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Coordination is key in improving adherence and outcomes in patients with chronic conditions. Here’s how.
The definition of a successful patient journey has evolved since the initial transition to value-based care. The focus on greater healthcare value, a perspective that includes driving better outcomes, necessitates greater patient education on medication therapies and the importance of adherence. Luckily, there are clear steps to take that are proven to guide a better patient journey and deliver improved outcomes for the patient.
Historically, the patient experience associated with obtaining and managing medications for chronic conditions has been confusing and difficult, requiring self-management with little to no coordination among or from prescribers. For these patients, the journey starts by being told by their doctor they have a condition that will require a lifetime of medication. Many times, patients are then left on their own to manage their medications.
Some patients never arrive at full acceptance of their condition. They must deal not only with the initial shock, grief and embarrassment often associated with their diagnosis, but they must also determine what this new condition means for their lifestyle, family and friends. Upon initial diagnosis, the physician may prescribe multiple new, often costly, medications. When the patient leaves the office, he or she may not understand what the medications are for, the therapy regimen, the likely side effects and the importance of adherence. Ultimately, the patient will fill the prescription or not.
The primary challenge with this model is that patients with chronic conditions are responsible for managing their medications and conditions on their own, notwithstanding sporadic visits to the doctor. This lack of patient education regarding their medications, prescriber coordination and a reliance on patient self-management has led to an annual $289 billion medication adherence issue.
As a society, we must implement better ways to coordinate care and assist patients with chronic conditions. In 2009, 7 out of 10 deaths in the United States were attributed in part to chronic diseases. Heart disease, cancer and stroke account for more than half of all deaths each year, according to the Centers for Disease Control and Prevention (CDC). According to the New England Journal of Medicine, people with chronic conditions receive only 56% of recommended preventive healthcare services.
Nationally, more than 75% of all healthcare costs are related to chronic conditions, according to the CDC. Four of the five most expensive health conditions (based on total healthcare spending in a given year in the United States) are chronic conditions – heart disease, cancer, mental disorders and pulmonary conditions, according to the Agency for Healthcare Research & Quality. A 2007 study reported that seven chronic diseases – cancer, diabetes, hypertension, stroke, heart disease, pulmonary conditions, and mental illness – have a total impact on the economy of $1.3 trillion annually. The Milken Institute reports that by the year 2023, this number is projected to increase to $4.2 trillion in treatment costs and lost economic output.
Simply sending patients out of the clinic or prescriber’s office with a prescription in hand and limited instructions to “get this prescription filled and come back in three to six months” does not work. It is a practice that must change if we are to improve patient adherence, health outcomes and reduce overall healthcare costs. All members of the care continuum must find better ways to coordinate care than the traditional patient medication self-management and healthcare call center environments.
The new patient journey requires a focused, coordinated effort to assist patients with multiple chronic conditions. Keys to success include:
#1. Building trusting, professional relationships between prescribers and pharmacy management teams. These relationships should include patient introductions and warm hand-offs from prescriber to the pharmacy management teams
#2. Aligning incentives across the healthcare continuum to ensure all resources are focused on assisting patients with medication adherence and proactive condition management. Coordinate results of patient adherence, including lab data, with all healthcare providers.
#3. Adding dedicated patient care coordinators and clinical pharmacists to the patient care team. Assign dedicated patient care coordinators who focus on individual patients and building strong, trusting relationships with them. Add a clinical pharmacist to the team to provide medication therapy management and additional patient education.
#4. Making it easy for the patient. Include patient-friendly, easy-to-use, personalized medication packaging based on time of day and patient lifestyle. Use technology, such as automated text messages, email or phone calls (as preferred by the patient) to remind patients to take their medications. Proactively ensure medications are picked up or are delivered to patient’s location of choice.
The 1917 Clinic, a Ryan White grantee at the University of Alabama at Birmingham (UAB), serves a large patient population that struggles with medication adherence. In 2015, UAB clinicians completed analysis of 652 HIV patients who engaged in medication management protocols provided by Curant Health over a 38-month period as part of their treatment plans. Of 157 patients who did not have suppressed viral loads at enrollment, 103 achieved viral suppression during follow-up tests, which ranged from six weeks to one year after enrollment. That’s a statistically significant increase in the proportion of patients achieving viral suppression.
Additionally, a 2012 Curant Health study of HIV patients on highly active antiretroviral therapy (HAART) by Patrick Dunham, CEO of Curant Health, and Jeffrey Karkula, RPh, showed 69% improvement in adherence to HAART via effective medication management protocols. In addition, overall healthcare cost savings for the same HIV patients totaled $3,000 per patient, per year.
David Cunnold is managing director of operationsfor Curant Health. Curant Health treats patients nationwide through its medication management protocols.