SCAN Tackles Major Disparities in Adherence

As SCAN Health Plan worked to boost medication adherence among members, it made a startling discovery. The Medicare Advantage plan used the CMS’ Star Ratings system to self-assess their program.

“We saw that we were a 4½-star plan overall,” says Sharon Jhawar, Pharm.D., MBA, the chief pharmacy officer at SCAN Health, a Southern California-based Medicare Advantage insurer. That was the good news.

When they dug deeper, they found bad news. “When you look at it by race, we were not a 4½-star plan for our Black and our Latinx populations.”

Although the health plan had been analyzing its own data for years and working to identify barriers to patient medication adherence, it found that the benefits were not accruing to all patients equally.

“We’ve been applying all these normal techniques that you do to help an individual adhere to their medications,” she says, “and we weren’t sure why there was still this big gap.”

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They quickly ruled out cost as the main driver of the disparity. They had already developed and launched interventions to help address that issue. So they decided to start holding conversations with members in demographic groups disproportionately linked with nonadherence.

When they did, they found that cultural issues had a major impact. For Spanish-speaking members, having a person who could speak their language and with whom the patient was comfortable asking questions was key.

For instance, one patient who was not taking diabetes medications as directed was doing so because she wanted to control her disease with diet and exercise. A pharmacist was able to explain to her that it was still important to take her diabetes medication daily. However, the pharmacist was only able to identify and solve the problem by speaking in Spanish with the patient.

“And then what we saw with our African American members was trust was important — getting recommendations from trusted sources,” Jhawar says, noting that a significant amount of medical literature suggests a historic lack of trust between some Black patients and their healthcare providers. “That trust hadn’t been built with health professionals.”

Solving those problems has not been easy, but she said an individualized approach has paid off. Some patients just need a reminder, a few are annoyed, but most appreciate the check-in. For some, it’s the difference between adherence and nonadherence.

“We’ve finessed the art of reaching out and communicating with them,” she says.