Pharmaceutical advancements have played a major role in improving the United States’ health and life expectancy. But for many, non-optimized medications have resulted in serious side effects, hospitalizations, or even worse health outcomes. In fact, 750 adults age 65 and older are hospitalized each day because of adverse drug events. In a recent Arine webinar, Dr. Terry McInnis, MD, MPh, CPE, Advisor and Chief Medical Officer at Arine, uncovered the true cost and how to optimize medication to improve health equity and patient outcomes.
In the webinar, Dr. McInnis discussed the following topics:
You can watch the full webinar here or keep reading for a summary of how to leverage AI-driven comprehensive medication management to optimize medication.
Improper drug utilization has a huge impact on the economy. In 2016, non-optimized medications cost $528 billion, or 16% of annual healthcare costs.
That $528 billion went toward preventable interventions such as:
And the cost of non-optimized medications is still rising. Based on Dr. McInnis’s projections, in 2020 numbers, non-optimized medications likely cost an estimated $659 billion in preventable healthcare spending and hundreds of thousands of lives lost.
According to the 2021 National Trends in Drug Expenditures study, pharmaceutical spending in the U.S. totaled $535 billion.
Considering the economic impact of drug expenditures, it’s easy to see why payers examine the cost of medications in terms of product and formulary structures. But maybe we need to think about it differently. Instead of having such a narrow focus on pharmaceutical spend, what if we also turned our attention to clinical outcomes? Do we have the right drug, for the right patient, at the right dose, used the right way?
If we saved $659 billion by starting to optimize medication, we could cover the cost of all drug expenditures with $100 billion of cost reduction remaining. Fortunately, we can now integrate the data and deploy analytic and clinical solutions that can address this problem.
Beyond the financial cost, the human toll of non-optimized medications is 276,000 lives lost per year, or just over 750 people per day. With such a high cost to human life, organizations must implement strategies to improve drug utilization if we are serious about health equity and financial stability in healthcare.
Medication adherence is often considered the top contributing factor to optimizing medication use. Even federal agencies like the Center for Medicare and Medicaid Services (CMS) assign almost one-third of a health plan’s quality score towards adherence. These scores determine payer reimbursement, making adherence initiatives a top priority for health plans. However, if the medications are not indicated, effective, or safe for a patient, asking them to be adherent to a medication can be dangerous—or even deadly. So yes, adherence is an issue, but it’s not the only concern. It’s not even the top medication-related problem.
According to a study published in the Annals of Pharmacotherapy, developed by Hepler and Strand, there are eight categories of drug-related challenges:
To illustrate just one drug-related problem, untreated indication, consider hypertension. Research from the World Health Organization estimates that 700 million people are living with untreated hypertension. This chronic condition leads to cardiovascular issues which account for the highest morbidity and mortality rates in the world. In the US alone, more than one-third of all deaths are attributed to heart disease or stroke. Untreated indications also place a burden on the economy, costing the healthcare system $216 billion per year. Although cardiovascular disease is a huge health and economic problem, antihypertensive medications can easily manage cardiovascular conditions at a low cost.
Care organizations must look at more than just adherence to optimize medications. All categories of drug-related problems should be addressed when reviewing a patient’s medications, as any of the eight above-mentioned challenges can cause poor health outcomes.
Patients should not only have access to treatment, but they should also receive the correct dosing to maximize the drug’s effectiveness. Both underdosing (dosages too low) and overdosing (drug toxicity) can cause severe morbidity or even death.
According to the Lown Institute, medication overload is defined as the “use of medications for which the harm to the patient outweighs the benefit” and is “America’s other drug problem.” Elderly patients in particular have a higher incidence of medication overload.
The Lown Institute estimates adverse drug events have more than doubled since 2008.
Research also shows older adults are hospitalized for adverse drug events at a greater rate than the general population is hospitalized for opioids.
To understand why the costs of non-optimized medications are so high and the health outcomes so poor, we need to look at why medication therapy management isn’t working.
Traditional MTM may allow payers to discover less expensive or reduce duplicative therapies or drug-drug interactions for its members within only the context of currently prescribed medications (the drug silo), but it doesn’t provide a scalable solution that can address the clinical goals of therapy and the all of the drug therapy problems such as indication and effectiveness within the clinical context. Here are a few reasons why:
Health plans that implement comprehensive medication management programs see reduced cost of care while improving patient outcomes. It’s a scalable strategy that provides an opportunity for collaborative practice between pharmacists, physicians, and other providers.
Physicians could also benefit from this multi-disciplinary team-based approach as well. The U.S. physician shortage is predicted to climb to 122,000 by 2032. Furthermore, within an average office visit time of 15 minutes, physicians spend an average of 26 seconds on guideline-recommended education, and 23 seconds on all other aspects of a new prescription.
Pharmacists must be integrated into team-based care to allow for proactive drug interventions that address gaps in care. Many studies show the positive impact of pharmacist-led interventions on clinical outcomes. For instance, when pharmacists are integrated into payer medication management programs, patients see:
Technology plays an important part in the advancement of comprehensive medication management. Health plans can use advanced AI-enabled CMM programs to provide patients with the most cost-effective therapy while maximizing clinical outcomes. How? By finally aggregating the clinical, claims, and real-time patient data to understand and solve the drug therapy problems in a patient-centric fashion. When social determinants of health (SDOH) and equity/cultural issues are addressed directly with patients, you can optimize medications to reach the clinical goals of therapy i.e., control hypertension, diabetes, or schizophrenia episodes.
Data insights provided by AI-powered platforms allow health plans and provider groups to address gaps in medication management by proactively:
Medication-related clinical and claims data collected through artificial intelligence helps put together the full medical picture of a patient. This ultimately leads to optimal interventions and reduces the total cost of care.
If your medication management program operates within the traditional MTM model, your organization could be missing tools and data that optimize costs as well as clinical outcomes.
So where do you go from here?
Dr. McInnis shares four actionable strategies, all enabled by intelligent analytics, for health plans and providers looking to enhance their medication management programs:
Arine provides healthcare organizations with innovative, AI-enabled solutions for medication management. To learn more about how AI-enabled comprehensive medication optimization delivers outcomes for patients, providers, and plans, download our white paper.