How to Make Gains with Population Health via Improved Medication Adherence
Chronic conditions are incredibly common in the United States. Six out of every ten adults have at least one chronic disease, and 4 in 10 have more than one long-term condition requiring ongoing monitoring and treatment.
Lifestyle changes are often the first line of defense for preventing or managing chronic conditions, but prescription drugs also play a crucial role in helping people live their healthiest lives.
Close to half of all adults, including more than 80% of U.S. adults aged 65 and older, take at least one medication, and more than half of seniors take four or more medications. Yet only 50% of people of all ages routinely take their medications as prescribed due to a variety of factors, including the burdens of accessing medications and the challenges of appropriately managing a medication routine at home.
These sky-high levels of poor medication adherence are tied to approximately half of all treatment failures, more than 125,000 avoidable deaths, and more than half a trillion dollars in wasted spending each year.
The numbers are a clear and urgent call to action for improving adherence to crucial prescription drugs, thereby meeting our shared obligation to reduce costs, improve experiences, and improve outcomes for individuals and populations as a whole.
To achieve these goals, we must deploy a coordinated array of person-centered strategies that are backed by advanced technologies and informed by the socioeconomic needs of the communities we aim to serve.
Understanding the barriers to medication adherence
Nonadherence rarely has a single cause or a simple solution. The unsustainable cost of drugs is certainly a significant component. Our nation spends more than $335 billion a year, however about 30% of people say they haven’t taken their drugs as prescribed due to the expense.
But there are other systemic and social determinant of health (SDOH) issues at play, as well. Pharmacy deserts are common across the nation, making it difficult for many people to physically access their drugs. Research has shown that these deserts disproportionately affect historically underserved communities, including Black and Latino residents and people in rural areas.
Even when medications are accessible, filling a prescription doesn’t mean the patient is taking the drug as prescribed. Low health literacy and daily functioning limitations can lead to skipped or doubled doses, while unwanted side effects can result in premature discontinuation—all of which contribute to worsened outcomes and higher spending on more expensive acute care.
Taking a person-centered approach to improving adherence
Addressing these issues starts by understanding why a person is struggling with their medication routine and providing actionable, personalized solutions for getting back on track.
For example, motivational interviewing is a powerful tool for getting to the root cause of a person’s challenges and gauging their readiness and ability to enact change. By asking empathetic questions in a culturally safe and socioeconomically sensitive manner, clinicians and outreach experts can identify specific issues, such as lack of transportation or the desire to communicate in a language other than English, that can radically enhance a person’s engagement with their own health.
Once these barriers are uncovered, clinicians and health plans need to have a playbook for resolving them. Connecting a person to a community resource that provides support to overcome an SDOH barrier is one critical way to resolve the direct issue they are struggling with and make room for adherence. Examples include food pantries, housing authorities, transportation networks, senior centers, schools, and faith-based groups that can create a network of care around individuals.
Layering in technology to enhance value and efficiency at scale
To truly address medication adherence at a population level, healthcare leaders will need to employ sophisticated data analytics to target their outreach efforts, document the results and integrate lessons learned into future population health initiatives.
The first step is stratifying patients by risk using a combination of clinical data, claims, member engagement data and socioeconomic vulnerability indices. Using rich, reliable, multi-source data to develop risk scores can ensure stakeholders are taking all factors into account when designing outreach programming. Stakeholders should consider leveraging digital platforms with strong data visualization and dashboard features that help guide staff through their outreach and pharmacy management workflows.
Prioritizing the highest-risk, highest-complexity individuals will produce the most immediate impact on costs and outcomes, while setting organizations up for success with value-based care contracts, CAHPS, Star Ratings and other industry measurement and incentive programs. As the population ages, the prevalence of chronic disease will only increase—as will the need for more comprehensive medication adherence across population segments. With a personalized, data-driven approach to identifying and addressing barriers to adherence, healthcare providers and health plans will be able to meet their population health goals and deliver more responsive, efficient care for all.
