Responsible use of drugs could save $200B annually

Delays in treatment and medication nonadherence are the major reasons behind avoidable costs in the healthcare system, according to an IMS study recently released.

Avoidable costs of more than $200 billion are incurred each year in the US healthcare system, representing 8% of the country’s total annual healthcare expenditures, the IMS Institute for Healthcare Informatics found.

“This also translates to a significant cost to patients and unnecessary utilization of healthcare resources, including 400 million hospital visits annually. This could all be avoided if medicines were used more responsibly,” Murray Aitken, executive director of the IMS Institute for Healthcare Informatics, said on a media conference call.

Medication nonadherence drives the largest avoidable cost-$105 billion annually-in US healthcare, IMS found. Delays in applying evidence-based treatment to patients also results in $40 billion in annual avoidable costs. After reviewing four primary disease areas: hepatitis C, diabetes type 2, atrial fibrillation, and coronary heart disease (CHD), IMS found that the largest avoidable impact to the US healthcare system is in the area of diabetes, where delays increased outpatient visits and hospitalizations.

“The key to national adherence in my opinion first lies in a well-structured results-proven program that takes a person from a state of non-adherence to a plan for success. Adherence is achieved when the person is given options and understands that the ultimate goal is better average blood glucose level. This goal may be achieved by incorporating diet and exercise as in the case with newly diagnosed patients as well as taking oral medications or insulin in individuals with high blood sugars,” said Tony Song, president of Diabetes Care Pharmacy and Health Program Centers, West Covina and Pasadena, Calif.

“One of the first steps toward achieving adherence is the ability to identify patients with chronic conditions,” said Stanley Goldstein, president & CEO of Patient Engagement Systems, Burlington, Vt.

“We know that health plans and medical groups need tools such as clinical decision support to create timely and effective information that will enable them to better identify, manage, and monitor their most costly patients by zeroing in on medication adherence opportunities and identifying patients that require evidence-based treatment so they can get the care they deserve, while reducing inpatient admissions and ER visits. And not just any tools. These tools must have a proven and measureable track record of success.”

Beyond adherence issues, another factor contributing to avoidable medication costs is the misuse of antibiotics which contributes to antimicrobial resistance and an estimated $34 million each year in avoidable costs. An additional $1 billion is spent on about 31 million inappropriate antibiotics prescriptions that are dispensed each year, typically for viral infections, according to IMS.

However, “There are encouraging signs that efforts to drive responsible antibiotics use are paying off, particularly in the declining number of prescriptions for the common cold and flu…,” according to a statement from IMS.

The IMS Institute for Healthcare Informatics also sees major improvements with medication adherence, which will drive down avoidable costs in the future. “The Affordable Care Act, including incentives for a performance-based payment system and the introduction of the Accountable Care Organization, enables Medicare to really put a focus on helping support these areas. Adherence is clearly indicated in the ACO performance metric,” Aitkin said.

“Performance-based payments and more integrated delivery of healthcare are elements that…will be positive forces in terms of addressing the avoidable costs we have described,” Aitken added.

Goldstein agreed, adding “Improving primary care is not just a lofty statement; truly it is a fundamental premise for the success of the healthcare reform mandate. At Patient Engagement Systems we partner with healthcare organizations that share the goal of effectively engaging patients and providers to improve care-the hallmark of the Affordable Care Act and the guiding promise of Accountable Care Organizations.”

Factors driving healthcare costs

Other factors driving US healthcare costs include: suboptimal use of generics, medication errors, and mismanaged polypharmacy, according to IMS.

“To address the issue of medication errors, mismanaged polypharmacy, and other patient-directed care management issues we have launched a secure Internet-based video consult program called Diabetescareconnect that we have been offering to medical groups and IPA,” Song said.

“For health plans and physicians to help patients achieve the goal hitting outcomes measurement milestones that are attainable, you can’t offer these patients a one-size-fits-all disease management program,” Song said. “These disease management and wellness programs must be tailored and continually evaluated with the patient for effectiveness in order to serve as the fuel that drives adherence.”

Based on the IMS report, Aiken offered the following recommendations:

■ Understand in your own practice/health system/managed care organization how medicines are being used and what the consequences are if they are not used responsibly.  Establish some base line metrics that you can use over time to assess whether you are improving or not in these areas.

■ Establish some fresh initiatives that capitalize on all that’s changing in the healthcare system-technology, payment systems, delivery structures, incentives, informatics capabilities, etc.-and develop new programs to tackle these areas.

■ Look externally to other stakeholders and think about how things look from their perspective–and what you can do collectively rather than separately in these areas.

“There is a large opportunity to reduce healthcare utilization and avoid costs by using medicines responsibly,” Aitken said. “Signs of progress are appearing but there is more to be done.”