Why Success with Value-Based Care Requires an Omni-Channel Approach to Medication Adherence

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Medication adherence is a complex challenge and requires multi-faceted solutions. Omni-channel communication is key to ensure providers, patients, and health plans collaborate to achieve better outcomes with lower costs.


Medication nonadherence is a perennial problem for the healthcare industry. Approximately half of all patients do not take their medications as prescribed, leading to avoidable utilization, poor quality of life, more than 125,000 preventable deaths, and over $500 billion in unnecessary healthcare costs each year.

To reduce the massive burden of medication nonadherence, providers and health plans must work together to improve patient education, expand access to affordable medications, and overcome socioeconomic barriers that often prevent higher-risk individuals from staying on track with their therapies.

One of the more significant barriers to medication adherence is high prescription drug costs. A new report from the US Department of Health and Human Services (HHS) Office of Inspector General (OIG) found that nearly $100 million dollars could be saved annually by Medicare by increasing the biosimilar coverage of Part D plans. Yet, these drugs and other equally effective, lower-cost therapeutics remain underutilized. A key reason is that getting accurate drug pricing data to patients is no easy feat. A complex maze of convoluted workflows and communication challenges often stands between people and their prescriptions. The healthcare system must do better to ensure that members at the greatest risk of cost-related nonadherence are given up-to-date information about lower-cost alternatives that provide the same therapeutic effectiveness.

We can start by changing the way we disseminate pricing information and working with plan members to achieve their individual goals. Instead of relying on narrow methods of communication, health plans and providers should adopt an omni-channel approach that meets consumers where they are.


Understanding the Barriers to Better Prescription Decision-Making

In 2020, Americans spent more than $535 billion on prescription drugs with costs continuing their steep upward trend of between 4 and 6 percent each year. Climbing prices mean that even common, life-saving drugs like insulin are out of reach for many individuals, forcing them to make unimaginable decisions between their healthcare and other basic needs.

Pharmacy Benefit Management (PBM) companies, payers, and healthcare providers attempt to tackle this issue by providing drug pricing transparency, especially as value-based care arrangements put pressure on healthcare stakeholders to control spending and improve medication adherence to generate better outcomes.

Currently, electronic health records (EHRs) are a primary channel used to disseminate prescription drug cost information to providers at the point of care. However, the reality is, in the traditional prescribing workflow, medication management is usually completed outside the EHR.  Even when e-prescribing within the EHR is part of the process, it is typically only used the first time a drug is prescribed. Providers are unlikely to log back into the EHR again if there is no medical reason to change the prescription after the first chronic care prescription is ordered.

More complications arise when considering people with multiple chronic diseases have many prescribers that don’t necessarily communicate with each other. What’s more, prescription pricing access is often based on general, non-specific formularies. As a result, the information is typically just plain wrong or out of date over 50% of the time. To help overcome medication cost-related nonadherence, we must care providers with accurate insights regarding lower-cost alternatives based on the consumer’s specific formulary benefit. Plans must ensure all members are given the option to choose lower-cost substitution prescriptions.

In value based care, health plans simply cannot rely on a single method of communicating information on the least costly, most efficacious drug to their patients and plan members at the right times. The challenge of nonadherence is much broader, requiring a more sophisticated, multi-faceted solution that goes beyond what physicians have access to provide in their normal practice pattern.


Adopting an Omni-channel Approach to Personalized Communication

Omni-channel communication leverages analytics generated from multiple, disparate data sources. It then disseminates this information using a variety of communication pathways and points of contact to convey messages to target audiences. Stakeholders in medication adherence require clinically approved drug substitutions available at the member’s specific formulary benefit. Using an omni-channel communication approach to provide these options is crucial to engage providers, health plans, pharmacists, and plan members at various touchpoints along the healthcare journey.

For example, plan-specific medication pricing information should be available in several different places. In addition to the EHR, PBMs and health plans should consider solutions that communicate with providers through a practice group portal for incentivized providers that share in cost savings for patient care. In addition, using the old fashioned telephone and/or facsimile – yes faxing – still accounts for around 75 percent of all medical communication and is an extremely effective communication channel as it is in the practice group clinical workflow.

Health plans should also explore partnering with a digital pharmacy to improve medication adherence and overcoming barriers of care. Data-driven outreach and regular touchpoints throughout the year can have a significant measurable impact overcoming social determinants of health (SDOH) that can improve medication adherence.

With advanced prescription formulary opportunity analytics and trained pharmacists, a digital pharmacy can optimize medications and augment the capabilities of care providers. Using predictive analytics and other innovative technologies, digital pharmacy platforms can proactively send out an alert when a lower-cost option is available, prompting timely outreach to the member and prescriber.

Plan-specific prescription formulary analyses consistently identify 10 to 20 percent of total annual prescription savings opportunities while improving member relationships and encouraging better adherence to necessary prescriptions.

In addition, enlisting a dedicated partner for medication optimization can reduce strain on health plans by educating members about medication adherence, building strong, ongoing relationships with members, and actively helping individuals address any socioeconomic challenges that may influence their personal decisions.

With the help of motivational interviewing techniques, predictive risk analytics, and deep formulary insights, practice group engagement workflows, specialized digital pharmacy experts offer even more touchpoints for members who may not otherwise engage with health plans or primary care providers.


Creating a Coordinated Ecosystem of Care

Making information more widely available through omni-channel communication techniques can help providers and health plans succeed in the quality-driven, value-based care environment.

Engaging stakeholders through a variety of communication channels creates a coordinated, seamless ecosystem of care that keeps members at the center. As value-based care continues to be a necessary and dominant force in the industry, medication adherence should be a focal point to achieve outcomes.

We must use all the communication tools available to turn the tide of rising medical and drug costs, make vital medications more affordable and accessible to all people – especially those with socioeconomic vulnerabilities that make medication adherence such a challenge.

Using omni-channel strategies to reduce unnecessary healthcare costs for patients will enable the care team to have a clear and immediate opportunity to dramatically improve healthcare outcomes. Thereby, higher levels of medication adherence will reduce avoidable medical utilization by curbing the nation’s spending on prescription drugs.