Healthcare Analytics, Population Health Management, Healthcare Big Data

Population Health News

Medication Non-Adherence Brings Millions in Avoidable Costs

By Jennifer Bresnick

- Healthcare providers aren’t the only ones impacted by the intractable problem of medication non-adherence for patients suffering from common chronic diseases, says a new white paper by Healthentic: the costs of preventable hospitalizations for diabetes, heart disease, and high cholesterol can bring more than $8 million a year in avoidable costs per 100,000 lives to employers paying for health insurance.

medication adherence and chronic disease management

Medication non-adherence, which may affect 50% of all patients, increases the likelihood of a hospitalization by up to 134% for high blood pressure, diabetes, and high cholesterol.

“There’s a high tragic cost for people who don’t take their medications as prescribed — even for people who take their medication most of the time,” said Jeff O’Mara, Chief Executive Officer at Healthentic. “Non-adherence is a huge health problem for individuals, and causes massive amounts of unnecessary costs for employers.”

The company analyzed close to 100,000 patient lives in its database to survey the impact of poor medication adherence on costs passed down to employers.  They found 128 avoidable hospitalizations related to diabetes that cost more than $2 million in just one year, 243 hospitalization for high blood pressure totaling $4 million in avoidable costs, and 150 inpatient admissions for high cholesterol, adding $2.5 million to the potentially needless costs of poor medication habits.  Across the three conditions, medication non-adherence averaged 50 percent.  As a result, non-adherence increased the likelihood of hospitalization for diabetics by 77 percent, and for high blood pressure and high cholesterol patients by 45% and 35% respectively.

With the average cost of these treatments approaching $17,000, healthcare providers – and the employers paying for insurance costs – have a significant opportunity to cut preventable spending at the source by improving medication adherence education, reminders, and follow-up.

READ MORE: CMS Promotes Chronic Care Management with Provider Education

“Managing specific people and conditions in a population, using tools like medication adherence, is one of the most effective ways to avoid expensive hospitalization and keep people healthy – if you target the right people,” said Al Lewis, Founder and President, Disease Management Purchasing Consortium.


“Not all interventions work for all patients,” said Clifford Jones, CEO of AllazoHealth, in response to a separate survey by his company that found a lack of effectiveness among medication adherence programs in some managed care organizations.  “Some patients won’t respond well to any intervention, and some patients will respond better to anything.  That’s where it’s really important to have effective targeting in terms of who you’re delivering those interventions to so that you can have the biggest impact.”

Providers have been utilizing a number of different strategies to ensure that prescriptions get filled and pills get taken, including the integrated of automated reminders into EHR systems and the use of predictive analytics to forestall problems before they develop into major issues.  In one study, Kaiser Permanente researchers found a 2% decrease in medication non-adherence among diabetics and heart disease patients when they implemented automated reminders generated from EHR data.  Patients received phone calls, letters and live support from nurses and pharmacists to ensure that prescriptions were filled on time.

Surescripts, meanwhile, has been working to reduce administrative “speed bumps,” such as prior authorization, that may slow down the prescription process and frustrate patients into forgetting about following through.  “The pharmacy can’t dispense the medication to the patient, so they have to get back in touch with the physician,” explained David Yakimischak, Executive Vice President and General Manager of Medication Network Services at Surescripts to HealthITAnalytics.  “The physician has to contact the payer or pharmacy benefit manager (PBM).  And it’s handled through phone calls, paper, and faxes,” he continued.  “It takes several days, and we end up with a high abandonment rate where a number of patients just don’t wait for everything to get finished, and they never do get their medicines.”

READ MORE: Challenges of Applying Predictive Analytics to Population Health

“Getting the medicine into the hands of patients quickly, efficiently, and cost effectively is such a huge, huge opportunity in healthcare, but prior authorization is viewed as one of the stumbling blocks or hindrances, if you like,” Yakimischak said.  “If you can get more through the system and you get more medicine into the hands of patients that are more compliant with their medication, they’re going to have fewer hospital admissions, fewer emergency room visits, less extensive impact to their health, to society, to their jobs, to their families.”



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