence-self-administered-medications-chronic-diseases-united-states
3 Source, 8 Reasons patients don’t take their medications, AMA Wire, October 16, 2016. https://wire.ama-assn.org/practice-management/8-reasons-patients-dont-take-their-medications
4 Comparing Adherence and Persistence Across 6 Chronic Medication Classes, Journal of Managed Care Pharmacy, 2009. https://www.jmcp.org/doi/pdf/10.18553/jmcp.2009.15.9.728