The Importance of Medication Adherence in Value-Based Care

January 2, 2020

The Importance of Medication Adherence in Value-Based Care

Trying to manage one’s own care in today’s health care system is confusing and presents many challenges. Some of these challenges include the struggle to afford medication, forgetting to take the medication, or having to choose between paying rent, buying groceries, or filing a prescription. In value-based care, this happens across entire populations, leading to higher costs and lower quality care. These barriers inhibit providers from making healthcare sustainable for the long-term.  

Studies show that health care providers can identify and resolve these issues to improve chronic disease control, lower heart attack rates, and reduce hospital re-admissions, among other outcomes. That is why health care systems and provider groups need to build a network of interventions and to individualize solutions - one patient at a time. 

Two Patients, Two Scenarios

For example, two patients taking the same blood pressure medications may have different preferences for the cost of the medications and the ease of use. Patient number one may prefer taking fewer tablets a day and can afford a higher cost combination medication. Prescribing a combination tablet (with both medications in one) at an affordable price, meets this patient’s preference. 

Patient number two may have a fixed monthly income and prefer the lowest copay. Prescribing two generic medications with low copays works better in this case. In other situations, patients with mobility issues may benefit from having medications delivered to their home. Health care teams can resolve cost, transportation, and other barriers by working directly with a patient, in person or over the phone.  

In value-based care, a patient-centered approach is supported by system changes that make the best care also the easiest care.

Health systems are extending the abilities of pharmacists and nurses, using collaborative practice agreements and standing orders, to help manage chronic and acute diseases.

Helping the Patient Help Themself

Standing orders empower nurses to order labs – such as hemoglobin A1c for diabetes monitoring – while collaborative practice agreements enable pharmacists to monitor and modify medications with the patient in order to reach desired outcomes. This engages the patient in their own care in a more coordinated and continuous way. Primary care providers also value the team-based care model and for the patient to receive additional monitoring and support between office visits.

Healthcare systems and provider groups should avoid placing the entire medication adherence burden on the prescriber and decide how to best use adherence-based technologies.

Medication adherence is not easy. As a patient I have had my own difficulty. I have been prescribed medications and have missed doses. Technology, such as a phone reminder, may have helped me remember, but for technology to improve adherence, it must meet each patient’s need and preference.  

Challenges multiply when a patient is taking many medications. For example, if a patient wishes to receive a text message alert when forgetting to take one of multiple medications, a medication plan must first be entered into the system followed with any changes to that plan moving forward.  

Cumbersome setup and maintenance steps discourage patients from using simple adherence technologies. Medication labels or printed material from pharmacies could contain barcodes (such as QR) for patients or caregivers to rapidly add the medication regimen to adherence-related systems.  Also, making health data from EMRs available will allow digital tools to seamlessly support patients. Patients should have access to their active medication list. Overcoming this barrier will transition the conversation between a patient and their provider at an office visit into the medication-taking habits of healthy behavior at home.

About the Author

Tom DiPiro, PharmD, MBA, MS
Director of Pharmacy Services at CHESS