Improving medication adherence

The New England Healthcare Institute (NEHI) is calling for a national strategy to examine the role care teams can have on improving patient adherence to prescription medicines. Given the shortage of primary care physicians and escalating health care costs, care teams may be useful to better medication adherence, but more research is needed on how to best deploy them in a wide variety of practice settings, according to a NEHI report titled "Medication Adherence and Care Teams: A Call for Demonstration Projects."

Poor medication adherence exacts a heavy toll by resulting in unnecessary illnesses, disability and premature deaths, and costs as much as $290 billion a year in unnecessary health care spending, according to NEHI. The report says adherence can be improved across broad populations with the coordinated implementation of multiple strategies.

One strategy to improving medication adherence rates that directly impacts plans is lowering costs, or providing incentives to adhere to prescriptions that can reduce overall costs in the long run.

"Going back several year with incremental shifting of higher costs to individual subscribers for folks with employer-sponsored health insurance, we see the more expensive healthcare became, the more negative impact there was on medication adherence," says Tom Hubbard, senior program director at NEHI. "Continuing research shows that, indeed, in many instances raising costs has a fairly immediate effect in driving down compliance. That has also spawned value-based insurance design (VBID), which tries to build in lower costs for highly valuable services, including medications."

While there is ongoing research on incentives, there is little research involving how care teams can be implemented across the wide variety of care settings. The new health reform law provides a foundation for using demonstration projects to test the potential care teams can have on improving poor adherence. The report suggests four key objectives for demonstration projects:

1. Test multi-component adherence strategies and not single-component interventions.
2. Overcome the limitation of prior studies and projects by having adequate sample sizes and rigorous performance measurements, and identifying barriers at an organizational, procedural and regulatory level.
3. Demonstrate adaptability to diverse care settings.
4. Design projects to be integrated with critical elements of national health care reform.

"We feel there is interest in this by health plans, so we feel there could be some involvement," says Hubbard. "Plans are interested in payment reforms, and adherence services could really come into the picture due to link between staying adherent and staying healthy. There is an interest level in finding cost effective ways to keep adherent and keep them away from unecessary complications and hospital stays."