- Nearly half of Medicare diabetic patients are unable to keep up with recommended medication adherence rates, according to a new report from IMS Health, leading to serious chronic disease complications and millions in preventable spending.
Diabetic patients, especially elderly Medicare beneficiaries who may have multiple comorbidities, mobility difficulties, and limited financial resources to pay for medications, may benefit from tailored chronic disease management and population health management interventions that address the root causes of inadequate adherence to their treatment plans.
“The rising prevalence of Type 2 Diabetes and its associated complications is the root of considerable strain on society and an economic burden on healthcare systems,” said Murray Aitken, IMS Health senior vice president and executive director of the IMS Institute for Healthcare Informatics.
Using the CORE Diabetes Model, a peer-reviewed framework for assessing the costs and clinical complications of patients with Type 1 and Type 2 diabetes, the report found that an estimated 46 percent of Medicare patients are experiencing sub-optimal levels of adherence, and are likely to discontinue therapies before their providers have directed.
Non-adherence to diabetes management plans can produce a 17 percent increase in HbA1c measurements, which may significantly increase the chance of developing common complications such as foot problems and cardiovascular issues.
Diabetics who struggle with medication adherence are 137 percent more likely than other patients to experience end-stage renal disease, and 29 percent more likely to acquire severe vision loss or blindness. Non-adherence may also increase the chance of foot or leg amputation by 20 percent.
Complications from diabetes, experienced by adherent and non-adherent patients alike, are estimated to cost Medicare close to $100 billion per year between now and 2025, the report states. Non-adherent patients are likely to account for 4 percent of those costs, or approximately $4 billion per annum.
“To provide a sense of proportion, $4 billion average annual cost of avoidable complications due to sub-optimal adherence and persistence is equal to approximately 3.9 percent of total annual Medicare spend on diabetes and, is approximately 32 percent of the total annual Medicare spend on diabetes medications and supplies,” the report explains.
Non-adherent patients are likely to cost $14,500 more during their lifetime than patients with optimal adherence habits, and previous research has also shown that medication adherence issues may increase the likelihood of hospitalization for diabetic patients by up to 77 percent.
The cost estimates do not include figures related to the economic burden of lost work days for patients or their caregivers. They also may not fully take into account the financial impact on providers, including clinician training and time lost on unnecessary patient appointments or medication dispensing.
While the impact of poor medication adherence for diabetics may be severe, providers and patients do have opportunities to lessen the clinical and financial burdens of this increasingly common chronic disease.
The report points out that patients with higher levels of “activation,” or patient engagement and education, exhibit improved adherence and lower levels of complications. Costs can vary as much as 20 percent depending on how much the patient knows about his condition and how to best care for his needs.
True activation relies on engaging patients to understand the relationships between five key elements, IMS Health says, including health attitudes and beliefs, personal socioeconomic circumstances, health status and comorbidities, patient health literacy, and access and affordability of care.
By targeting these five areas and tailoring interventions to the individual patient’s needs, providers may be able to address the underlying issues that prevent optimal medication adherence.
“Simple, customized interventions that put patients on the path to optimal adherence and persistence can yield tangible results,” said Aitken, “but require alignment between healthcare and government leaders, as well as the active involvement of voluntary associations and the private sector.”
The report suggests that providers take a three-step approach to generating patient activation, starting with risk stratification and patient profiling, then moving into the implementation phase for targeted interventions. Lastly, providers should keep patients engaged through follow-up and health maintenance activities in order to maintain a high level of adherence.
Healthcare organizations may wish to invest in predictive analytics and risk stratification technologies that will identify patients who might benefit from increased attention to their chronic disease management skills. Providers should offer access to patient education and support, and may wish to coordinate with community, pharmacy, and public health resources to ensure easy access to the tools that will encourage steady adherence.
Care coordination techniques, including the use of patient navigators and dedicated care teams, may also help to keep patients on track with their diabetes management needs, the report adds. A health plan liaison may also be helpful for educating patients about the costs, limits, and opportunities within their insurance coverage to ensure that beneficiaries are maximizing their available resources.
“By making steps to pilot these recommendations and measure their benefits, the US government, insurers and providers could make informed decisions on how and what interventions to scale up for successful reduction of significant and unnecessary costs of sub-optimal Type 2 diabetes therapy adherence and persistence, as well as improve health of millions of Medicare patients with diabetes,” the brief concludes.