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Medication Management and Member Engagement: 4 Tips for Health Plans Looking to Improve Medication Adherence


Climbing medical costs are forcing more and more people to make tough choices about prescription drugs. But higher prices aren’t the only factor affecting medication adherence.  

 An aging population, rising chronic disease rates and a lack of action to address social determinants of health make medication nonadherence a problem for patients, providers and health plans alike. 

 The domino effect of medication nonadherence is devastating. Unfilled or improperly taken prescriptions result in: 

  • Stopped or delayed disease treatment 
  • More health complications 
  • Frequent trips to the emergency department  
  • Increased hospital admissions 

These physical costs to patients result in enormous financial costs to the U.S. healthcare system. One study cited nearly $530 billion in costs for morbidity and mortality associated with medication nonadherence.  

And the problem isn’t going anywhere anytime soon. 

What affects medication adherence in health plan populations? 

Our daily interaction with about 70,000 patients and health plan members gives us a unique perspective on why people don’t follow their medication regimens. Many barriers to medication adherence come from socioeconomic conditions, language, literacy, transportation and culture. Each case is different and may include a combination of factors. 

Fortunately, our work with hundreds of health plans has also given us critical information about improving adherence. 

Don’t ignore the gap: Make medication reconciliation a priority 

A recent Gallup poll found that medication adherence is linked closely with 30-day readmission rates. Respondents reporting medication adherence failure had a 59% greater risk of hospital readmission compared to those reporting full medication adherence.  

In addition, adverse drug events lead to many return trips to the hospital—an especially problematic issue among patients with low health literacy, complex medication regimens or high-risk prescriptions. 

Health plans must ensure that members understand their medication instructions and that medications are coordinated effectively during the gap between a hospital stay and the first visit to a physician after discharge.  

That’s where medication reconciliation processes hold promise in reducing drug-related readmissions.  

At Carenet Health, our experienced nurses work with health plan members to promote medication adherence and reconcile medications post-discharge.  

Member engagement for health plans: The key to medication adherence 

Member engagement is critical to successful medication management and adherence programs. Without a trusted relationship between health plans and members and without the ability to reach out and discuss their medication with them, creating medication compliance becomes much more difficult. 

  1. Foster understanding: Health plans must devise multichannel, multiple-touchpoint strategies to reach out to members to identify why they aren’t taking their medications as prescribed. Talk to them about their needs and concerns. Identify the true barriers and address them. Focus on empathy and patience to build trust and goodwill.  
  2. Motivate compliance: In-depth prescription discussions can be rare at the pharmacy counter and rushed at the end of a physician office visit. Make sure your members know what their prescription can do to help them so they’ll understand the need to comply.  Educate your members on the reasons their doctor prescribed the medication and explain how to take it properly—and for how long. Equally important is to ensure members know their health plan and that their providers are there to support them. 
  3. Offer solutions: Medication costs are a substantial barrier to adherence, and not just for members below the poverty line. Even families with two full-time monthly incomes are often stretched to pay for unexpected high-dollar prescriptions. Implement personalized engagement services to offer members generic and mail-order options to reduce costs and solve transportation issues. Plan for multiple touchpoints and interactions—via various channels. Ask your engagement teams to share telehealth resources and the information members need to navigate the healthcare system. 
  4. Encourage confidence: The concept is simple but powerful. Let members know they have the knowledge and support to obtain and take their medications for better health successfully. 

To learn more about medication adherence, download our ebook, Overcoming Barriers: The Faces of Medication Nonadherence. Or contact us to discuss how we can optimize your medication adherence efforts. 


Carenet Health is acquiring Health Dialog

uniquely positioning us to transform the business of healthcare by leveraging our expanded insight-driven, personalized consumer engagement and activation platform.