Using Claims Data to Improve Medication Adherence

Medication adherence refers to?whether patients take their medications as prescribed (e.g., twice a day) as well as whether they continue to take a prescribed medication after the first pharmacy pick up.

According to the Centers for Disease Control (CDC), adherence to prescribed medications is associated with improved clinical outcomes for chronic disease management. Nonadherence results in:

• Higher rates of hospital admissions and emergency department visits
• Substandard health outcomes
• Increased health care costs

Direct health care costs associated with medication nonadherence have grown to approximately $100–$300 billion of U.S. health care dollars spent annually. Improving medication adherence is a public health priority and could reduce the economic and health burdens of many diseases and chronic conditions. CDC November 17, 2017

Improve Medication Adherence Using Claims Data

Most value-based care programs have access to all encounters claims data for their patients.

Many patients will pickup the prescribed maintenance medication the first time but discontinue use of the medication for a variety of reasons such as weight gain, fogginess, or nausea. These reasons are usually never reported to the provider until the next encounter 3, 6 or 9 months later.

Instead, providers conducting chronic care management activities should conduct outreach to the patient with a telephone call to review the prescriptions the patient has stopped picking up (removed) and discuss with the patient other medication options or scheduling a less costly Part B physician encounter to discuss the medication.

Kris Gates, 480.912.1209, [email protected]