After a decade of foundations, the industry is beginning to gain some real momentum as medical continues to grow thanks to guilty treatment organizations and value-based treatment models, such as CMS claims for the Medicare Shared Savings Program. Ok, there are some essential components that contribute to victory. The key components of achieving ACO and VBC goals are persistent engagement and medication adherence. And yet modest increases in medication adherence can have significant socioeconomic effects on health systems. Dr. Colin Banas, chief medical officer at DrFirst, a drugs management technology firm, says these techniques translate into real-world gains from the “prescriptions view”. We just spoke with him to learn more about some of the progress being made. Q. What did the first ten or so years of value-based maintenance look like, and where are we now? A. The value-based treatment trip spans more than two years, with earlier efforts marked by major challenges. In the beginning, agencies struggled with devices connectivity, information sharing and the high cost of engineering improvements – barriers that complicated the transition from fee-for-service to value-based models, which rely heavily on data analytics and EHR systems. First, the emphasis was more on reducing prices than improving person results. Health systems had to manage two conflicting economic models: fee-for-service, which incentivized level and procedures, and value-based attention, which prioritizes preventive care and keeping patients good. Organizations with capitated payment models, like Kaiser, gained early advantages because they didn’t have to pay high procedure volumes financially. In contrast, smaller providers hesitant to adopt value-based models because of financial risks and limited resources for infrastructure upgrades. To understand the growing pains and demonstrate the viability of value-based care, advancement required forward-thinking innovators. Pioneers eventually became successful, and CMS improved metrics and provided incentives for high-quality care. With more and more people realizing the value of involving patients in their care, these efforts have gradually changed the focus from reducing costs to improving patient outcomes. Today, value-based care emphasizes collaboration among providers, payers and other stakeholders to share best practices and improve care coordination. While steady progress has been made, reconciling fee-for-service and value-based models remains a challenge, as the financial incentives often remain at odds. Q. What part, in your opinion, does medication adherence play in the achievement of value-based care objectives and an accountable care organization? A. Adherence to medications is crucial to any approach to managing chronic diseases. We’ve all seen the stats on the high costs of nonadherence: the readmissions, emergency visits and complications that arise when patients don’t take medications as prescribed. And we are aware that if diabetics skip their insulin, the next stop is most likely the hospital, without the need for detailed data. Congestive heart failure, COPD, hypertension, and cardiovascular disease are all closely related to medication adherence. Unfortunately, evidence shows many patients only adhere to their medications for chronic conditions about half the time, which means their treatments won’t be effective. When patients stay on track with their prescriptions, their risk of serious complications drops, which is precisely what value-based care aims to achieve. Even minor changes in adherence can have a significant impact, especially when managing large patient populations. Adherence can be increased by just a few percentage points, which will result in significantly fewer hospitalizations and better outcomes. However, achieving this requires a dedicated, multidisciplinary team that includes nursing, pharmacy, remote monitoring and social work to address real-life barriers to access, affordability and adherence. Patients sometimes have trouble sharing what’s stopping them from taking their medications or are unaware of the effects nonadherence can have on their health. The right questions are crucial because they aid in identifying those barriers. The key is education and open communication. Patients need to be aware of their treatment plan, and providers must be aware that patients ‘ difficulties may change over time. What makes a difference in helping them stick with their medications is keeping them connected and adaptable. I’d also add that accurate data is crucial – you can’t manage what you don’t measure. So, while adherence is a cornerstone of value-based care, it depends on the right team, tools and targeted patient engagement to be effective. Q. How can even modest improvements in medication adherence have significant economic effects on health systems? A. Even modest improvements in medication adherence can have a significant impact on health systems’ quality metrics, such as those impacted by CMS star ratings for Medicare Advantage plans. A four-star plan often results in a 1 % or 2 % improvement in adherence to conditions like diabetes or heart failure, where a five-star plan brings greater incentives and better marketability. Even with some uncertainty about how incentives may change with the new administration, if a plan’s adherence rates jump from 80 % to 85 % or even 90 %, it creates a measurable advantage over competitors. Higher plan enrollments are aided by higher ratings, which encourage devoted followers. Both the benefits to patient care and the financial incentives are obvious. By lowering adherence rates, health systems not only gain a competitive edge, but also reinforce value-based goals with tangible, quantifiable outcomes. Q. What role does patient engagement play in ensuring that ACO and VBC objectives are maintained? A. Patient engagement is critical, and today, ACOs have more tools at their disposal than ever before. Ten years ago, telehealth was more of a concept than a reality, and smartphones weren’t nearly as ubiquitous. Interoperability among health IT systems was, at best, a work in progress. Now, interoperability is improving, and patient portals, digital health platforms and even asynchronous communication with mobile devices are widespread. Both providers and patients are finding it easier to engage in activities outside of in-person visits. Today’s digital health tools allow for continuous patient engagement. For instance, prescribed digital therapies can serve as a guide for a patient after surgery or through management of chronic conditions by providing reminders and tasks to complete on specific days. Imagine a patient who has a knee replacement being asked to use blood thinners to track their mobility or do mobility exercises. This keeps the patient on track and sends data back to providers, enabling proactive adjustments if a patient’s recovery isn’t going as planned. Known as patient-reported outcomes, this data can be collected via mobile devices to shed light on a patient’s functional status, symptoms and health behaviors, which is vital for objectively assessing a patient’s progress. With these insights, providers get an understanding of patients ‘ physical health, pain and overall experience, and how these measures change over their course of care. Most importantly, the data is gathered in real time, so the doctor doesn’t need to wait until the patient’s one-month follow-up to find out they haven’t been taking their blood thinner, for example, or doing their physical therapy. A decade ago, this wasn’t possible. Today, patients are engaged with them beyond portals, reaching for SMS reminders sent to mobile devices and using sensor-based medication tracking systems, which notify both patients and healthcare providers if their doses are missed. By reducing the gap between when patients fill prescriptions and when they actually take the medication, these tracking devices are making a difference. The provider can at least assume that a patient isn’t taking their medication as prescribed if they should have taken 30 pills over the course of the month but the pill bottle was only opened 20 times. Healthcare providers can meet patients where they are using tools that are already at their disposal with this multimodal approach. We’re creating the seamless ecosystem that other sectors of the economy have had for years, from banking to retail, as healthcare adopts these technologies. In this regard, it seems likely that healthcare will finally catch up. Follow Bill’s HIT coverage on Linked In: Bill Siwicki
Email him: bsiwicki@himss .org
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Even modest increases in medication adherence you have financial benefits for health systems.
