Pharmacy Adherence (Waste) And The Need for MD-RPh Collaboration

I spent the day today at the NEHI adherence event in DC. I pulled out a few of my takeaways below, but while I was riding on the plane to get here, a few things were running thru my head:

• The focus on budget and the estimates that adherence costs us $290B a year here in the US.  (or as one person pointed out that’s $1.2T in a presidential term)
• The recent report estimating that chronic conditions could cost us $47T worldwide over the 20 years which is leading to the UN talking about healthcare for only the second time ever.
• The discussion by George Paz from Express Scripts the other day about how PBMs drive value by eliminating waste (see Drug Trend Report). A large piece of waste is adherence and certainly one of the forecasted benefits of the combined Express Scipts and Medco entity is the intersection of Consumerology with the Therapeutic Resource Centers (TRCs).
• The ongoing dialogue around motivational interviewing, commercial MTM, and blending face to face interventions with technology to “nudge” behaviors.
• The huge opportunity which I believe exists in leveraging technologies like Surescripts to create data exchanges with physicians around MPR and barriers.
• The exciting fact that the new STAR measures for Medicare include more adherence metrics that are weighed more heavily than some of the operational metrics.

Fortunately, these were a lot of the topics that were discussed.  Here some of the discussion topics:

• The fact that there’s no “easy button” for adherence.
• How adherence is a foundational building block for quality.
• The role of HIT in sharing data bi-directionally across the care team.
• Upcoming evidence around VBID.
• The role of the pharmacist and need for them to collaborate more with the physician to discuss and manage adherence.
• The fact that the adherence solution has to be multi-factorial.
• The need to optimize the drug regiment and individualize care (aka patient-centered care).
• The role of the caregiver.
• Opportunities around PCMH, readmissions, MTM, and eRx.
• The need for patient engagement.
• The need for the patient to believe in the therapy and that it will make them better.
• Good discussion on the role of the PCMH (patient-centered medical home) versus the pharmacy as the foundation for adherence.
• Discussion on whether physicians could address adherence if time wasn’t an issue.  Do they have the training and skills?
• Social media as an emerging factor.
• Reaching the consumer when they have time and are receptive to information.
• Helping prepare the consumer for the encounter (i.e., checklist or list of questions).
• What happens when the patient waits in line and then is rushed themselves in the encounter.
• The role of technology in complementing the physician and patient.
• How to share data across team members.
• The need for ROI data on interventions.
• The value of having a Dx on the Rx.
• The need to vary incentives and not keep doing the same thing.
• If prevention is long-term and adherence is short-term, should the physician focus more on adherence and less on screening and other preventative measures.
• The need for – sufficient accountability, information, and skills.
• Adherence as a solution that needs to be localized.
• Patient centered or disease centered solutions.
• The governments role in improving adherence via policy and funding demonstration projects through CMS.
• STAR ratings and the bonus payments as an incentive to motivate research and programs in this area.

Overall, it was a good discussion with a very engaged panel and audience.  We didn’t come to any answers, but you certainly got to think about the topic, identify some projects that should be done, and identify some research questions. 

I look forward to pulling out a few of the topics in more depth.  They align well with the communications platform and intervention strategies that Silverlink provides for our clients around adherence.