Adherence to a medication is at least as important to patient outcome as the therapy itself.   

A recent publication by Zhang et. al  in the Journal of General Internal Medicine studied the relationship between chronic medication adherence and potentially preventable healthcare utilization.  Specifically, the authors examined the association of adherence to diabetic medications, renin-angiotensin system antagonists (RASA), and statins with potentially preventable utilization and spending.

To explore this association the authors designed a retrospective cohort study using Medicare claims data (2013 to 2016, included 177,881 unique patients).  Patients using the index medications were divided into two groups – adherent (>80% proportion of days covered (PDC), 6-month interval after the index prescription) and non-adherent (<80% PDC).  Potentially preventable utilization was defined as preventable emergency department visits and hospitalizations.

The authors found that non-adherence was associated with a statistically significant 1.7% increase among the diabetic and RASA medication cohorts and a statistically significant 1.0% increase among the statin cohort in the probability of preventable utilization. For patients with at least one preventable encounter, medication non-adherence was associated with between $679-$898 increased preventable spending.

Zhang et. al.’s work continues to add credence to the belief that improving medication adherence is essential to reducing preventable utilization and spending.  Additionally, for most chronic drugs, adherence rates of 80% or more are needed for optimal therapeutic efficacy.  Finally, the Zhang study design provides an elegant module for measuring adherence program ROI.

Traditionally, adherence programs have been designed to react to non-adherence, relying on motivational coaching to encourage non-compliant patients to follow provider instructions and consistently take the proper dose of medication at the correct time and for the recommended length of time.  However, reactive programs that focus on an adherence measure (i.e. PDC) that is foreign to the patient.  In many cases, patients enrolled in reactive motivational coaching programs don’t even recognize that they are non-adherent with their therapy.  

To this end CSS Health has developed a proactive, event-based adherence program that engages and coaches patients at critical points in the prescription refill cycle.  The program can be operated by plan pharmacists using the CSS Health MTMPath platform or by the CSS Health clinical call center.  I am happy to discuss how your plan might incorporate our CSS Health Enhanced Adherence program, measure adherence improvements and reduced avoidable costs.   Additionally, the Enhanced Adherence program has the elasticity to include other drug related quality measures as needed at any time during the program year. 

I believe that our unique approach will give you the early detection tools you need to identify at-risk patients, build adherence, and improve patient lives. Reach out if you’d like to learn more. 

Best – Jim
Jim Notaro, RPh, PhD
Founder and Chief Clinical Officer