HIT and medication adherence: Aligning incentives

Kennedy

Poor adherence to prescription drug regimens has long been seen as a substantial roadblock to achieving better outcomes for patients. Data show that as many as half of all patients do not adhere faithfully to their prescriptions, and the result is more than $290 billion spent each year on avoidable medical treatment.¹

In an increasingly high-tech world, one begs to ask: Can health information technology (HIT) change all that? Could HIT be the silver bullet for improving patient medication adherence?

Many think so, but considerable challenges remain to unlocking the full potential of HIT to boost adherence. Most notably, the appropriate incentives to spur adherence must be aligned through policy, payment, and delivery reforms. That was the message delivered by national experts at a recent roundtable in Washington, DC, hosted by NEHI (Network for Excellence in Health Innovation) in partnership with Prescriptions for a Healthy America.

Policy

One of the core challenges to harnessing HIT to improve adherence is that there are no specific Meaningful Use standards aimed at improving adherence. Moreover, Meaningful Use objectives as currently defined actually exclude pharmacists who, after all, play an integral role in medication management-not only after discharge but also throughout delivery of care between visits to the physician or hospital. Clearly these standards have to be changed to more fully integrate and utilize pharmacists. Stephanie Zaremba, Project Manager of athenahealth, agrees that this is an essential standard: “We can get to that point of medication management when the pharmacist is no longer just a side piece of someone else’s goals.”

As electronic health records (EHRs) continue to be adopted and integrated into daily work flow,  Meaningful Use also needs to focus on incentivized certification measures so that these records include comprehensive, operational, and secure yet transferable real-time data collection, including up-to-date, cross-provider patient medication lists. Many systems currently fall short of interoperability, bringing an abrupt halt to necessary bidirectional patient information flow between operators in the delivery system.  When this fails, confusion surrounds transitions of care and care coordination between physician visits that negatively impacts medication adherence.  Health IT policy incentives have the capacity to prioritize population management and address these disruptions in care and adherence.

Payment

As the healthcare system transitions from fee-for-service toward a value-based model, the focus on population well-being becomes essential in implementing HIT to reduce overall costs. As Robert Popovian, Pfizer’s senior director of US government relations, noted, “To change the system, payment reform must occur … [HIT] tools will be utilized because incentives will be to keep the patient healthy.” Medication management tools through technology such as medication therapy management, synchronization, and reconciliation must not only be prioritized in policy, but must also stand out as an opportunity for reimbursement. Point-of-Care Partners’ CEO Tony Schueth observed that there is no reimbursement in today’s model for reaching out to patients after they leave the hospital or doctor’s office. Incentives focused on population management must transition from appointment-only care to include engaging patients through the continuum of care outside the doctor’s office. Pharmacists are in the most strategic position to offer this support and already employ some of these HIT tools for patients to manage their medication regimens, yet there is no reimbursement for doing so.

Along this line, greater pharmacist integration into the care continuum heightens the necessity for real-time, secure data in the hands of the provider. As incentives are realigned under health reform, the gaps due to costs associated with bidirectional communication and information flow should be examined. In the view of Tejal Gandhi, MD, MPH, president of the National Patient Safety Foundation: “There’s a lot of challenge around ‘Who owns the med list? Who should update it? Whose job is it really?’ Financial incentives would help this.” Thus, standards that emphasize the use of HIT in collecting, sharing, and updating information at all points of care need to be worked into the system in order to achieve the broader goals of medication management and patient adherence.

Delivery

The healthcare delivery system increasingly requires the continuous management of patients, with an emphasis on adherence between doctor and hospital visits. Transitions now not only focus on the transitions of the patient, but also on the transfer of real-time information needed to appropriately manage the patient’s health. At the same time, this process has become increasingly challenging. Comorbidity rates at high levels create care difficulties with patients on intricate medication regimens and complications that are difficult to eradicate. HIT Meaningful Use objectives stand to offer both the ways and the means to set the appropriate incentives for these issues, which encourages the necessary bidirectional flow of information and distributed responsibilities to improve delivery of care.

In some ways, reform in healthcare delivery often precedes and presages changes in policy and payment. Thought leaders in the field of medication management and health IT can be identified by looking at hospitals, provider offices and other places of care where these methods of patient care have become common practice. Steve Mullenix, SVP of public policy from the National Council of Prescription Drug Programs, noted: “The equation isn’t just HIT passage; it’s having a caring, attentive individual who sends the message and is responsible for care.” Delivery reform aimed at improving adherence comes from changing behavior, and there has been noticeable progress on this front. However, HIT incentives through policy and payment systems must provide the support necessary to prioritize and drive these behavior changes.

Conclusion

The US healthcare system is transitioning from fee-for-service, episodic medical care to team-based, outcomes-oriented population health management, with medication adherence a key to success. The use of HIT systems is becoming the standard in daily workflow and provides easier communication and transitions for patients. It is clear that aligning the appropriate incentives through policy, payment, and delivery reforms can enable health information technologies to keep patients healthy by improving their adherence to prescription medicines.

References

1. NEHI. (2009). Thinking Outside the Pillbox: A System-Wide Approach to Improving Patient Medication Adherence for Chronic Disease. Available at http://www.nehi.net/publications/17-thinking-outside-the-pillbox-a-system-wide-approach-to-improving-patient-medication-adherence-for-chronic-disease/view. Accessed February 2014.

Ashton Kennedy is a health policy analyst for NEHI (Network for Excellence in Health Innovation). She joined the NEHI program team to support the research, analysis, and reporting of critical issues in health policy.