Three Ways to Improve Medication Nonadherence

San Diego—Medication nonadherence is a costly problem in healthcare, but predictive modeling, value-based insurance design (VBID), and the application of gamification could help improve adherence rates. These 3 strategies and the challenges surrounding nonadherence were discussed in detail in a Managed Care Essentials session at the AMPC meeting titled Emerging Solutions for Medication Nonadherence Management. The session was presented by Yelena Yankovskaya, PharmD, a managed markets fellow at the University of the Sciences in Philadelphia.

It is been estimated in a recent report from Express Scripts that nonadherence could be costing the United States approximately $317 billion a year. Dr. Yankovskaya said that nearly $106 billion of this cost each year is related to failure to take diabetes, high cholesterol, high blood pressure, and heart disease drugs.

The cost of nonadherence includes not only the cost of unused medication, but also negative health outcomes or the worsening of disease due to the failure to take prescribed medications.

If adherence could be improved in diabetes patients, it is estimated that diabetes-related hospitalizations would decrease, resulting in a savings of $5 billion a year.

There are several factors that drive nonadherence in patients. The largest factor, Dr. Yankovskaya said, is behavioral issues, which account for 69% of nonadherence. Other factors include cost (16%) and clinical reasons (15%).

One strategy to improve adherence is the use of predictive modeling. Under this strategy, Dr. Yankovskaya said several predictors of nonadherence can be identified, including a patient’s lack of belief in treatment benefits, a complex treatment regimen, high cost, an asymptomatic disease, presence of mental health conditions, or a poor relationship between the patient and the provider.

Previous research has estimated the impact of possible interventions in improving adherence rates and found that with no intervention, adherence improves the medication possession ratio (MPR) by 7%. However, a reminder sticker mailing improved adherence in the MPR by 8.5% and an authority and loss prevention letter was shown to improve adherence in the MPR by 8.8%.

Another strategy is VBID. This strategy, often employed to improve clinical outcomes and control the cost of healthcare, seeks to remove barriers to essential, high-value healthcare services. Dr. Yankovskaya said VBID targets the cost aspect of nonadherence drivers.

Previous research has shown it has beneficial effects. One pilot program highlighted during the session showed that adherence rates with VBID group interventions improved from 69% in 2009 to 75% in 2011, while those who had no inventions improved from 59% in 2009 to 61% in 2011.

The third strategy discussed during the session was gamification and social media. Dr. Yankovskaya said this strategy uses fun to serve real-world objectives. To engage patients, gamification uses game elements and game-design techniques in nongame contexts. Some of these gamification strategies include ways to incorporate points, badges, or leaderboards.

For example, Mango Health is an iPhone application that was developed to improve medication adherence. People who use this application receive alerts if their drugs have potentially dangerous interactions and reminders to take medications or supplements. When patients take their medications, they earn points that can unlock the chance to win rewards such as donations to a charity or gift cards to popular shopping spots.