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Value-Based Adherence Driving Landmark Results

Value-Based Adherence Driving Landmark Results

Taking medications is a routine for most Americans.  Almost 3 out of 5 American adults take at least one daily medication, and the proportion of people taking five or more prescription medications doubled from 2000 to 2012. However, it has been well documented that for many, taking their medications as prescribed can be a challenge.  Approximately 50% of patients with a chronic disease have difficulting using their medications as prescribed.  Moreover, it has become widely accepted that medication non-adherence has significant health consequences and societal costs. It has been estimated that upwards of $300 billion of avoidable health care costs have been attributed to medication non-adherence annually in the U.S (~ 10% of total health care costs).  CMS is sufficiently concerned with the adverse effects of non-adherence that it includes three triple weighted STAR measures as part of its Medicare STAR quality program.

To mediate the adverse impacts of non-adherence and assist its clients to improve adherence STAR performance, in the 4th quarter of 2018, CSS Health rolled out its Value Based adherence program – Enhanced Adherence.  Enhanced Adherence recognizes that a significant portion of the Medicare population must navigate the health care system with poor social supports.  Enhanced Adherence was designed to provided a unique combination of centralized motivational coaching with local pharmacy medication synchronization and compliance packaging.  The goals of the program were two pronged:

  • Raise the proportion of days covered (PDC) for fragile populations with multiple co-morbidities to at least 80%.
  • Maintain members with border-line adherence in an adherent state

By minimizing the social determinants of care barriers to adherence, improving adherence for members commonly thought of as unrecoverable Enhanced Adherence supports plans to achieve the best outcomes and, in turn, target STAR ratings.  After tens of thousands of coaching calls, we are able to share our findings, results and insights.

Non-Adherence is more than Cost: We know adherence is more than a co-pay. Through tens of thousands of calls, our clinicians are working to uncover the root cause for non-adherence and remediate the underlying issue. What we have found is that over 90% of the reasons for non-adherence are NOT cost-based. Within one urban population, we found that our clinical outreach center could remediate 43% of non-adherent instances by addressing and educating the member on proper use.

Social Determinants of Care: We find the underlying issue and work with the patient to resolve the problem. Our coaching calls with members average 5 to 7 minutes of talk time. This engagement time builds trust with each member and identifies the key issues causing non-adherence. Our clinicians work through the social determinants of care discussing proper use, side effects, transportation, cost and literacy issues for each participating member. The subsequent calls build upon the initial relationship to ensure the member is fully supported and adherence issues haven’t re-appeared.

Member Level Visibility: We track each members’ PDC rate throughout the plan year. This allows us to instantly flag members that are in jeopardy of falling below 80%  PDC for the plan year. This reporting also documents the evolving reasons for non-adherence. For instance: within a dual eligible population, aligning the transportation service (one of the main social determinants that lead to non-adherence) resolved 26% of the issues within the non-adherent population

Refill Reminder Timing: To improve program performance, we structure our calls around the refill date. Aligning the reminder, with the assessment of social determinants of addresses two of the key drivers to maximizing an individual’s PDC. The timing of the refill is magnified within the fourth quarter as every fill counts.

Enhanced Adherence Results

Eliminate the Q4 PDC Drop-off. Historically, plans see up to 30% of their membership relapse to non-adherence within the fourth quarter. Across our participating plans, we retained over 90% of the adherent members. One of our plans saw a 94% retention rate!

Move Non-Adherent Members above 80 PDC. Not only did the program retain members between 80-85% PDC. We also moved 10-15% of the population that was non-adherent above 80% PDC. By targeting the at-risk members within the population 50-85% we help secure the target STAR rating across the triple weighted measures.

Save Previously Thought Non-Recoverable Members. We achieve this by combining adherence coaching and member outreach with local pharmacies that deliver the medication regimen through compliance packaging. This has allowed us to push members with an average PDC of 28% into compliance.

Positive PDC Change Across the Population. The adherence program demonstrated a positive PDC change for 45-50% of the population with little to no regression in the remaining population

I am happy to discuss any of these thoughts in greater detail. Feel free to reach out by phone or e-mail. 

Jim Notaro
716.541.0273 x101

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