Promoting Adherence: From Force to Finesse - Pharmaceutical Executive


Promoting Adherence: From Force to Finesse

Pharmaceutical Executive

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Plenty of research has been done to prove that high adherence rates improve health outcomes and reduce costs to the system, and pharmacies understand that better adherence also means higher quarterly returns. The largest chain pharmacies have all rolled out digital services for patients (e.g., e-refills) and physicians (e.g., e-prescribing), and in May, the National Association of Chain Drug Stores (NACDS) Foundation awarded three research grants totaling $1.8 million to study "the impact of pharmacist-collaboration in helping patients manage their medications and avoid readmissions following discharge from the hospital."

Hospital readmissions are expensive, and Section 3025 of the Affordable Care Act requires CMS to reduce payments and, therefore, penalize some hospitals when patients are readmitted within 30 days of a discharge; the provision went into effect in October 2012. Historically, hospitals haven't done a good job supporting patients after they're discharged—there isn't a clear financial incentive attached to counseling patients about healthy routines and medication adherence outside hospital walls. Hospitals make money when patients walk in, not out.

In an effort to fill this gap, for patients and for hospitals worried about readmission rates, Walgreens launched "WellTransitions," a program aimed at patients transitioning out of the hospital to "make sure the patient knows what they're supposed to be doing when they go home," says Kristi Rudkin, senior product development at Walgreens. Medication regimens and schedules often get changed during a hospital stay, so WellTransitions helps patients get comfortable with a new medication routine. "I think patients generally want to do what they're supposed to do, but sometimes things get in the way," says Rudkin.

Walgreens pharmacists assigned to the WellTransitions program—which requires a "small upfront fee to the hospital"—provide medication alignment and bedside prescription delivery; patient counseling and clinical follow-up with physicians; reinforcement contact with patients at nine days and 25 days after discharge; and an monthly joint outcomes report to assess the program's effectiveness in terms of cost and readmission reductions. At the 2014 American Pharmacists Association conference last April, Walgreens unveiled data showing that patients who participated in the WellTransitions program were 46% less likely to experience an unplanned hospital readmission within 30 days of discharge.

In addition to online prescription management tools like opt-in refill reminders and therapy consultations, Walgreens, like Kaiser, is analyzing its own data for targeted interventions. "Our overall technology strategy is to leverage the systems we have and build new systems that allow us to identify the patients that need an interaction with a pharmacist, or need a certain level of service to remain adherent," says Rudkin.

As an example, Rudkin says Walgreens identifies patients filling a new prescription for the first time, and passes that information to the pharmacist, to ensure the patient gets adequate instruction. "When that patient comes back for the first refill [of a new prescription], we alert our system to tell the pharmacist right on the screen whether that patient is on time to refill, or late," says Rudkin. "The pharmacist doesn't have to do any calculations, and that enables a different conversation." Anticipating non-adherent behavior, and intervening before a refill is missed, is a powerful, data-enabled service. But Rudkin says there's work to be done. "Predictive modeling is interesting in and of itself—it's a very important component—but the other side of that is, what do we do with that information, and how do we use it?" says Rudkin. "How do we fit that into the pharmacy workflow to make sure the patients that are struggling can be helped?"

One historical problem with refilling prescriptions—and a leading cause of the periodic pharmacy haggle so many patients have experienced—has to do with prescription alignment, or being able to get every prescription filled at the same time. Rudkin says Medicare has made "huge strides" by implementing override tools to make prescription pick-up more efficient for patients. She also hopes that more insurers will embrace longer refill periods in the retail setting, like a three-month, 90-day supply, for example, which cuts down on trips to the pharmacy, and related non-adherence.

Asked for an example of how pharma might support the pharmacy experience for patients, and facilitate better adherence through Walgreens, Rudkin called pharma's device training programs "a unique service" for patients. By delivering training and instructions to the pharmacist at the time a prescription is dispensed, these programs "help ensure that the pharmacist has a consultation with the patient prior to the sale of the prescription," says Rudkin. "In some cases, the doctor's office has already covered [device training] with patients, but even some of those patients will say, 'Show me again.' Most patients starting a new medication decide in the first three months whether they're going to continue that medication or not."


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