Patients with chronic conditions have a higher risk of medication-related problems including medication non-adherence. Managing medications for chronic disease populations can prove challenging because patients with chronic disease often experience polypharmacy at higher rates than the average population and social and behavioral barriers to health may more impact their health. To streamline medication management, improve patient health outcomes, and reduce the cost of care, we will examine seven actionable strategies care teams can take in this article.
Data shows that five percent of patients, known as super-users, drive 50% of healthcare use. To control costs for the patients, many health plans have shifted to spend more resources on these patients.
However, stratifying patients with chronic medical conditions into just two groups — users and super-users — isn’t enough to effectively manage their prescription medications. For instance, Kaiser Permanente found out that beyond the five percent super-users of healthcare, the biggest opportunity for cost reduction was for patients with rising risk, patients with a chronic health condition that is not yet severe but could quickly become severe. By focusing their resources on this group, the health plan was able to improve outcomes in diabetes and hypertension.
Just identifying the high and rising-risk patients is not enough. Healthcare organizations need actionable analytics that accurately predict medication-related problems before they happen. Arine’s artificial intelligence (AI) medication management platform determines the risk trajectory of patients by identifying patients who are at higher risk of falling out of compliance and targets those patients with low-cost, high-return interventions. Then it expands interventions to patients who are currently stable to keep these patients healthy.
Socioeconomic factors, like housing, access to food, and income can drive as much as 80 percent of health outcomes. For instance, transportation issues, which prevent access to care for over three million Americans, can be a major barrier to effective medication management for people with chronic diseases. Low financial status is another critical social determinant that can negatively impact a person’s ability to afford their medications and can lead to cost-related non-adherence and unnecessary hospitalizations.
Integrating social determinants and psychosocial factors in medication management can prevent costly medication-related problems, like treatment failure or hospitalizations. Arine ingests social and behavioral data in addition to clinical and claims data to predict the likelihood of a patient becoming non-adherent and to prompt interventions that help remove socioeconomic barriers to care. After analyzing a patient’s data, the platform triggers the healthcare team to ask patient-specific questions to remove additional obstacles to care. The answers to these questions enhance the patient’s data, allowing Arine to better personalize the patient’s care. After integrating all these unique data points, the system creates tailored recommendations for patients and healthcare providers that can be sent at the touch of a button.
The lack of interoperability of health information systems poses another barrier to effective medication optimization. Care teams providing medication management services often have to operate different systems for billing and documentation. This added layer of complexity can lead to unnecessary costs, decreased speed of care, and negative impacts on patient safety.
Medication optimization software that integrates workflows improves the efficiency of the care team. Platforms like Arine quickly exchange healthcare data and integrate with existing workflows and systems to streamline care and ensure medication management programs stay on track.
Another way health plans can leverage technology to improve efficiency is in the measurement of outcomes. Measuring outcomes across clinical and cost improvement parameters is crucial to gaining insight into the impact of interventions, further personalizing recommendations, predicting future outcomes, and uncovering opportunities to improve future care.
Health plans have access to a large amount of data, but may not know how to convert that data into actionable insights. Using Excel or legacy software can be labor-intensive and time-consuming. Arine’s platform continuously analyzes the outcomes of interventions, enabling real-time reporting and self-optimization of the system through a feedback loop.
Misprescribing and therapeutic inertia are two other challenges in providing effective medication management to patients with chronic diseases. Therapeutic inertia is one of the key reasons for treatment failure in chronic diseases, like diabetes, hypertension, or COPD, and can lead to disease complications. For instance, one-year clinical inertia in diabetes can increase the incidence of retinopathy, neuropathy, and nephropathy. Misprescribing is another major prescribing problem that affects almost 70% of older adults with multiple chronic diseases. Medicare spends over ten percent of its medication expenses on inappropriate medications. It’s also associated with an increased risk of hospitalizations, emergency department visits, and outpatient visits, which translates into higher total expenditures.
Relevant prescriber analysis and subsequent education can help address both therapeutic inertia and misprescribing challenges. By using Arine’s prescriber analytics solution to identify prescribing patterns in their network, health plans can uncover prescribing outliers, provide relevant recommendations to prescribers, and address prescribing gaps.
The reading level of health material is usually too high for most readers. More specifically, almost nine out of ten adults struggle with health literacy, as even people with high literacy skills can still struggle with health literacy. Limited health literacy can increase the risk of medication errors and make it harder for people to manage chronic diseases and, as a result, can lower patient satisfaction and increase healthcare utilization.
To provide effective medication management to people with chronic diseases, health plans need to ensure that all their members have easy access to health information and services needed. With its user-friendly platform, Arine allows care teams to easily create patient-friendly material in the patient’s preferred language and to connect patients with the health plan resources that they need.
Polypharmacy can lead to unnecessary medications, avoidable adverse drug events, and increased financial costs. One study showed that reducing polypharmacy to reduce adverse events reduced costs by over $1,000 per medication review. In another study of elderly Japanese patients, polypharmacy was directly correlated to potentially inappropriate medications which led to higher hospitalization rates, increased outpatient utilization, and a 33% increase in medical costs. Polypharmacy is also a risk factor for falls, drug-drug interactions, cognitive impairment, and drug-disease interactions, all of which can result in costly complications for patients.
Strategies to reduce polypharmacy for patients with chronic diseases include:
Arine’s algorithms identify opportunities to simplify regimens and assess the risk-benefit profile of medications to suggest discontinuing any medications that do not lead to adequate benefits.
Managing medications is a central part of caring for patients with chronic diseases. With simple and cost-effective strategies, health plans can improve their medication management programs and deliver value to their members.
Register for Arine’s webinar, Medication Optimization: The Missing Link in Value-Based Care, to learn more about how to reduce the high costs of non-optimized medications: