Minimizing Medication Adherence Gaps

Thursday, August 27th, 2009
This post was written by Melanie Matthews

Thom Stambaugh, chief pharmacy officer and vice president of clinical programs and specialty pharmacy with CIGNA Pharmacy Management, discusses how CIGNA identifies medication adherence and the solutions for improving this issue.

How do we identify medication adherence gaps and assess the barriers? CIGNA’s overall approach of identifying medication adherence is through our Outcome Improvement Program. Through our program, we strive to:

— Promote a more active physician/patient dialogue. In other words, identify where medication adherence issues may exist, and then provide the information to the physician and patient so it can be discussed.

— Influence adherence to appropriate medications. Give the individual patient information so that they understand why the medication is important.

— Maximize the potential for positive health outcomes.

— Reduce unnecessary drug costs associated with inappropriate utilization. Improve those outcomes to get the total medical cost reduction.

Medication adherence is not the single issue of importance in looking at evidence-based standards of care. Rather, when you look at medication adherence, it’s one of many evidence-based standards that U.S. healthcare is not achieving in terms of treating patients. A study in the New England Journal of Medicine said that 55 percent of Americans don’t receive the care that is identified in evidence-based standards. It’s important that when you look at medication adherence, it’s in the context of a condition overall, and in the context of other therapies and things that may not be occurring for an individual.

As much as improving adherence is important to us, we’re also interested in ensuring that the patient is adherent with going to the physician’s office and getting the appropriate monitoring of the condition. Are they having an office visit every 12 months? Is that leading to appropriate monitoring of the condition? Has the patient had a low density lipoprotein (LDL) cholesterol test in the past 12 months? Are they achieving the targets that are identified as the clinical marker for the condition? If they’ve had a cholesterol test, have they achieved an LDL of less than 100 milligrams per deciliter? Are they getting the appropriate medications to treat the condition? While we’re concerned about adherence — getting refills and taking medications in an appropriate time frame — we’re also making sure that they are on appropriate medications and haven’t fallen off that medication. Once we’ve established all those points, what’s left is to identify where adherence might be an issue for an individual.

One of the most important and critical starting points that we’ve identified is a systematic approach to evaluating the evidence-based standards, and one of those is looking at medication adherence on a frequent basis. We’ve done this by taking our 10 million members and setting up evidence-based standards as rules in a rule engine. You can then assess those evidence-based standards and medication adherence for the previous six months on a monthly basis. This allows us to review each month if a patient has been medication adherent. Are they getting their refills on time? Do we see a pattern in the date that would indicate that they are medication adherent? Once this information is identified, we create a profile for that individual. The profile includes all of their evidence-based standards, including medication adherence, and indicates whether they are or are not meeting those.

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