As the healthcare system continues to evolve, the focus has shifted toward providing quality care and driving patient outcomes. Today, a strong emphasis on the cost of treatment—combined with a true understanding of the patient journey—is key to identifying the touch points where patient engagement is most impacted. Patient outcomes continue to move to the forefront of the healthcare environment, the focus is now on comprehending patient insights.
No two patients are ever the same—nor are their treatment experiences or healthcare journeys. This means stakeholders across the continuum of care are trying to better understand how patients behave throughout their therapeutic lifecycles. To gain insights, providers, payers and manufacturers are seeking new ways to interact and stay connected with patients. One example: The investments made in patient support programs that combine technology and integrated care coordination—all designed to engage with patients and help drive patient access and adherence to therapy.
“Plugging in” to Patients
Patient support programs help keep payers and providers “plugged-in” to the patient, which can provide key insights into how patients are participating in their therapy. This data can help tell a comprehensive and sophisticated “patient story” and offer critical insights on behavior, activities and patient needs. For example, data can indicate whether or not a program or medication is providing a benefit or needs to be adjusted. Data can also offer actionable and measurable utilization trends and insights affecting factors that directly impact patient outcomes, such as adherence.
At a micro-level, monitoring patients’ prescription refill rate and using education and reminders can increase adherence rates, and thereby potentially improve or maintain their health in various ways. From a more global perspective, by managing and measuring chronic and high-cost care conditions appropriately, studies show improvements in quality for the patient—and financial benefits by decreasing high-cost services.
Shining a Spotlight on Non-Adherence
The focus on outcomes puts a spotlight on medication non-adherence, which is a driver of significant hospital readmissions each year. Industry estimates suggest the total costs of unnecessary medical expenditures resulting from medication non-adherence are approximately $300 billion annually—which represents more than 30% of the total waste, excluding fraud and abuse. Failure to take medications as prescribed costs more than $100 billion annually in excess hospitalizations. It is estimated that nearly one-third of patients never fill their prescriptions, and three out of four Americans do not take their medications as directed.1 With the appropriate interventions, this problem can be monitored and rectified to help patients stay adherent to their therapies and ultimately drive healthcare costs down.
Patient adherence programs can help too, by providing real-time and longitudinal data that can offer insights on access issues, timing of prescription fills, and when side effects may be generally occurring, thereby limiting readmissions. These programs collect data to better understand patient adherence behaviors, which then can be used to interject and change behaviors. Adherence programs also assist providers and manufacturers, as the data can showcase what medications are best suited for which patients. Such data can also be leveraged to demonstrate the success of a support program or how it can be improved, either of which can, in the end, save healthcare system resources.
Keys to Coordinating Patient Care
Data, available through EHRs, EMRs and other platforms, can be a viable asset to those who are coordinating the patient’s care. They can give caregivers useful information and allow them to follow the patient to ensure adherence. EHR use, for instance, is one method that exemplifies how data that supports medication adherence through real-time information gathering is acquired. These systems can be used to track many factors affecting a person’s health and disease state. The languages spoken by patients and other demographic data can help providers understand and engage with their patients more effectively.
A more comprehensive picture of a patient’s care journey can be afforded by these electronic platforms, allowing providers to better gauge the quality of care and the patient satisfaction that generates outcomes, which are essential to addressing disparities in care. Increased patient-centric coordination improves quality of care—and that results in lower healthcare costs due to fewer repeat visits and misdiagnoses. Such platforms can allow providers to easily access patient data for behavioral coaching, reviewing lab data and imaging, and/or to discuss disease and treatment guidelines.
Finding the “Vital” Gaps
These technologies can also enable providers to see gaps in visits and information vital to uptake and adherence, such as abandoned (or unfilled) prescriptions and refills. At the same time the patient has access to meaningful information about medication side effects, disease and medication education, and the ability to electronically request refills—all drivers for improved medication adherence and successful patient outcomes.
The ability to monitor the patient’s date of initial fill and subsequent refills in real time can also assist providers by alerting them that the patient may need (financial) help. Access to affordable medication is a barrier affecting many patients, and when they are not able to pay for their medicine, they do not fill their prescriptions and do not adhere to their treatment. This causes negative effects that ripple across the healthcare system. Financial obstacles to medical care have direct consequences, including prescription abandonment, forgoing medical tests and lower adherence to therapy, which is twice as high among underinsured compared to the insured.2
Easing Financial Barriers to Access
Easy access and affordability to medication are essential to continuing adherence. Co-pay assistance programs can help by providing patients with the necessary resources to afford their medication and keep them on treatment. High co-payments can decrease a patient’s ability to fill a prescription and decrease their ability to skip doses in order to make the medicine last longer. In either instance, decreased persistency and/or adherence can reduce the efficacy and outcome of a drug.
Successful co-pay assistance programs can be supported through data analysis—and details about availability and patient adherence can highlight their value. This data and information helps providers and payers to understand patients’ behavior and sets them on the path for successful outcomes. Patients benefit through co-pay programs since they assist from a cost perspective—but they also help providers monitor patients to ensure they are following their therapy. Manufactures can benefit from the data insights taken from patient support programs as well. Appropriate data can make a strong case for their product and showcase its value in the healthcare treatment process to all stakeholders, including patients, caregivers, payers, physicians and pharmacists.
As they look to expand access to medications by lowering out-of-pocket costs for patients (especially specialty drugs), manufacturers can also help improve uptake and duration of therapy. With a variety of medications in the marketplace, positive efficacy and outcomes data can support the use of one treatment over another. Not surprisingly, those responsible for assisting patients in their therapeutic journey, as well as the patients themselves, will turn most often to those therapies with the best data demonstrating positive outcomes.
Knowledge and data are powerful for patients (who are invested in their own healthcare), and for caregivers, payers, providers and manufacturers. Every patient (in theory) wants a successful health outcome—and improving those outcomes is the main driver of all stakeholders in the healthcare industry. Leveraging patient support programs, and combining that with relevant healthcare data, helps to better serve patients by providing more detailed information to all parties involved.
Ultimately, this process should improve the various therapies needed throughout a patient’s treatment journey. As cloud and pond technology continues to improve, expand and integrate with more sources, such as EHR, EMR and claims data, the capability to truly understand the patient journey will also continue to improve—and so should our ability to impact patient outcomes.
1. Varshneya, Ashish: “Medication Non-Adherence: A $290 Billion Unnecessary Expenditure.” Healthworkscollective.com Web. April 13, 2015. http://healthworkscollective.com/ashish-varshneya/300471/medication-non-adherence-290-billion-unnecessary-expenditure.
2. Cole, Lauren: “Factors and Solutions Driving Commercial Co-pay Assistance Strategies.” Lash Group.