It's the healthcare crisis you've never heard of: medication nonadherence. This occurs when a patient fails to take a medication according to the prescribed dosage, time, frequency, and direction. The reasons for nonadherence are myriad, but at the end of the day, it is an entirely preventable problem with deadly consequences.
Poor medication adherence claims an estimated lives a year. To put those numbers in perspective, that is nearly the number of fatalities attributed to the opioid epidemic in 2016 – all for a health crisis that receives a fraction of those resources or attention.
While Washington has too often dithered on real solutions to incentivize proper medication use, innovators throughout the rest of the country are finding what works -- and, finally, there are signs that lawmakers are taking notice.
At , where I serve as Executive Director, there are three specific private-sector breakthroughs we believe that Congress and the administration should look to duplicate right away:
Better Information Sharing: Parkland Memorial's DASH Pilot Program
Roughly of older Americans have at least one chronic condition, and more than three-fourths have at least two. That makes for many doctor appointments, trips to the pharmacy counter, and prescription drug claims sent to the insurance company -- but, until recently, there was no statutory framework for proper communication between these settings.
If claims data shows a patient is not filling his or her prescriptions, or if a patient has past hospitalizations tied to poor medication adherence, for example, other points of care in the patient's healthcare experience should have that information so they can tailor their services accordingly and optimize an individual's chances of sticking to a treatment regimen.
Parkland Memorial Hospital in Dallas recognized this need, rolling out its Data Across Sectors for Health (DASH) pilot program last year; the program uses a sophisticated web portal to facilitate communication among various care settings for 150 of Parkland's most at-risk patients with chronic health needs after they leave the hospital.
According to a in Politico, "early data from the pilot showed that it had reduced emergency room visits by 8% in people who participated in the trial," and "90% of the clients in the study said the program helped them manage their disease, fill prescriptions, and keep doctor visits."
It is time to bring this solution to the Medicare space, and the recently enacted will allow us the opportunity to do exactly that.
Nestled in the 650-page bill is a provision mirroring an earlier to the Senate-passed CHRONIC (Creating High-Quality Results and Outcomes Necessary to Improve Chronic) Care Act, which would open the lines of communication between Medicare's hospital, medical, and prescription drug benefits to give clinicians a fuller picture of patients' healthcare decisions and needs.
Of course, there is a difference between simply putting good policy into law and putting it into practice. With a legal construct for data sharing between Medicare Parts A, B, and D now in place, we must all closely follow implementation of this statute to ensure that open, seamless communication takes place as the law prescribes to deliver real benefit to those with serious healthcare needs.
Appointment-Based Medication Synchronization Models
According to recent from the Centers for Disease Control and Prevention, 40% of adults age 65 and over reported taking five or more prescription medications in the last 30 days. That is a lot for any person to keep straight, but it can be especially difficult for older Americans with mobility issues or without reliable transportation to the pharmacy counter. Medication synchronization programs -- which align patients' prescription drug refills to enable pickup of all medications on a single visit -- can help.
A recent in Health Affairs showed that participants in a medication synchronization program saw their rate of hospitalization fall by 9%. If that is not enough proof for policymakers of the need to seize on this important tool, there is good news – the Bipartisan Budget Act also provides for a Government Accountability Office (GAO) study and report on medication synchronization programs.
At Prescriptions for a Healthy America, our found that these programs could also save up to $42 billion a year in healthcare costs from improved adherence and reduced hospitalizations. If the GAO's findings bear any resemblance to this and other research that already exists, it will present an undeniable case for putting these programs to use across the Centers for Medicare and Medicaid Services (CMS) for at-risk beneficiaries.
Electronic Prior Authorization
When picking up medications from the pharmacy counter, patients may be delayed or asked to return at a later date due to prior authorization requirements. These prior authorization dilemmas rank among physicians' , and worse, 40% of prescriptions requiring a prior authorization are abandoned by the patient altogether.
Insurance providers are not wrong to set these cost-control mechanisms in place, but doctors and patients are also not wrong to grow frustrated by the arduous process for resolving these claims. Fortunately, there is a better way.
Private insurers, doctors, and pharmacies are turning to electronic prior authorizations that allow clinical questions to be resolved more rapidly -- raising the odds that, even if a prescription does require a prior authorization, a resolution can be reached before the patient reaches the pharmacy counter.
Medicare, however, is still stuck in the past -- relegating prescribers and pharmacists to antiquated paper forms, faxes, and phone calls to resolve prior authorization issues.
The link between prior authorization delays, nonadherence, and poor health outcomes is undeniable, as is the need for Congressional action. To that end, Rep. David Schweikert (R-AZ) led a bipartisan group of lawmakers in introducing the .
The bill would spur greater adoption of electronic prior authorizations in Medicare Part D, thereby reducing delays in access to medication and permitting patients to obtain treatment as soon as possible -- something that even today's Congress should be able to find agreement on.
Congress and the administration still need a victory on bipartisan healthcare reform -- and patients grappling with the consequences of medication nonadherence still need a lifeline. Put to use effectively, these solutions can offer both.
Sloane Salzburg, MS, is the executive director of Prescriptions for a Healthy America, a medication adherence partnership that brings together leading patient, physician, and healthcare industry leaders to support solutions that will reduce healthcare costs and improve quality of life for patients. Learn more at .