Medication Adherence Lowers Health Care Costs

Over a third of all Americans, approximately 133 million people, have at least one chronic disease and adherent patients who take medications as directed do indeed impact the health care system on a less costly basis (CVS Caremark Research Partnership, 2012). Yet, nearly 75% of adults do not follow their doctor’s orders when it comes to taking medications (PhRMA, 2011).

Approximately 20% of patients discharged from the hospital to their home experience an adverse event and more than 66% of these adverse events were medication related. (Center for Technology and Aging, 2009) The Medicare Payment Advisory Committee (MedPAC) estimates that readmissions cost about $7,200 per case. About two-thirds occur within 15 days of discharge.

Poor adherence has been estimated to cost approximately $177 billion annually in total direct and indirect health care costs. (Center for Health Value Innovation, 2010) The identified barriers to adherence are cost of drugs, the inconvenience of accessing them, and patients’ lack of understanding of their medications’ effectiveness. (Center for Health Value Innovation, 2010).

Increasing adherence is key to decreasing healthcare costs, thus adherence to medical treatment is a critical aspect of medicine today impacting patients, caregivers and third party payers. There are four identified activities that increase adherence: (1) forming good habits around taking medication as prescribed; (2) using only one pharmacy; (3) using tools to remind the patient to take medication; and (4) using medication trackers.

Accountable Care Requires Technology

At the same time, the nation is moving in the direction of accountable care, transferring some degree of risk to the providers for quality outcomes that are dependent on medication adherence.

In order for providers to work “at the top of their license” and thus have the ability to impact adherence levels, they need timely data that will help them to intervene and interact with patients. With the 2010 Affordable Care Act and the emergence of new delivery and payment methods such as accountable care organizations (ACOs), the sector needs data capabilities and processes that work in an outcomes-based world. (PwC Health Research Institute, 2012).

Technology and advanced analytics can enable real-time consumer information exchange and engagements using portals and consumer health profiles, which allows for higher quality of care to be performed at the point a consumer is accessing care services. (PwC Health Research Institute, 2012) Additionally, presenting an active choice increases compliance with the desired behavior (i.e. medication adherence). (CVS Caremark Research Partnership, 2012).

Behavioral Health is Key

Patients with chronic diseases and/or behavioral health disorders are particularly vulnerable to adverse outcomes due to non-adherence. There are 43.7 million adults aged 18 or older in the U.S. with Any Mental Illness (AMI). This represents 18.6% of all U. S. adults. The National Institute of Mental Health (NIMH) conservatively estimates the total costs associated with Severe Mental Illness (SMI), those disorders that are severely debilitating and affect approximately 6% of the adult population, to be in excess of $300 billion per year.