Extracting Greater "Value" From Medication Adherence Strategies
By Jack Pinney, M.D.
Why provider-pharma partnerships matter more than ever.
The health of any organization’s bottom line exposes a growing reality for today’s physician practices: revenue is increasingly tied to your ability to improve and (optimize) patient outcomes. That’s why providers must embrace the “value” proposition of proactive care delivery and collaboration across the continuum for sustainable success within the framework of value-based care.
Working in tandem with this reality is a growing challenge: medication affordability. When deploying strategies to improve population health, physicians know that the best outcomes are only achieved if patients adhere to their prescribed drug therapies.
Yet, (adherence) requires that patients have the means to afford medications in the first place. And within the perfect storm of high-deductible health plans— (some with out-of-pocket expenses as high as $13,800 annually)—and skyrocketing drug costs, affordability, simply put, is often out of reach.
The value proposition of improving medication adherence is not lost on the industry. Everyone is looking for ways to make this happen. One way to strategically move the needle on this opportunity is to improve collaboration between stakeholders that have not traditionally partnered at the point of care—(patients), providers, and pharmaceutical companies. When these key industry players can establish direct, (efficient) communication lines and work together to improve medication affordability and adherence, the opportunity to advance “value” in healthcare increases exponentially.
The Growing Affordability Challenge
While anecdotal, the following example is an all-too-familiar scenario seen in today’s physician practice environments.
A diabetic patient presents to his primary care physician following a hospital stay related to a hyperglycemia emergency. It’s the patient’s second emergency room visit since January. During the follow-up visit, the physician learns that the patient did not pick his latest insulin refill because another family health emergency left him unable to afford the $300 per month price tag for the prescription. The patient is still at least one month from meeting his $2,500 deductible, and the physician is unaware of any discounts that could improve the outlook.
In 2016, 45 million adults in the United States did not fill prescriptions due to cost, and industry research points to high drug costs as a primary contributing factor to medication non-adherence. It’s a continual frustration for primary care physicians working on the front lines of care. They want to help patients improve their overall health while also optimally managing tight profit margins that hinge on outcomes improvement.
Notably, recent research suggests that the majority of patients look to their physicians for guidance with medication affordability, and most physicians (90 percent) believe they have a role in discussing healthcare costs with their patients. The challenge is that many providers simply lack knowledge about how they can help improve the cost outlook (for their patients). For example, had the primary care physician in the above anecdotal scenario been aware of vouchers and coupons available from the pharmaceutical company producing the insulin, the patient could have left the office with the ability to pick up his refill.
The unfortunate reality is that billions in drug savings are left on the table at a time when medication costs have reached critical levels.
A Better Medication Adherence Strategy
The good news is that the simple step of improving communication lines between providers, pharmaceutical companies and patients can have a dramatic impact on medication adherence.
Providers are already investing heavily in infrastructures that improve information flow with other stakeholders along the continuum. The next part of this evolution must extend to tighter provider-pharma networks, especially since research reveals that lowering co-payments can improve medication adherence.
The key is getting the information into a physician’s EHR workflow at the right time—during a patient encounter. Today’s physicians spend the majority of their time in front of a computer, and a recent Surescripts report revealed that 85 percent of providers (are) now use ePrescribing—a critical juncture in the patient encounter for bridging the knowledge gap related to patient savings opportunities for medications.
Point-of-prescribe platforms are opening direct communications lines that allow coupons and vouchers to be embedded into ePrescribing workflows. Physicians simply search for a brand name drug within the EHR, and in near real-time, they are alerted to available offerings for a specific patient. The voucher or coupon is then shared with the patient to present to a retail pharmacy provider, improving medication affordability, encouraging adherence and fostering better clinical outcomes.
These tighter partnerships and communication lines also can equip providers with knowledge of whether a patient followed through with a drug purchase or picked up their refill—important information that can inform the need for proactive outreach or intervention within population health management strategies. In addition, customized patient education materials and support program enrollment also can be distributed directly to physicians at the point of care, helping improve patient health literacy and giving physicians greater confidence that patients know how to take their prescribed therapies.
When it comes to value-based care, the business case for investing in strategies and infrastructures to improve medication adherence is an easy one to make. Tighter pharma-provider-patient partnerships can not only empower better outcomes and higher reimbursement, but they also improve patient experience for long-term engagement that improves health in a sustainable way.