Harnessing Telepharmacy to Maximize Population Health, Medical Cost Savings and Improved MTM Star Ratings
Healthcare plans face an extremely challenging environment when faced with the daunting task of boosting health and well-being in their
Delivered as tech-enabled telepharmacy services or Software-as-a-Service (SaaS), the Adhere Platform™ touches nearly 30 million patients across dozens of health plans, self-insured employers, and other risk-bearing entities. As a comprehensive platform, it delivers telepharmacy intelligent clinical workflow that integrates advanced analytics into a proprietary patient relationship management (PRM) tool, supporting better clinical outcomes, patient experience, and medical cost avoidance.
The Adhere Platform™ is designed to address areas of non-adherence and gaps in care, engage providers and patients for better healthcare access, overcome SDOH issues and coordinate community resources needed to improve health outcomes.
"To put AdhereHealth’s impact in perspective, our plan’s CMS Star Rating was 2.5 prior to using Adhere, which was very low.
We engaged Adhere to work with our medication adherence measures and we improved 1 to 1.5 points for each measure in the first year of the program.”
"I think they're really strong in analytics for at-risk population identification. And, they're able to onboard additional members and programs quickly.
Their scalability is a huge value because inevitably in Q4, we always need something else, and they're always able to accommodate that, which has been key to our multi-year relationship with them."
"Part of our decision-making is the member experience the vendor is able to provide.
We're a very high-touch organization. So we want to make sure that members are seeing value in the experience. So that's one of the things that we look at, which comes along with the AdhereHealth solution."
"Pricing is definitely one of the keys to our decision process. And specific to pricing, AdhereHealth's outcomes-based billing model, where they work our members and only get paid if they benefit our business, is a big factor for us."
"So we were looking for an end-to-end platform that could help us with adherence that was why we started talking to AdhereHealth and ultimately led to us going with them.
The Adhere Platform can connect and integrate with a range of pharmacy services including the PBMs. It parses out the patient information and provides the support, the risk levels and things that are needed to best manage a Medicare patient population."
"I know from an enterprise perspective, there are other markets that have a relationship with AdhereHealth too.
Our particular plan started using them across our entire population in 2018. Since then, we’re in our second 3-year contract with them.”
"Another thing we like about AdhereHealth is how good their language capabilities are. This allows them to support our diverse patient population very well.
In different states, our members' primary language may be Spanish, Mandarin or several other Asian languages. Adhere is able to support all of these languages well, communicating with the member in their primary language.”
"We needed help as far as reaching more at-risk members. In addition to excelling at that, AdhereHealth offers additional benefits, like addressing mental health and many other HEDIS measures. They provided a higher touch approach that reaches more members and gets them adherent.
Based on some webinars that AdhereHealth put out at the end of last year, they're thinking in the right direction with whole patient care.”
Prescribing pattern analytics that identify potential adherence issues for ACE/ARB.
Identify potential adverse medication effects that require a change in drug classification to mitigate adherence barriers.
Demystify which measures, patients, and providers are most important for achieving quality outcome improvement and insight into the financial outlays.
Opioid surveillance analytics for potential patient prescription fraud and discontinuation of benzodiazepine.
AHA and CAD clinical guideline analytics to initiate a dual pronged engagement approach for patients and providers.
Improve diabetic health though medication adherence to enable HbA1c control, kidney function and decreased risk of retinopathy.
Karen was taking two antidepressants and during a CMR, AdhereHealth’s analytics alerted our pharmacist to a potentially dangerous medication duplication. Our pharmacist discussed the issue with Karen and subsequently the consumer addressed the issue with her doctor. The doctor modified her regimen thus improving her overall care plan.
Julie was taking a high-dosage of morphine for pain, but due to side-effects her physician changed medications to hydrocodone, oxycodone and acetaminophen. AdhereHealth analytics identified a acetaminophen dosage guideline issue, prompting our pharmacist to contact Julie’s physician to discuss alternatives and ultimately improved the chronic pain management.
Mrs. Robbins’s heart disease requires simvastatin and clopidogrel to reduce heart attack and stroke risk. AdhereHealth's medication adherence analytics prompted our pharmacist to discuss these risks. Mrs. Robbins supported the plan, improving quality and reducing her risk of hospitalization.
Keith is in a long-term care center and was taking blood thinners warfarin and dabigatran as part of his daily regimen. AdhereHealth immediately contacted Keith's provider about the oversight. The provider agreed to discontinue one of the blood thinners. AdhereHealth's OptimizeMTM™ platform caught the therapy duplication preventing severe bleeding and other potentially life-threatening complications for this consumer.
Ida R. has type 2 diabetes and misunderstood how her insulin would regulate glucose release during the early dawn hours. AdhereHealth analytics identified insulin fill gaps that increased Ida's risk of complications and future hospitalizations. Upon our clinician intervening, Ida was educated about the importance of insulin and diabetes educational support. Ida returned to her prescribed care plan, improving her quality of care.
Josh’s medication was changed from lisinopril to losartan for his hypertension. AdhereHealth analytics identified Josh hadn’t filled the lostaran which increased risk for stroke. Our clinician contacted Josh who was confused and followed up with his pharmacist and physician to close the gap.
Greg’s hospital discharge plan included new medications to treat his cholesterol. AdhereHealth’s analytics identified a high statin dosage and upon a discussion with our pharmacist, it became clear Greg was taking two statins prescribed by two physicians. Greg met with his doctor to resolve the error.
Stephen was prescribed lisinopril for high blood pressure but missed doses increasing risk for cardiac arrest. AdhereHealth’s analytics identified the risk and upon our clinician’s discussion with Stephen about his apparent memory issues, a pill organizer was facilitated ultimately improving adherence.
David’s cholesterol medication refill was months overdue and during AdhereHealth’s CMR, he stated the discontinuation was due to receiving positive lab results. Our pharmacist convinced David the good lab results were a result of the medications, addressed the serious health risks with him and the consumer immediately refilled the medications.
Roberta is 67 and her muscle pain was being treated with methocarbamol, which increases the risk of falling for consumers over 65 or older. AdhereHealth analytics identified tizanidine as a safer alternative, alerting our nurse to discuss the gap with Roberta’s clinician prompting a medication change.
Ed has type 2 diabetes and is at risk for heart disease and/or stroke. AdhereHealth’s analytics identified a gap in statin usage for his diabetes and this prompted our nurse to reach out to Ed’s doctor. The doctor prescribed lovastatin to Ed and it addressed the quality issue.
Carla struggled with high blood pressure and her losartan prescription was out of refills. AdhereHealth’s pharmacist reached out to Carla due to medication adherence analytics identifying medication gaps and subsequently contacted the physician for the refill order and improved quality of care.
Margaret’s chronic asthma benefits from a rescue inhaler for flare-ups. AdhereHealth's analytics showed a prescription gap and during AdhereHealth’s CMR discussion, our pharmacist discussed the issue with Margaret, prompting outreach to her doctor for an order to prevent asthma emergencies.