The Collaborative Forum

In a previous post, called Medication Adherence Part II, published July 31st, I unpacked 5 of the 10 recommendations from a recent New England Healthcare Institute (NEHI) report, ”Thinking Outside the Pillbox”.  Let me hit the remaining 5 recommendations now. 

Three recommendations fall under the category of “Incentives”:

• Plan Design – The concept of “value based” insurance benefit design is one that creates incentives for the use of high value prevention and wellness services.  Applied to the opportunity of medication management, insurers for example, are waiving medication co-payments for chronic condition therapies such as diabetes medication or asthma.  The design theory implies that members with chronic conditions are more likely to comply with treatment regimens if their out of pocket costs are lower or they perceive to be receiving an economic benefit.
• Other Employer Sponsored Programs and Incentives – A related approach to waiving medication co-payments is to actually offer benefits and premium differentials for employees who participate in wellness activities or programs, complete a Health Risk Appraisal or enroll in disease management programs.  These programs MAY indirectly influence medication behavior but would likely do so as an indirect result of educational interactions through the offered programs.
• Redirecting Manufacturer Rebates – Interest is growing among drug manufacturers to tie purchasing rebates to the availability of discounts or other incentives for patients to be adherent to treatment.  An example is the work that Merck has done with Cigna to provide discounts on diabetes drugs if the insurer demonstrates increased member adherence to diabetes medications.  The hope is that “pass through” discounts or other adherence programs will be the result of this incentive alignment.

The final two recommendations fall under the category of “Enabling Technologies”:

• Health Information Technology (HIT) – This category sounds a bit like a Rorschach Test, in that HIT means what you want it to.  The sense of the recommendation, however, is that HIT can enable important data exchange between key players in the medication adherence value chain.  This could include the ability of physicians to know whether a medication presciption was actually filled, or that a refill is due.  It might include better coordination of medication prescription information between providers or between sites of care, such as following a hospital discharge.  Here, the ability to do medication reconciliation through HIT is promising.  However, this recommendation requires a significant element of both technical, cultural and incentive change to occur to become wide-spread.
• Technologies for Reminders and Monitoring – Several innovative approaches are now in testing and use that hold the promise of capturing medication taking behaviors and supporting adherence through alerts and reminders.  Electronic pill caps, dispensers, and in-home monitoring devices are at the “device-heavy” end of this spectrum, while cellular phone applications, web applications, interactive voice applications and even SMS text messaging applications stand at the “Software” end of this spectrum.  Key issues of patient appropriateness and targeting, patient adoption and comfort, as well as logistical issues of deployment and retrieval, training and customer support remain a challenge to wide-spread adoption.

The NEHI report, “Thinking Outside the Pillbox” was recently published at http://www.nehi.net/publications/44/thinking_outside_the_pillbox_a_systemwide_approach_to_improving_patient_medication_adherence_for_chronic_disease.

So…which of these recommendations do you think hold the most promise in transforming the cost and quality of healthcare related to medication adherence?  Tell us what you think.  Next time, I’ll share the results of the NEHI think tank poll.  The results may surprise you…