Health plans have access to a wealth of data about members, including financial, demographic, buying habits, and lifestyle choices. At the Abarca Forward conference in Puerto Rico earlier this year, George Van Antwerp, managing director at Deloitte, led a discussion on how we can use these social determinants of health (SDOH) to improve medication adherence and provide a more personalized healthcare experience.
The cost of medication nonadherence and waste is estimated to be more than $500 billion, according to Health Affairs data provided by Van Antwerp, and trying to unlock the complex causes for this issue has been an ongoing challenge in the healthcare industry. Although it is far from solved, Van Antwerp explained, the availability and analysis of health plan member data has helped in trying not only to better understand causes of nonadherence but how healthcare organizations can develop new ways to address access, medication concerns, and improve understanding about their healthcare needs.
However, the reasons why prescriptions aren’t filled can vary by healthcare condition, among other factors.
Having a job, what type of insurance is provided, and patient out-of-pocket costs, can all be determining factors of medication adherence. Another is access to care— a consideration which is traditionally dependent upon how long it may take patients to get an appointment, which varies significantly around the country. Van Antwerp noted that in St Louis, for example, it takes a few days to get an in-person appointment while in Boston the wait time is significantly longer, and healthcare deserts can face even greater delays. However, telehealth is helping to close that gap.
Van Antwerp mentioned meta-analysis that showed that housing and food insecurity are also likely to impact medication adherence.
Van Antwerp also noted that research has demonstrated that patients can be significantly influenced by the people around them. For example, social media networks and family members can play a role in smoking and obesity. That influence can also extend to certain medications and healthy behaviors.
There are also factors related to the patient’s healthcare experience that may impact adherence, such as:
Unclear guidance
One reason that patients don’t pick up their medication, or stop taking it altogether, is that they no longer feel unwell and/or they think they’re cured. And, because providers often have relatively short interactions with patients, opportunities to explain some of the nuances of their condition and prescribed medication may be lost. Van Antwerp discussed research that focused on patients prescribed statins to manage high cholesterol in which some participants reported that their provider never said that they need to take the medication for a long time to get their cholesterol under control—instead operating under the impression that they would be cured after 30-days.
Patients may also feel uncomfortable asking their provider questions about their prescriptions, which may impact their ability to take the medication as intended.Identifying what’s important to patients
One way providers can potentially improve adherence is by personalizing the goals and benefits an individual can achieve by managing his or her condition. For some, it’s to be healthy enough to attend their child’s wedding. For others, it may be being able to enjoy certain foods or be physically active. Having the dialogue to identify patient motivations and linking actions, like adherence, to those outcomes could make a meaningful impact.
Trust and literacy
In the United States, only 12% of adults have proficient health literacy—so trust between patients and providers is critical. This can be especially true in minority groups or marginalized communities, according to a study published in JAMA.
It’s clear that one way to improve medication and care plan adherence is by getting to know patients better to identify and assess SDOH-related factors, such as access to transportation, healthy food, employment status, health literacy, mental health and more. But successfully retrieving this often sensitive information depends on how patients are asked about their situations, their comfort level in sharing this information and the ability of pharmacies, providers, and plans to use it to help improve a consumer’s health.
And while this process may be difficult, and vary from patient to patient, it is critical to improving patient health and reducing unnecessary costs across healthcare.
