Medication non-adherence has gained national attention as a driver of medical costs. As C. Everett Koop, former U.S. Surgeon General, said, “Drugs don’t work in patients who don’t take them,”and data supports that seniors especially have difficulty with their medications. The Centers for Medicare and Medicaid Services (CMS) reports that 11% of hospital readmissions and 23% of nursing home admissions are due to non-adherence with prescription drugs. Although many factors can contribute to non-adherence, a frequent reason is forgetting to fill or re-fill a prescription.
Insurers have taken the lead in interventions that support medication compliance, primarily using risk models to select patients and Interactive Voice Response (IVR) technology as the intervention. It is likely that ACOs and hospitals operating under risk-based models will soon seek to implement these best practices to support their patients’ outcomes.
Risk stratification algorithms and predictive models that incorporate historical claims and prescription data are central to selecting patients who will benefit from an intervention. However, because medication adherence is not a one-size-fits-all problem, it’s important to match the member to the technology. Each member is unique, not just in terms of their medications and medical conditions, but also their life experiences, cultural identity, comfort with technology, etc.; personal attributes that go beyond claim and prescription data.
In this regard, choosing patients who will improve their medication adherence through a particular technology, such as IVR, can be more art than science. As algorithms and models become more sophisticated, they will account for these socio-economic factors to provide assurance that intervention investments result in improved health outcomes.
IVRis a technology that seems low-tech but that can have significant impact on medication adherence according to a number of published studies. The technology automates pre-recorded phone calls to remind patients to fill or refill their prescriptions.
The messaging used for these calls can be extremely important, not just in terms of the content but also the delivery. The actual message must be engaging, can’t be too long, and studies show that the voice is incredibly important in capturing a member’s attention. Tone, pitch, pace, inflection, accent and whether the speaker is male or female all have an impact on whether a person is compelled to take action. It’s important for the voice to sound friendly and credible and volume can be an important factor for the elderly.
According to IVR vendors, the national average rate for a person to listen to an IVR call is about 35%, but the person need not answer the call for the call to be successful. Many people see the caller ID as their insurer or pharmacy and know that the call is a medication reminder.
The annual costs of hospital readmissions and nursing home admissions related to medication non-adherence are estimated to be $100B and $31B, respectively. As healthcare providers proactively seek interventions to keep seniors out of the hospital and in their own homes, medication adherence will continue to be an important area of focus.
Karen Golden Russell, MA MBA is a member of the HIMSS Health Business Solutions Committee. As Principal of GOLDPoint Healthcare, a management consulting firm, she has supported clients in their medication adherence and predictive modeling solutions. Email Karen.