Archive for September, 2011

10 Ways Cancer Patients and Physicians Can Better Communicate

September 29th, 2011 by Jessica Fornarotto

Talking with doctors about cancer and cancer treatments can feel like learning a new language, and people facing cancer diagnoses often need help to understand their treatment options, and the risks and benefits of each choice.

The U-M Health System suggests 10 things healthcare professionals can do to help improve the way they communicate information about treatment risks to patients. These suggestions from the associate professor of internal medicine at the University of Michigan Medical School and a University of Michigan Comprehensive Cancer Center researcher, and colleagues, explain how patients can tap into these same best practices to become fluent in the language of cancer care and better understand their options:

1. Insist on plain language. If a patient does not understand something their doctor says, the patient should ask their doctor to explain it better.

2. Focus on the absolute risk. The most important statistic a patient should consider is the chance that something will happen to them. Sometimes, the effect of cancer treatments is described using language like “this drug will cut your risk in half.” But, such relative risk statements do not say anything about how likely this is. Research has shown that using relative risk makes both patients and doctors more likely to favor a treatment, because they believe it to be more beneficial than it actually may be.

If, instead, a doctor says to a patient “the drug will lower your risk of cancer from 4 to 2 percent,” now the patient knows that most people will not get cancer regardless. And it will give the patient the exact benefit they would get from taking the drug.

3. Visualize the risks. Instead of thinking about risk numbers, patients should try drawing out 100 boxes and coloring in one box for each percentage point of risk. If their risk of a side effect is 10 percent, they would color in 10 boxes. This kind of visual representation, called a pictograph, can help people understand the meaning behind the numbers.

4. Consider risk as a frequency rather than as percentages. What does it mean to say 60 percent of men who have a radical prostatectomy will experience impotence? Imagine a roomful of 100 people: 60 of them will have this side effect and 40 will not. Thinking of risk in terms of groups of people can help make statistics easier to understand.

5. Focus on the additional risk. Patients may be told the risk of a certain side effect occurring is 7 percent. But if the patient did not take the drug, is there a chance they’d still experience that? Patients should ask what the additional or incremental risk of a treatment is.

6. The order of information matters. Studies have shown that the last thing someone hears is most likely to stick. When making a treatment decision, patients should not forget to consider all of the information and statistics they’ve learned.

7. Write it down. Patients may be presented with a lot of information. At the end of the discussion, the patient should ask their doctor if a written summary of the risks and benefits is available. Or, the patient could ask the doctor to help them summarize all the information in writing.

8. Don’t get hung up on averages. Some studies have found that learning the average risk of a disease does not help patients make good decisions about what’s best for them. A patient’s risk is what matters — not anyone else’s. Patients should focus on the information that applies specifically to them.

9. Less may be more. Patients should not get overwhelmed by too much information. In some cases, there may be many different treatment options but only a few may be relevant to the patient. Patients should ask their doctor to narrow it down and only discuss with them the options and facts most relevant for them.

10. Consider your risk over time. A cancer patient’s risk may change over time. If a patient is told that the five-year risk of their cancer returning after a certain treatment, the patient should ask what the 10-year or 20-year risk is. In some cases, this data might not be available, but patients should always be aware of the timeframe involved.

4 Ways New CMS Primary Care Program Will Help Doctors to Better Coordinate Care

September 29th, 2011 by Patricia Donovan

To help primary care doctors better coordinate care for Medicare patients, CMS is taking a page from large private payors' care coordination programs. The Medicare Comprehensive Primary Care program announced this week will work with commercial and state health insurance plans to offer additional support to primary care doctors who better coordinate care for Medicare beneficiaries in order to deliver higher quality and more patient-centered care.

This collaboration is modeled after innovative practices developed by large employers and leading private health insurers in the private sector.

This support will help doctors in the following five areas:

  • Help patients with serious or chronic diseases follow personalized care plans;
  • Give patients 24-hour access to care and health information;
  • Deliver preventive care;
  • Engage patients and their families in their own care;
  • Work together with other doctors, including specialists, to provide better coordinated care.

The voluntary initiative will begin as a demonstration project in five to seven healthcare markets across the country. Interested public and private healthcare payors must submit a letter of intent by November 15, 2011. In the selected markets, Medicare and its partners will enroll interested primary care providers into the initiative.

CMS will pay primary care practices a monthly fee for these activities in addition to the usual Medicare fees that these practices would receive for delivering Medicare covered services. According to the HHS, this collaborative approach has the potential to strengthen the U.S. primary care system and reduce healthcare costs by using resources more wisely and preventing disease before it happens.

Across the country, systems based on comprehensive, higher-functioning primary care show that patients are healthier and avoid having to seek care in more complex and expensive settings when primary care practices have the resources to better coordinate care, engage patients in their care plan, and provide timely preventive care. Large businesses have been able to make independent investments to promote more comprehensive primary care – improving the health of their employees and lowering their healthcare costs, thus making it easier for them to hire more workers and invest in their workforce.

New Healthcare Cost Institute to Offer Access to U.S. Payor Data

September 26th, 2011 by Cheryl Miller

A new healthcare cost initiative will give researchers and policymakers access to de-identified data from plans operated by Aetna, Humana, Kaiser Permanente and United Healthcare, as well as some government data from Medicare Fee-for-Service and Medicare Advantage activity. The Health Care Cost Initiative (HCCI) is designed to offer new insights into healthcare costs, utilization, and intensity. It’s a timely move, given research that predicts U.S. health spending could rise from an estimated $2.5 trillion to $4.6 trillion by the end of the decade.

CMS will create a new database too — a system of records containing the health information of Medicare beneficiaries who receive treatment with providers participating in an ACO. The database will also contain personally identifiable information (PII) about certain individuals participating in the ACOs, including healthcare sole proprietors, providers, key leaders and managers of ACOs and contact persons. It will be used to support policy activities and reimbursement for its programs to bundle payments and share savings, say CMS officials.

More savings could be achieved by enrolling dual eligibles into managed care plans, says a new study by Kenneth Thorpe of Emory University. The study predicts savings of up to $125 billion for the federal government and $34 billion for states over ten years. Dual eligibles account for more than one-third of Medicare and Medicaid spending, even though they make up only a small percentage of the total enrollment in these programs. Research further shows that federal spending on dual eligibles will total nearly $3.7 trillion over the next decade.

And B4 we go, do u text? If so, you’re not alone : ) Approximately 2.2 trillion text messages were sent in the United States in 2011, and while teenagers were particularly dexterous, 80 percent of low-income households on Medicaid reported texting regularly. Research suggests that the use of mobile phone text messaging can be effective in improving health behaviors and health outcomes. The HHS is proposing seven new recommendations to support health text messaging and mobile health (mHealth) technologies.

CDPHP Makes a Business Case for Embedded Case Managers

September 23rd, 2011 by Cheryl Miller

Three years ago primary care was in crisis, says Lisa Sasko, director of clinical transformation for CDPHP. There was a projected shortage of primary care physicians, due in part to a less than competitive earning potential, which was keeping physicians and graduating medical students at bay.

So CDPHP, a not-for-profit, physician-founded and guided health plan that has more than 350,000 members, designed a unique model that would provide enhanced reimbursement for current PCPs, and make it more attractive to medical students and health providers.

That enhanced primary care model was the subject of the Healthcare Intelligence Network's (HIN) recent webinar The Role of Embedded Case Managers in Clinical Transformation. Together with Charlene Schlude, director of case management at CDPHP, Sasko described the evolution of their model, which incorporated a blend of payment reform and practice transformation, and also shared the following:

  • The operational and cultural issues critical to the success of the program
  • Results from the two-year analysis of the program
  • Planned enhancements of the initiative
  • Business reasons for developing an embedded case management program
  • The day-to-day interactions of embedded case managers with providers in a practice
  • CDPHP's payment reform strategy uses a risk adjusted base capitation payment, plus bonus opportunities aligned with IHI's Triple Aim initiative, so that patient satisfaction, quality of care, and cost effectiveness were targets for rewards.

    CDPHP also "retooled the operations of the primary care practice," said Sasko, focusing on care coordination, leadership development, team care, improved access and population management, with the goal of realizing NCQA Level II medical home certification. To achieve this, they integrated their resources, specifically case management, disease management, behavioral health, pharmacy reporting, and discharge notification.

    Fundamental to the overhaul was embedding case managers in the physician practice, said Schlude.

    "The fundamental concept of case management is that when individuals with complex diseases maintain optimum levels of health and functional capability, everyone benefits: the patients, their support systems, caregivers, healthcare delivery systems and payors. Embedded case managers are indicative of a new era of healthcare in which payors, providers and patients work together in partnership."

    To be most effective, case managers should have access to EMRs, physician support, aligned goals and be able to interact with patients face-to-face on a consistent basis, Schlude continued. Practices for embedded case management should have willing physicians, and the opportunity to improve quality metrics, and have strong stratification and prioritization techniques in place. Reducing avoidable hospital admissions, and empowering patients to successfully self manage their disease conditions and communicate effectively with their case managers and physicians were key objectives for the embedded case managers.

    Currently one RN covers two enhanced primary care practices two times a week, Schlude said. There is a high focus on Medicaid and Medicare patients, direct documentation in EMRs, and face-to-face introductions with telephonic follow ups.

    Case managers can play significant roles with diabetic patients, the frail elderly, comorbid chronic patients, and end stage renal failure disease (ESRD) patients; ESRD patients in particular consume a disproportionate amount of financial and healthcare resources. In all cases, Schlude said, embedded case managers can help to reduce hospitalizations and costs, and improve quality of life.

    The size of the practice doesn't matter, Schlude emphasized. Instead, to successfully embed case managers in a clinical practice, it is important to sustain ongoing communication among all, select a case manager that is a "good fit" in the practice, and maintain flexibility and an ability to modify the program model as needed.

    For more information, watch our video Embedded Case Managers in Healthcare:

    Meditation Reduces Stress, Healthcare Costs

    September 19th, 2011 by Cheryl Miller

    Open wide and say...

    Ommm?

    That's what doctors might be saying to their patients given the results of a new Canadian study that shows the health benefits of Transcendental Meditation (TM.) The study, which used people who consistently incurred the highest healthcare costs, found that the group that practiced the age-old technique for five years decreased their healthcare costs by nearly one third, or 28 percent, while the non-practicing group showed no significant decrease in healthcare payments. Chronic stress is the number one factor contributing to high medical expenses, and TM is known to play a significant part in reducing stress.

    It turns out meditation could be just what the doctor ordered for the 81 million Americans who were uninsured or underinsured in 2010, a number that has increased by 80 percent since 2003. Despite having insurance, these people suffer from financial stress due to higher than usual premiums and limited access. And lower income families aren’t the only victims; in 2010, one out of six middle class families earning between $40,000 and $60,000 a year were underinsured. The PPACA could provide relief, according to the study, not only for the underinsured, but for the uninsured.

    Illustrating the impact that diabetes is having on not only the U.S. healthcare system, but on a global scale, the International Diabetes Foundation (IDF) released the following findings: 366 million people are suffering from diabetes worldwide; 4.6 million people died from the disease in 2011; and healthcare spending on diabetes reached $ 465 billion. The IDF delivered the grim news a week ahead of the UN Summit on Non-Communicable Diseases (NCDs), which will be the second of its kind to focus on a global disease issue. It will target the four most prominent NCDs: cancers, cardiovascular diseases, chronic respiratory diseases and diabetes, and aim toward agreeing on a global strategy to address them. The first UN Summit related to health was the HIV/AIDS meeting in 2001, which led to the creation of the Global Fund to fight AIDS, tuberculosis and malaria.

    These stories and more in this week's Healthcare Business Weekly Update.

    New Transitions of Care Credential Program for Case Managers

    September 14th, 2011 by Cheryl Miller

    A timely new certification in care transitions recognizes skills and expertise in patient handoffs between sites of care.

    The Case Management Society of America (CMSA) and the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) are collaborating to create a sub-specialty certification for transitions of care (TOC.) According to the CMSA web site, this new credential is

    "the first one to support professionals not only as a team, but also individually, who demonstrate competence and skills in providing the key elements of transitions of care."

    Successful transitions of care from one managed care environment to another are key to reducing hospital readmissions and improving overall healthcare costs and patient satisfaction. According to market research compiled in Healthcare Intelligence Network's second annual Managing Care Transitions Across Sites survey conducted in May 2010, the hospital-to-home transition is the most critical transition in care, followed by skilled nursing facility (SNF)-to-home (49.2 percent) and ER-to-home transitions (45.9).

    But until now, care transitions haven't traditionally been part of medical education and training; according to the American Geriatrics Society:

  • Nearly 20% of Medicare patients readmitted to hospital within a month
  • Patients are frequently confused and dissatisfied by the discharge process
  • Communication between hospitalists and PCPs is equent
  • And patients are suffering: from those recently hospitalized who are often discharged without proper instructions on what medications to take or resume taking to faulty or incomplete handoffs of patients between provider shifts in teaching hospitals that may be responsible for more medical errors than overworked, sleep-deprived medical residents.

    The majority of HIN's survey respondents said that post-transition patient contact, such as home follow-up visits and post-discharge telephone calls, were the most successful strategies to improve care transitions.

    And more than half of the respondents said that the case manager was most frequently charged with care transition management.

    Says Jan Van der Mei, continuum case management director at Sutter Health Sacramento Sierra Region:

    "One of the main focuses for care coordination is to avoid duplication of services when patients move from one site of care to the next. When someone is leaving the hospital, care coordination can help the patient get a follow-up appointment. When you are monitoring the patient, it may be helping them get to the office instead of going to the ED.

    "It is also many rounds of addressing the psychosocial issues and making sure that patients can actually make it to their appointments - that they have transportation and that when they get a new prescription, they are able to pick up the prescription and pay for it," Van der Mei continues.

    Other elements for care coordination involve making sure when a PCP refers a patient to a specialist, that the specialist has the necessary information so they can provide the assessment that is being sought without actually duplicating tests that have already been done, recommends Van der Mei.

    Says Mary Beth Newman, MSN, RN-BC, CMAC, CCP, CCM, as quoted on the CMSA web site:

    “...we have worked hard to design the credential to help identify best practices, as well as to assist case managers in making recommendations that balance the appropriateness of health care services with cost and quality as related to transitions. It is vital that the program address the need for effectiveness, efficiency, equity, safety, and timeliness in transitions of care."

    Four Transitions for Back-To-School

    September 12th, 2011 by Cheryl Miller

    It's back to school time, and the healthcare industry is undergoing its fair share of transitions.

  • NCQA is launching a new accreditation program for ACOs this fall. The organization worked with consumer advocates, purchasers and other healthcare and managed care experts to develop seven standards by which it will evaluate ACOs. Early bird adopters of the accreditation effort can get reduced rates on survey fees, online education tools and promotion. Order the NCQA ACO standards.
  • The one-year report card on Cigna's ACO approach with Medical Clinic of North Texas (MCNT) is in; and both healthcare systems are reporting excellent grades in four key areas: reducing avoidable emergency room visits, following evidence-based medicine, lowering medical costs and better controlling diabetes. Since the accountable care program began, MCNT has received the highest level of recognition from NCQA for meeting national quality standards for physician group medical homes. Cigna helped by sharing patient-specific data that identifies individuals who could benefit most from additional outreach and follow-up care.
  • Medical students, rather than teachers, are getting apples this year: Apple iPads. Many universities, including Yale Medical School, profiled here, are downloading curriculum onto the tablets in an effort to be more "green," save money, and protect patient confidentiality. Computer security has been a particular concern for the Yale School of Medicine, and the iPad is compliant with security and privacy laws and does not carry the same risk of information loss that a laptop might, Yale officials say.
  • And finally, a lesson that can't be taught enough: smoking just a few cigarettes can kill. A new report from the CDC shows that smokers are smoking less: the percent of daily smokers who smoke nine or fewer cigarettes per day rose to nearly 22 percent in 2010, up from an estimated 16 percent in 2005. But smokers need not be heavy or long-term smokers to be affected with a smoking-related disease, or suffer a heart attack or asthma attack, CDC officials say. And states with the toughest anti-smoking campaigns, like like Maine, New York and Washington, have the fewest smokers. Which just goes to show that even the most resistant students can be taught to change their ways.
  • Meet Health Coach Amy Hendel: ‘HealthGal’ Sets Sights on Lifestyle Modification

    September 8th, 2011 by Jessica Fornarotto

    This month’s inside look at a health coach, the choices he or she has made on the road to success, and the challenges ahead.

    Excerpted from the September 2011 HealthCoach Huddle.

    Amy Hendel, R-PA, CEO and health coach for HealthGal.

    HIN: What was your first job out of college and how did you get into health coaching?

    Amy Hendel: I went to college thinking that I would apply to medical school. My dad actually convinced me to look at the physician assistant (PA) degree, which would allow me to pursue a health career without the having to commit to a very extended education and the kind of financial debt I would be paying off for at least a decade. After three years as a PA in internal medicine helping people try to manage multiple diseases associated with poor lifestyle choices, I decided I would rather get involved in helping to prevent disease or helping patients to dig their way out of chronic disease by using lifestyle modification techniques. Back when I started there were no 'coaches' — just health professionals from a variety of health backgrounds trying to modify people's habits, one habit at a time.

    Has there been a defining moment in your career? Perhaps when you knew you were on the right road.

    In my third year as a PA, I was dragging my newborn quite early every morning to a babysitter near the hospital where I was working, so I could breastfeed her before and after my early AM duties in the operating room. My duties included performing routine pre-surgery history and physicals on patients with all kinds of complicated illnesses like diabetes, high blood pressure, heart disease, and I felt like I was watching a procession of 'train wrecks' pass before me. I was challenged as a mother and professional, trying to juggle the needs of my newborn and feeling escalating frustration with the typical patient who seemed to want pills to fix everything. One day I walked upstairs to the hospital administrator and gave notice to him that day. I also impulsively told him that I planned on setting up a lifestyle modification program and hoped he would tell doctors at the hospital to refer patients to me who were willing to work on modifying lifestyle habits contributing to their multiple health issues.

    In brief, describe your organization.

    The HealthGal is a name I began using about 10 years ago, after expanding my health coaching practice to include media projects. I started contributing weekly health segments to KCBS after a chance on-air guest appearance, which led to a one-year position there. I have been a contributing guest health expert on local and national news and talk shows — TV and radio — and I've been a host of a PBS health talk show, as well as a Westwood One radio show. I blog for several health Web sites and my most recent streaming video show is Food Rescue at www.healthination.com. I do a fair amount of consulting work, particularly on health campaigns, but still maintain a private practice in California and New York.

    What are two or three important concepts or rules that you follow in health coaching?

    As a coach I'm always truthful and empathic, and I always ask 'the hard questions.' Obesity is a disease, so you never 'cure it.' You simply put it into remission.

    What is the single-most successful thing that your company is doing now?

    Though I continue to coach individuals, I feel that my Tweets at HealthGal1103 and my blogs at www.healthcentral.com/obesity and www.healthcorps.net are reaching so many people who are struggling with obesity and health issues related to obesity. Getting outreach to parents who struggle with obesity themselves and so easily hand off these same issues to their kids, is hugely accomplished through my Internet efforts.

    Do you see a trend or path that you have to lock onto for 2011?

    Though I am a huge exercise fanatic and it is always a component of my health coaching, 2011 and 2012 will showcase a trend of accepting that we largely 'are what we eat and we do need to label foods as either necessary foods or treat foods. Ninety percent of the time we need to be eating good or necessary foods.

    What is the most satisfying thing about being a health coach?

    When you can take a person who sees their weight as an insurmountable burden or someone who has been yo-yo dieting for years and show them the way and make them realize that they can manage their lifestyle, one habit at at a time — you, as a coach, feel like a true healer.

    Where did you grow up?

    I grew up in Brooklyn as the daughter of a school teacher and a homemaker. Money was always tight but I was raised to believe that education and a profession was the key to success. The women in my family all struggled with weight issues — my mom was obese and by age 14 I was 50 pounds overweight.

    What college did you attend? Is there a moment from that time that stands out?

    I attended Brooklyn College and fell in love with organic chemistry...I know, what a crazy subject to love! I remember thinking that science explains pretty much everything. One of my professors was really into nutrition and spending time in his lab actually exposed me to rudimentary nutrition lessons.

    Are you married? Do you have children?

    I am married to a physician and we have a daughter who just finished her master's degree in architecture. My son is a junior at MIT. They are both athletes — my daughter was a ranked junior tennis player in California and played for NYU and my son is a long distance runner. I suppose that I am most proud of the fact that both of them are active, healthy and understand the importance of living a healthy life.

    What is your favorite hobby and how did it develop in your life?

    My favorite hobbies are playing tennis and I've recently taken up gardening.

    Is there a book you recently read or movie you saw that you would recommend?

    I loved the book "Room," probably because the young woman in the story was an extraordinary protagonist, surviving and raising a child under the most horrific circumstances. I also just saw "Sarah's Key" and thought it told an important story from the Holocaust that had not received significant exposure.

    Headlines Show How Registries Boost Care Accountability for High Risk and Special Needs Patients

    September 7th, 2011 by Patricia Donovan

    Recent headlines illustrate the use of patient registries to enhance care of high-risk and special needs patients:

    First, medpage Today reports that a first look at a massive international registry of treatment for atrial fibrillation indicates that a high percentage of individuals are not being prescribed anticoagulation treatment that can reduce their risk of stroke. Researchers shared this data at the European Society of Cardiology meeting.

    Of the nearly 10,000 patients in the initial cohort of the Global Anticoagulant Registry in the Field (GARFIELD), CHADS2 scoring showed 55 percent of them to be eligible for anticoagulation therapy, but 33 percent of them didn't get it, Ajay Kakkar, MD, of University College London, reported at the meeting.

    The Bayer-sponsored registry was designed to describe the real-life patterns of treatment in newly diagnosed atrial fibrillation patients with at least one additional risk factor for stroke.

    And in last month's lead-up to Hurricane Irene, Rhode Islanders with special healthcare needs were urged to enroll in an emergency special needs registry. In particular, the registry sought individuals using home oxygen, a respirator, ventilator, dialysis, pacemaker, or who are insulin dependent; those with mobility issues and using a wheelchair, walker, or cane; those that are visually impaired, blind, hard of hearing or deaf; those developmental or mental health disabilities; or those using assistive animals or a prosthesis.

    Almost half of respondents to a HIN August 2011 survey say they use some type of registry to collect health data related to their patients or plan members.

    The most popular reason for using a registry is to measure quality and performance on key health outcomes, said 105 healthcare organizations who answered 25 multiple choice and open-ended questions on patient registries. Download an executive summary of the survey results.

    85 percent of survey respondents believe that a registry will one day be a requirement for either Medicaid or Medicare reimbursement. Registries are already mandated for organizations seeking NCQA medical home recognition.

    "NCQA and patient-centered medical home actually requires that you develop registries," noted Dr. Gregory Spencer during a recent presentation on “Patient Registries: A Cornerstone in Creating and Delivering Accountable Care."

    "A registry is another name for a list of patients who meet a certain criteria, usually for a high risk or an important condition," continued Dr. Spencer, chief medical officer with Crystal Run Healthcare. "Other real tangible benefits of registry use are in quality efforts, specifically in identifying groups of patients who need certain tests performed."

    4 Key ACO Year-One Returns from CIGNA Accountable Care Effort

    September 6th, 2011 by Patricia Donovan

    CIGNA reports four key improvements from its ACO approach with Medical Clinic of North Texas:

    • Avoidable emergency room visits continue downward trend, seven percent better than market;

    • Following evidence-based medicine continues to improve, six percentage points better than market;

    • Medical cost trend is more than two percentage points better than market;

    • Diabetes is better controlled, will improve long-term health and lower medical costs.

      In a recent press release, CIGNA, which shares patient-specific data with the clinic that identifies individuals who could benefit most from additional outreach and follow-up care, credits care managers with much of the program's first-year success:

      The care coordinator, who is fundamental to the program’s success, is a nurse on MCNT’s staff who uses the CIGNA data and reaches out to these patients.

      “We’re able to share information with MCNT about potential gaps in care, such as which patients might be overdue for a mammogram or colonoscopy, or which patients with diabetes are missing important blood tests or didn’t refill a prescription,” said Dr. Mark Netoskie, senior medical director for CIGNA in Texas. “Using this information, MCNT’s care coordinator can reach out to these patients to ensure they get the care they need, which results in higher compliance with evidence-based medicine guidelines and a healthier population.”

      During the program’s first year, MCNT’s enhanced care coordination improved control of A1c blood sugar levels in diabetes patients by nearly 3 percent. Management of cholesterol and blood pressure levels also improved for these patients. Helping people with diabetes control their disease and manage their overall health can have significant long-term benefits, including longer, more productive lives and lower medical costs.

      As part of the program, MCNT also improved patient access to care by expanding office hours, contributing to more primary care office visits.

      Learn how CIGNA Pharmacy Management improves medication adherence in its population.