How to improve medication adherence 101

Medication adherence refers to whether patients take their medications as prescribed, including the correct dose, at the right time and for the prescribed duration. It is a critical component of effective healthcare management, particularly for chronic conditions such as diabetes, hypertension and cardiovascular diseases. Adherence supports patients in receiving therapeutic benefits from their medications, leading to better health outcomes and reduced healthcare costs.

A staggering $105 billion in annual cost opportunity is attributed to avoiding medication nonadherence alone.¹ Why does medication adherence have such a large impact on overall savings to the healthcare system? Firstly, it directly impacts the effectiveness of treatment. When patients do not adhere to their prescribed medication regimens, they risk experiencing suboptimal health outcomes, including disease progression, complications and increased mortality. Nonadherence can also lead to higher healthcare costs due to increased hospitalizations, emergency department visits and additional medical appointments.²

And medication nonadherence doesn’t just affect patients. It’s also critical for a healthcare organization’s quality performance. Five out of 23 CMS Star Ratings performance measures across the Staying Healthy, Managing Chronic Conditions and Drug Safety domains are related to medication adherence.³

Medication management plays a key role in the Healthcare Quintuple Aim. This framework emphasizes optimizing the overall healthcare system to establish health equity, ensuring that all individuals receive fair and just access to healthcare services. It expands upon the original Triple Aim (improving population health, enhancing the patient experience, reducing costs) and the Quadruple Aim (addressing clinician burnout) by adding the fifth dimension of advancing health equity.

Despite its benefits, improving medication adherence is often challenging for many healthcare organizations. One in 4 prescriptions for chronic conditions are never picked up from the pharmacy.⁴ This may be due to multiple barriers like lack of transportation, low health literacy, forgetfulness, access to a prescribing provider and mistrust. Beyond these challenges, many patients may also face:

• High drug costs: 31% of adults do not take medication as prescribed due to costs⁵

• Negative side effects: 21% of adults stop taking medication because of side effects⁶

• No perceived positive effects: 17% of adults stop taking medication because it wasn't working⁶

• Prescription complexity: 54% of seniors take 4 or more medications⁷

And for those patients who fail to pick up their prescriptions, many see adverse health outcomes. One internal study found that nonadherent patients experienced 5% higher hospitalizations and 2% higher emergency visits within 90 days of not picking up their medications.⁴

The pharmacies who fill these patients’ prescriptions face challenges as well. There is a 14-day gap from when the physician e-prescribes the medication to the pharmacy to when the pharmacy typically reverses the claim and restocks the medication. Without this real-time visibility, it’s difficult for members of the patient's care team — especially those with limited resources — to perform outreach to patients requiring support. 

What’s more, many health care organizations manage their medication adherence programs across multiple, disjointed systems and workflows, including EHRs, case management systems, Excel trackers, payer files and dedicated analytics tools.  

Addressing these complex challenges requires a multifaceted approach that includes patient education, support and innovative technologies.

Educating patients about the importance of medication adherence and how to manage their medications can empower them to take an active role in their healthcare. Simplifying medication regimens can make it easier for patients to adhere to their prescriptions. Utilizing tools such as smartphone apps and automated reminders can help patients remember to pick up or take their medications. Pharmacists can play a crucial role in supporting medication adherence by performing outreach to patients at risk of nonadherence and engaging in shared decision-making to address barriers to adherence.

In addition to these strategies, healthcare organizations can also leverage technology to optimize many of these processes. Optum Prescription Adherence and Clinical Management (PACM) is a comprehensive solution designed to improve medication adherence for health plans, provider groups and life sciences organizations. PACM leverages proprietary machine learning algorithms and artificial intelligence (AI) to automatically identify patients who are most likely to not pick up their prescriptions.

By integrating electronic prescribing and pharmacy point-of-sale data, PACM provides near real-time insights, allowing healthcare providers and pharmacists to quickly identify and reach out to these patients who have not picked up their medications.

For organizations with limited resources, the Optum Clinical Pharmacy team can perform outreach on behalf of the patient’s primary care provider (PCP) to at-risk patients via text or call, helping them overcome barriers to adherence and encouraging them to pick up their prescriptions. This team can also directly communicate with the patient’s PCP and care team through the EHR. This proactive approach not only improves patient adherence and health outcomes but also enhances the patient and provider experience. 

A comprehensive approach that integrates both cutting-edge technology and human outreach has proven to be a success at Optum. An internal study found that leveraging Prescription Adherence and Clinical Management for clinical intervention not only resulted in patients being 49% more likely to pick up their medication but also led to the healthcare organization identifying an additional $229 in cost savings per member per month (PMPM).⁸

In conclusion, improving medication adherence is essential for achieving better health outcomes and reducing healthcare costs. Prescription Adherence and Clinical Management offers a comprehensive solution to address this critical issue, leveraging advanced technologies and dedicated support to help patients stay on track with their medications. By partnering with Optum, healthcare organizations can enhance patient care and drive positive health outcomes.