How the life sciences industry can move beyond traditional strategies to educate consumers and prescribers on effective treatment options and the importance of medication adherence
While care providers and health plans have historically viewed the pharma industry as somewhat separate from value-based care, the push to achieve healthcare’s quintuple aim across the care continuum is shining a light on shared goals—and highlighting the need for partnerships that transcend any perceived divides.
Medication adherence is a prime example. About half of all chronic disease patients fail to take their medications as prescribed, contributing to more than 125,000 preventable deaths and over $500 billion in avoidable medical spending each year. Clearly, addressing this dire situation is good for patients and their outcomes. But in the value-based care environment, the benefits of medication adherence extend even further.
For pharma, the growing focus on medication for chronic disease management in value-based care represents an opportunity to broaden access to ground-breaking therapies. However, it involves a major shift in thinking about how to sell and market new or existing medications. Rather than relying on traditional approaches, such as direct-to-consumer advertisements, commercial teams instead need to develop innovative new strategies to educate consumers and prescribers on the importance of adherence. Collaborating with health plans and technology providers is a practical approach.
Defining the scope and scale of the medication adherence challeng
Health plans have long been challenged with improving adherence within the member population, particularly among the most vulnerable, medically complex members. These populations tend to incur significant costs—the top 5% of high-risk patients account for 50% of all medical spending—and require specialized support and services that go beyond the basics of standard clinical care.
Approximately a third of adults living in the United States have more than one chronic disease, with markedly higher rates among certain groups, including Black and Hispanic populations, low-income individuals, and those with social determinants of health (SDOH) barriers, such as lower educational attainment, social isolation, housing and food instability, and transportation issues.
People who fall into these categories are less likely to be able to afford or access their medications, may not be fully aware of the importance of medication adherence, and are often much less likely to engage with the healthcare system overall in a consistent, positive manner. As a result, they often become the individuals at the highest risk of worsened health outcomes within the member population and can pull down their health plan’s performance on value-based government programs and employer costs – especially related to medication adherence.
Why bring pharma into the picture?
For many years, pharma companies have invested in disease state awareness campaigns as part of their broad media-based marketing efforts. These campaigns are designed to enable patient activation to visit their doctors, who, in turn, can prescribe appropriate treatments.
While the approach is logical, there may be opportunities for it to be more effective. Disease state awareness campaigns are almost always direct-to-consumer, requiring a great deal of investment. For example, in 2021, media reports revealed that Sanofi and Regeneron spent more than $523 million on ads for the immunology drug Dupixent. Most of that spend was on TV ads, which are difficult to measure in terms of impact and ROI.
Pharma can boost their odds of connecting at-risk patients with the high-value therapies they need by collaborating with healthcare industry partners that focus on value-based care. For example, health plans and technology solution providers in the space often leverage advanced analytics to identify high-risk patients with chronic diseases. Value-based care stakeholders are strongly motivated to identify these complex members as early as possible and provide both clinical and non-clinical support to ensure medication access and long-term adherence.
This hyperfocus on identifying and engaging people who fall into high-risk categories offers pharma an opportunity to enhance the efficiency and effectiveness of unbranded campaigns. Once high-risk members are identified, the pharmaceutical industry can play a role in empowering these individuals with unbranded information about the characteristics of their particular disease and how medication can improve their quality of life.
While conducting personalized outreach to patients, care teams and technology partners can share unbranded free, educational information that may prompt a visit to their provider for proper evaluation and treatment. They can also share information on preventive vaccines and the importance of adhering to regimens.
Using Data Dots to Reveal Hidden Diagnoses
Beyond better medication adherence, pharma companies can realize other benefits when partnering with health plans and technology solutions providers.
For example, there are many patients living with chronic conditions, such as epilepsy, that remain untreated. They may have an ICD-10 diagnosis, but pharmacy claims show the patient hasn’t received or isn’t filling their prescription for anti-seizure medications. Advanced analytics can connect those dots to identify these unmanaged patients and ensure they receive the therapies they need to stay healthy.
Analytics can also be used to identify patients with high instances of asthma-related emergency room visits. Research shows a majority of those admitted did not have their asthma controlled prior to visiting the emergency department. Here again, connecting data dots presents an opportunity to ensure these high-risk (and high-cost) patients are receiving the therapies needed to avoid hospitalization.
As the healthcare landscape continues to shift towards value-based care, more healthcare stakeholders are using advanced technology to identify patients that fall into high-risk categories and prioritize them for personalized outreach. This outreach is often most effective when rooted in the pharmacy. According to the World Health Organization, no other treatment has a more direct impact on patient outcomes than medication adherence. Since medication adherence affects how much a patient will consume from the time of initial therapy start, it directly impacts the sales dollars a life sciences company product can generate. In short, nonadherence can lead to a significant opportunity loss in revenue.
By partnering with health plans and technology solution providers, pharma companies can not only increase their bottom line but also contribute to the advancement of chronic disease management, as well as quality of life and health outcomes. Although the regulations and health plan requirements won’t allow the education to be branded or any protected health information (PHI) shared with the sponsoring pharma organization, de-identified outcomes of patient activation and new diagnoses can be shared. As such, pharma can assess their typical market share for the new diagnosis with the appropriate medication therapy.
Jason Rose is the CEO of AdhereHealth, a healthcare technology company that delivers purpose-built, innovative technology solutions to improve quality of care, medication adherence, and cost outcomes—all with an emphasis on overcoming social determinants of health (SDOH) and improving patient experience.
