Exclusive: Health Care Service Corporation expands personalized medication adherence model

Medication adherence tool

Health Care Service Corporation had a simple goal: Create a medication adherence program that is as unique as each individual.

With that in mind, the nation’s largest privately owned health insurer rolled out a program, Pharmacists Adding Value & Expertise (PAVE), tailored to the goal of maximizing member engagement--and achieving optimal healthcare outcomes. Launched in January for Medicare and dual-eligible members in three states, the organization has just announced it will expand the program to additional states and offer it for Medicaid and retail plans.

The secret sauce

headshot of Jay Ghandi
Jay Gandhi

"The secret sauce is member engagement,” Jay Gandhi, divisional vice president of enterprise pharmacy at HCSC, said during an exclusive interview with FierceHealthPayer. HCSC operates Blue Cross Blue Shield plans in five states. 

HCSC approached pharmacies with a business proposition: Leverage data collected about patients’ use of medication to keep them taking their medication on a proper schedule.

“The opposite of adherence is lost revenue” for pharmacies, said Gandhi, adding that pharmacists have been “very receptive” to PAVE.

HCSC, as well as other payers, are in a unique position to equip pharmacies with resources for improving medication adherence. Since HCSC is able to aggregate a patient’s whole pharmaceutical history, the company captures patient data from different locations.

Fueled by data

HCSC gives pharmacists data on how compliant a patient has been with his or her medication regimen to help pharmacists engage each patient with individualized questions. Asking detailed, specific and personalized questions, Gandhi says, is vital to engagement, and “engagement is key to enduring outcomes.”

HCSC encourages pharmacists to ask patients if they need smartphone assistance, a different length of supply, options for automated refills, tailored care for the elderly with devices such as a medication pillbox, or if they want to switch to a generic medication.

Research supports the strategy of syncing patients' smartphones with their medication regimens. Texting patients medication reminders can double the odds of patients being adherent, according to a study in JAMA Internal Medicine.

Patients' failure to adhere to prescribed medications can be costly for the healthcare system. A study published in the American Journal of Managed Care found that diabetes patients with multiple conditions cost $2,736 more per year to treat if they were non-adherent.

HCSC hopes pharmacists will use its data to better engage patients and ensure they are following their doctors’ orders. From a communications standpoint, PAVE is a program that recognizes “pharmacies and pharmacists are culturally in line with patients and the communities they live in,” Gandhi told FierceHealthPayer.

Pharmacies are able to communicate in an effective manner and at a time when the patient is available, “like a second shift after work, or 1 a.m. after a third shift,” he said.

Return on investment

Synchronizing medication adherence--allowing patients to fill all their prescriptions on the same day at the same time--has been shown to significantly improve medication adherence, especially among Medicare Advantage members with low baseline adherence, FierceHealthPayer has reported. 

The main premise driving the desire for greater medication adherence is achieving positive health outcomes, Gandhi said. The point of having great medication adherence rates is to ensure people receiving treatment get healthier.

So far, testimonials from pharmacist members and pharmacist associations say "everyone is thriving," according to Gandhi. "PAVE is turning pharmacy 'customers' into pharmacy ‘patients,'" he added.

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