CVS panel: Provider incentives, targeted interventions improve med adherence

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The annual price tag for medication nonadherence totals roughly $290 billion, yet the industry still lacks evidence of what to do to ensure patients take their medications, according to a breakfast panel yesterday discussing new research from CVS Caremark.

In their second annual study, researchers from CVS Caremark, University of Pennsylvania School of Medicine, Harvard University and Brigham and Women's Hospital explored patterns of nonadherence, as well as the potential benefits of interventions--lower costs and better outcomes.

To enjoy those benefits, the industry still needs to adopt a business model that supports better medication adherence, noted Will Shrank, M.D., assistant clinical professor of medicine at Harvard Medical School.

"How do you convince doctors to invest in improving adherence ... if there's no meaningful reimbursement for them on the basis of whether or not their patients are taking their meds?" he asked.

Highlighting the misalignment of incentives for hospitals and providers, Shrank cited a program at Boston Children's Hospital that reduced admissions for asthma patients by improving the way they used their asthma meds. However, as a result of better medication adherence, the hospital lost substantial revenue.

But the industry is moving in the right direction, the panel noted. Thanks to the healthcare reform law--which rewards value over volume and holds providers accountable for quality and costs--medication adherence is becoming a key part of the bottom line. "All of the care coordination in the world is not amount to a hill of beans if patients go home and they don't take their medications," Shrank said.

Healthcare reform's focus on patient engagement also can provide some spillover effects to improve medication adherence, according to Niteesh K. Choudhry, M.D., associate professor at Harvard Medical School, Brigham and Women's Hospital.

Knowing that more activated patients make better health choices and have lower healthcare spending, organizations can use that as a way to stratify patients for med adherence interventions. For example, a large health delivery system in Boston is testing an approach that stratifies patients based on their level of patient activation and then tailors interventions based on their activation levels, said Choudhry.

Acknowledging those dollar comparisons between engaged and unengaged patients, Shrank said ongoing research is focused on how to turn an unengaged disconnected patient into an engaged connected patient, and in a cost-effective way.

Stratifying patients based on engagement is one way organizations can target med adherence interventions. According to the panel, hospitals and providers need to better personalize medication-taking strategies, as no one size-fits-all approach will work.

"Not everything will work for everyone," Anita Allemand, vice president for Enterprise Product Innovation at CVS Caremark said. With that in mind, the researchers touted predictive modeling to determine which patients to target, and with what interventions and intensity.

And the industry sorely needs personalized, targeted solutions: Americans received a C+ for medication adherence, with one in seven adults receiving a failing grade, according to the National Community Pharmacists Association's new report card.

For more:
- check out the CVS Caremark research announcement

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