We can also create more of an ongoing relationship between the physician and the patient, rather than the seven-minute visit
where the doctors say, 'Here's you medication, I'll see you in six months.' There's a greater understanding now in the provider
community that the traditional delivery system needs to do a much more effective job to support the patient in being adherent.
If we package all of those things together—education, the right incentive, knocking down cost barriers, coaching and counseling,
getting the delivery system to be more supportive of longitudinal relationships—we have a greater probability of moving the
needle on this important issue than if we only did one thing.
Average Rxs For New patients In first six Months Of Therapy By Patient Cost Experience
PE: How can employers quantify the ROI of adherence programs that they're implementing?
AW: I think the basic ROI of encouraging medication adherence, and management of chronic disease in particular, is that it reduces
ER visits. Keeping people out of the hospital has a huge ROI. If you couple that with indirect health and productivity measures,
such as reducing absenteeism, then you're talking about pretty powerful ROI analyses.
PE: How has healthcare reform and the focus on wellness and prevention shifted employers' perspectives on adherence?
AW: I don't think people understand there are many important provisions in healthcare reform that relate to prevention and health
promotion. My hope is that with some patience and more time for healthcare reform to roll out with strategies such as ACOs,
there will be greater awareness that there are critically important incentives that will transfer the system away from acute
care to a system that's focused more on upstream interventions.
PE: What do you think employers can expect from government at the federal and state levels as far as collaboration, cooperation,
and information to help with adherence programs?
AW: I'd start with comparative effectiveness research. The first question is whether pharma medications are effective in terms
of improving health status and treating illness. So this new federal and societal investment in comparative effectiveness
research is foundational to what we're doing.
For another example, we have within the federal reform legislation the creation within CMS of a center for Medicaid/Medicare
innovation—a multibillion dollar center that is supposed to be a catalyst for innovation and is supposed to encourage the
public and private sector—payers in particular—to get together on aligned strategies, whether it's paying providers differently,
advancing ACOs, or working together on standardized measures of provider performance.
I think the government programs have a lot to learn from the private sector and I think the private sector needs to be informed
by the federal investments, commitments, and strategies that the public sector programs are putting in place. But we've got
to create mechanisms to make that happen.