It’s well-known that people who don’t take their prescribed medications face increased health risks. A new analysis of nearly 100,000 people by Seattle-based Healthentic found that slacking on prescriptions carries a heavy financial burden, too.
The company, which helps employers evaluate the health needs and costs of their workers, plumbed its database to determine prescription adherence rates for people with diabetes (which afflicted 3,314 of the 99,165 people Healthentic studied), high blood pressure (afflicting 10,960), or high cholesterol (afflicting 10,322). Roughly half of people with these conditions took at least 80 percent of their prescribed medications, the threshold for adherence.
The other half faced significantly higher hospitalization rates, resulting in avoidable hospitalization costs that Healthentic estimates at more than $8.6 million a year just for these three conditions within the population studied, and not including lost-productivity costs due to time away from work. Nationwide, prescription non-adherence costs hundreds of billions of dollars, Healthentic says, citing estimates of other researchers.
“Medication adherence is one very important way to get more health for less money,” Healthentic CEO Jeff O’Mara says in an e-mail interview. He adds, “We want to make employers aware that they have a huge opportunity to help people, save money, and improve productivity.”
This is a huge issue with far-reaching implications for individual patient and population health, as well as the business side of healthcare as reimbursement models shift from pay-for-service to pay-for-performance. Under the Affordable Care Act, for example, some hospitals face reduced Medicare payments if they have high rates of readmission of patients with heart disease and pneumonia.
The Obama administration earlier this year announced plans to expand the pay-for-performance model to cover half of Medicare payments by 2018.
O’Mara says this shift is helping drive demand for the sort of information his company is providing.
“When providers share the financial risk they have much more incentive to gain targeted health insights so they can optimize performance,” he says.
Healthentic, part of the Seattle area’s growing cluster of companies working at the intersection of IT and healthcare, says it serves more than 10,800 employers covering more than 38.7 million people.
So what can employers do to improve medication adherence? Healthentic says selecting insurance plans with lower out-of-pocket costs for medications can encourage adherence among people who never fill prescriptions because of cost concerns. And selecting health systems that emphasize team-based care—in which pharmacists collaborate closely with prescribing physicians, for example—can help address non-adherence due to patients taking the wrong dose or failing to keep on schedule.
The company also suggests providing information specifically to people who aren’t taking their medication. This can be done while maintaining patient privacy, he says.
“Employers often have disease management programs that they pay for as part of their health benefits program,” O’Mara says. “We see all too often that these don’t deliver great results because they are not targeted at the right risks and conditions and the specific people who have them. Sometimes they aren’t even turned on.”
