When your plan members stop taking their medications as directed, it can have a domino effect. Disease treatment may be halted, complications may arise and a person may end up in the emergency department or needing to be admitted to the hospital.
In addition to the physical cost to the patient, medication non-adherence costs the U.S. healthcare system about $300 billion each year, according to Healthcare Finance News.
And the problem isn’t going anywhere anytime soon.
As medication costs increase, the country’s population ages, chronic disease cases continue to rise, and the system fails to recognize and act on the importance of social determinants of health, medication nonadherence will continue to cause problems for patients, providers and health plans alike.
What affects medication adherence in health plan populations?
Our daily interaction with 50,000 to 60,000 patients and health plan members gives us a unique perspective on why people don’t follow their medication regimens. Many of the barriers to compliance come in the form of 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 key information about what it takes to improve adherence.
Member engagement for health plans: The key to medication adherence
We’ve found that there are four “E’s”—or four steps—to improving medication adherence.
- Engage to foster understanding: Recommended steps begin with the most important one: engagement. Without a trusted relationship between your health plan and your members, without the ability to reach out and discuss their medication with them, creating medication compliance becomes much more difficult. Health plans must devise multichannel, multiple-touchpoint strategies to reach out to members to identify why they aren’t taking their medication. Talk to them about what they need and what their concerns are. Identify the true barriers and address them. Empathy and patience are important here.
- Educate to motivate compliance: We’ve found that many members may bring home a prescription, but don’t really understand what it is supposed to do for them or if there is a real need to take it. After all, in-depth prescription discussions can be rare at the pharmacy counter and rushed at the end of a physician office visit. Health plans can help their members by educating them on the reasons their doctor prescribed the medication, and explaining how to properly take it and for how long. And this is also important: Ensure they know the health plan and their providers are there to support them.
- Equip to supply solutions: Costs of medications are a substantial barrier to adherence, and not just for those members who are below the poverty line. Even families with two full-time monthly incomes can be stretched to pay for unexpected high-dollar prescriptions. Health plans can help by implementing personalized engagement services to offer members generic and mail-order options to reduce costs. Mail order can also help solve transportation issues. Again, this will take multiple touchpoints and interactions, via multiple channels, but the success rates can have a major impact. Be sure your engagement teams are also sharing resources for telehealth services and the general assistance they may need navigating the healthcare system—to further help members and lower costs.
- Empower to encourage confidence: The concept is simple, but powerful: Let members know they now have the knowledge and support they need to obtain and take their medications successfully, and to support overall better health.