Blog Categories

Blog Archive

Best Practices to Face the Beneficiary Medication Adherence Challenge

December 31 2015
Author: v2softadmin

Medication volumes and costs continue to grow at a rapid pace year over year. While the volumes continue to rise, paradoxically, the actual level of adherence to the prescribed medications continue to drop. This paradox has cost implications to the payer that is eventually passed onto the member in terms of increased premiums.

Leading us to the question, is there is a better way to control prescription medication costs and improve effectiveness in the medication space? Thus, making a positive impact to the payers’ bottom line and reduced premiums for the member. With our aging population --- a demographic group that has high levels of medication needs --- numbers are growing steadily and it is essential for technology companies to find innovative solutions to the adherence challenge.

Maintaining accurate and accessible data at the various points of healthcare service delivery is the stepping-stone for improving adherence. Solutions that can move the data in a timely manner to the participants, enables making improvements in adherence and eliminate the problems related to drug wastages and increased costs. Some questions that we can be answer are as follows: Is there a duplication of drug classes? Is there a drug utilization review issue? Does the member have enough or excess quantities on hand? Errors and inconsistencies in the information used while prescribing medications will lead to drug duplications, utilization mistakes, etc.

Continual research on multiple payers, prescribers and beneficiaries helps us to correlate the cause and effects of medication adherence and develop the “Building Blocks Model” to design interventions. Each block and its corresponding wheel can be implemented as a technology solution based on the type and levels of adherence.

For example, in cases where we notice that the prescription abandonment rate is high, we may recommend developing an intervention that identifies these members. After identifying, passing that data to the providers so that they can intervene with the patient during their next consultation. Solutions could range from direct integration with the practicing physician’s EMR solution, an EDI transaction to the payers care management solution or a voice activated message delivered to authorized members.

The Building Blocks of Beneficiary Medication  Adherence

Implementing these solutions require a range of technical and analytical skills that involve system integration, communications design and data analytics. We can offer a free review of your prescription spend data and identify patterns in either the causes or effects and provide recommendations for intervention. Our qualified staff of medical/pharmacy benefits and system integrators are available to engage with your operation and clinical teams to deliver solutions. Should you be interested, we would love to talk with you!