For all the dizzying talk of repeal versus repair, one of the greatest cost drivers in healthcare is still hiding in plain sight. It’s called medication nonadherence: the simple fact that people often don’t take their medicines as prescribed.
Medications cost the healthcare system approximately $325 billion annually, and research indicates that suboptimal medication use—including taking too much or not taking enough—leads to avoidable annual healthcare costs totaling $300 billion. People who don’t take their medicines are more likely to end up back in the hospital or in the emergency room than those who do.
What can we do? Here are the four priorities for fixing this problem:
Change The Law To Create Better Incentives
Simple steps like patient refill reminders or disease management coaching can help patients achieve better health outcomes and contain healthcare costs. However, healthcare providers, plans and drug manufacturers are discouraged from developing and carrying out programs to improve patient adherence in federal healthcare programs (like Medicare and Medicaid), for fear of triggering a law known as the federal anti-kickback statute. A well-designed “safe harbor” to the anti-kickback statute can fill an important gap in the current regulations, which have not been updated in years. We support policies that remove anti-kickback uncertainties and encourage appropriate adherence interventions with suitable safeguards.
Update Laws To Improve Information Sharing
As it stands today, there can be a dangerous data disconnect between the clinical setting, where patients are diagnosed, and the pharmacy setting, where patients receive their medications.
Congress can fix this. The Senate Finance Committee recently passed a long-awaited, bipartisan bill called the CHRONIC Act. The legislation makes key improvements to how we care for those with chronic disease. The law included an amendment championed by our members to better coordinate information sharing between Medicare Parts A and B–which covers hospital and doctor visits–and Part D, which covers prescription drugs.
This would allow seniors’ prescription drug plans to identify patients most at risk of medication mismanagement and adapt their treatment plan accordingly.
Building Off Better Information And Incentives, We Need Better Integration
Our current healthcare system is heavily siloed, with limited to no communication between the various points of care. As a patient, you might have a primary care physician prescribe drugs A and B, a cardiologist prescribe drugs C and D and then, after visiting the emergency room due to a heart attack, be on a wholly different set of medications, prescribed by the attending ER physician.
A team-based approach with a holistic view of the patient through integrated data sharing and learning will greatly accelerate and improve healthcare delivery. This approach starts with the formation of multidisciplinary, interprofessional healthcare teams–made up of a primary care physician, cardiologist and pharmacist, for example–that optimize each provider’s role. For such an approach to be successful, it will be imperative that all providers have access and insight into the patient’s medication use and health data to provide greater context about the individual’s overall health status and goals of therapy.
New and emerging technologies, like wearable devices or mobile medication adherence platforms that track and record adherence habits, should also be leveraged to help doctors see how medication-taking behavior affects individuals (i.e., blood pressure) and harness the power of predictive analytics to identify patients at highest risk for medication-related issues.
Health plans should encourage the use of technology to track medication-taking and other healthy behaviors as wellness incentives. We are in the midst of the Information Age, and our healthcare system must adapt accordingly to help curtail bad outcomes and encourage healthy living.
As the former Surgeon General C. Everett Koop reminded us nearly four decades ago, “Drugs don’t work in patients who don’t take them.” These simple words still ring true today. For too long we have missed the opportunity to lower costs and improve outcomes via medication adherence solutions. It’s time to come together, roll up our sleeves and get to work on making this worthwhile cause a national priority.
