When health plan participants fail to take their medications as prescribed, research shows, they are more likely to experience negative health outcomes such as higher rates of hospitalization and increased mortality. Those negative health outcomes also translate into higher costs. And for self-insured health plans, higher costs directly affect the employer’s bottom line.
Taking medicine when you’re sick may seem like a no-brainer, but for many, it’s not that easy. In the United States, 3.8 billion prescriptions are written every year, according to the CDC. About 1 in 5 of those prescriptions are never filled, and of those filled, approximately half are taken incorrectly. That may mean they are taken at the wrong time, dosage or frequency or for the wrong duration.
A lack of medication adherence is rampant—and it is costing between $100 billion and $300 billion in the United States. Providers of self-insured health plans that can get plan participants to take medications correctly can cut their costs significantly, while improving health outcomes for their participants.
Why People Don’t Take Medications Correctly
There are a number of reasons people don’t complete the medication their doctors prescribe. In many cases, plan participants’ nonadherence to medication protocol is unintentional. They simply forget to take medication or to get a needed refill, or they may not understand the needed dose or schedule. Participants also intentionally avoid adhering to medication plans because they experience side effects from the medication, can’t pay for the medication, or have differing beliefs and attitudes about their condition. They may also feel unengaged in decisions about their own treatment, or have impairments or mental health conditions that prevent them from following through.
Sometimes, the medication nonadherence is because providers don’t communicate clearly with patients or the dosing regimens are too complex. When multiple providers don’t coordinate care with one another, that can also limit patients’ ability to fulfill medication regimens.
Superior Care Management Is the Solution
Fortunately, there’s a practical solution for self-insured health plans that want to improve medication adherence among their participants. A robust care management solution can eliminate almost all the barriers that keep participants from taking their medications at the right time, in the right dosage and for the right duration. The use of continuous data analytics can provide ongoing insights that lead to better care management all around, including medication adherence.
With a data-driven care management solution such as Narus Health—which Lucent Health acquired in 2019—a care coordinator will be notified of a participant’s prescriptions. He or she can follow up if the prescriptions aren’t filled to find out why and if the participant needs help. For example, the care coordinator could arrange for home delivery of the medication if necessary. If the participant experiences unexpected side effects, he or she can reach out to the care coordinator for input rather than simply stopping the medication. Through ongoing communication and feedback, a care coordinator can help ensure that participants adhere to their medication plans, cutting employer costs and improving health outcomes.
Lucent Health’s recent independent audit reveals that successfully engaging members and walking with them through their healthcare journey helps avert or mitigate health crises, resulting in significant savings for both members and employers. Learn more in our e-book, “Top-Notch Care Management Is Crucial for Managing Healthcare Costs.”