Hello CHPA Network,
I came across some statistics the other day that stopped me in my tracks. It is estimated that a staggering 50% of Americans don’t take their chronic long-term therapy medications as prescribed. Moreover, it is estimated that poor adherence contributes to more than $500 billion in avoidable health care costs, around 125,000 potentially preventable deaths, and up to 25% of hospitalizations in the United States.
This issue of medication adherence is so important, yet so vexing to solve because it is so multi-faceted and entrenched into the business economics of healthcare. This is a life-or-death situation – both from an economic and a clinical perspective. Combined with the other inefficient and ineffective aspects of our broader healthcare delivery system, the weight of the entire structure could collapse upon itself due to the unsustainable costs that are incurred due to avoidable healthcare utilization that medication adherence could have prevented.
Payers are taking note and they are steering incentives toward healthcare providers finding ways to support their patients differently so that medication adherence is improved. According to the World Health Organization, medication adherence can have a more direct impact on patient outcomes than a specific treatment itself. It is critically important that we focus on this as an Accountable Care Organization because it is not only in the best interest of our patients, but it will also lead to increased incentive dollars that can be reinvested into our members.
To achieve pay-for-performance and/or shared savings dollars in our Medicare Advantage contracts CHPA is evaluated on a stars quality performance. Stars performance is based on 10-20 HEDIS measures depending on the contract. The medication related measures are five or six of those measures and when adjusted for weight makeup approximately a third of our performance. Historically we have ended these measures at three stars making it virtually impossible to obtain an overall rating of 3.76 or higher.
In response to these realities, CHPA is actively recruiting for a new contracted role, which is a Clinical Pharmacist for Value-Based Care. This role will serve as the clinical pharmacy point-of-contact for all value-based contracts, and developing, delivering, overseeing, and measuring clinical pharmacy interventions to optimize medication use for CHPA’s members. They will also provide pharmacy expertise for clinical pharmacists providing medication management services across CHCs and care teams.
A quality improvement methodology will guide a phased approach as we plan, do, learn, and modify along the way. The initial phase will include partnering with the Pharmacy Workgroup and targeted CHCs to complete a root cause analysis of current performance. This analysis will drive activities that will improve stars performance. Based on the root cause analysis, individualized performance plans will be developed with the targeted seven CHCs. Data will guide the effectiveness of the plans. Future phases will be informed by what is learned and what progress is made in phase one. Possible further activities could include working with care management and other care team members to leverage established relationships with patients and align support to improve health outcomes. This may include addressing social drivers of health and maximizing utilization of plan benefits and resources.
Please be on the lookout for more information soon. Let us know how this position can support you and your care teams.
Be well,
Ben Wiederholt, Interim CEO
Sources:
- Medication Adherence: The Trillion Dollar Opportunity to Save American Health Care (and our Patients) from a Tragic Demise, with Jason Rose
- Contributor: Medication Adherence Is Not a Zero-Sum Game
- Cost of Prescription Drug-Related Morbidity and Mortality
- The Unmet Challenge of Medication Nonadherence
