To deliver real near-term return on investment, it is essential that medication adherence be made the foundation of any disease management initiative.

The economic stimulus package making its way through Congress in early February included $3 billion for a prevention and wellness fund to manage and treat chronic and infectious diseases. The fund included support for hospital infection prevention programs, immunization programs and evidence-based disease prevention programs.  

Many in the healthcare industry are anxiously waiting to see what type of programs the government will ultimately choose to implement to manage chronic disease. The following facts capture the epidemic nature of the problem: according to the Centers for Medicare and Medicaid Studies, total spending on public and private healthcare in the United States amounted to approximately $2 trillion in 2005.   

According to the Centers for Disease Control and Prevention, more than 75 percent of that amount went towards the treatment of chronic disease. Unless these new programs empower – or gently coerce – people to better manage their chronic conditions, many believe we will not make a meaningful reduction in our spiraling healthcare costs.   

An Essential Foundation
Given the current economic climate, the $3 billion allocated for prevention and wellness needs to deliver some concrete, near-term benefits. Unfortunately, this is difficult for a typical disease management (DM) program, which includes objectives such as weight loss, smoking cessation or improved diet. Creating such lifestyle changes for patients is, of course, important and these goals should not be abandoned. In fact, the CDC estimates that eliminating three risk factors – poor diet, inactivity and smoking – would prevent:

• 80 percent of heart disease and stroke
• 80 percent of type 2 diabetes
• 40 percent of cancer   

But, in order to deliver real near-term return on investment (ROI), it is essential that we make medication adherence a foundation of any DM initiative. For unlike many components of a typical DM program, one can see the financial benefits of adherence in a relatively short time period with many chronic diseases.    

And, if certain patients are non-adherent to their medication regimens, it often negates any benefits derived from other components of the program.       

In addition, one could make the argument that adherence is one of the easiest behavioral healthcare initiatives to implement. The challenge of altering human behavior is significant, but by employing new tools and technologies – such as telephone-based medication therapy management or Web-based medication management tools – in creative ways, we have an opportunity to deliver education, communication and interaction as vehicles for sustainable behavioral change.

A Breach in the System
Medication non-adherence exists because there is a breach within our healthcare system. For typical patients, management of their medications is left in their own hands. Patients move in a circle that starts with a physician’s consultation, which then leads to a prescription; they proceed to a pharmacy (assuming the patient actually does go the pharmacy – fully 33 percent of patients don’t even fill their initial prescription) where the medicine is dispensed and then they are left on their own to follow their medication regimen correctly.     

The process often breaks down just when treatment is about to take place. This happens because the cycle of care is not a closed circuit. Many patients need assistance and support in this last phase of the cycle.

Analysis of Non-Adherence
Under our current healthcare system, it is assumed that the patient will follow the doctor or pharmacist’s direction and take their medication as prescribed. However, a recent survey by the National Community Pharmacists Association found that there are many reasons why people are non-adherent:

• 49 percent forget to take the prescribed medication.
• 31 percent do not fill a prescription they were given by their doctor.
• 29 percent stop taking a medicine before the supply runs out.
• 24 percent take less than the recommended dosage.
  

So, what should an effective adherence solution look like? There are many ways to address the problem, but a viable adherence program should always:

• Empower patients to take control of their medication regimens;
• Work with the current initiatives, budget and strategy of the healthcare organization that is paying for the care;
• Work across all disease states, age groups and demographics;
• Employ patient-centered and adaptable pharmacy interventions;
• Provide one-to-one education and support;
• Scale according to payors’ needs through the use of technology; and
• Provide actionable outcomes data.
  

Enjoying Rewards
An investment in medication adherence programs for chronic diseases will yield significant and quick financial rewards. A recent study conducted by Medco Health Solutions found that for diabetes patients, every additional dollar spent on medication saved $7 in medical costs. A clinically sound adherence program has the potential to make a rapid impact on ROI.     

To be sure, managing prescription drugs is a challenge for everyone in the healthcare industry. The drain on the system in terms of costs and resources is immense: Medication non-adherence alone ripples out across the healthcare continuum causing $300 billion in related costs.    

But through empowerment, education and technology, and a committed and unified effort from all healthcare stakeholders, adherence can be improved, dramatic savings can be realized and patients’ lives can be saved.

A Place to Start
As our ever-precious public dollars are dispersed in the name of wellness, let’s make sure that, in addition to long-term investments in disease management and wellness programs, we earmark some money for programs that provide immediate savings and health improvement. Medication adherence is an excellent place to start.

Sean D. Teare is the president of InnovationRx. InnovationRx, the healthcare division of the Innovation Group, provides prescription adherence solutions in a research partnership with the Northeastern University School of Pharmacy in Boston. InnovationRx can be found online at innovationrx.com.