Medication adherence is one of the most important levers for improving healthcare outcomes and reducing costs. In a recent Bright Spots in Healthcare live episode, our CEO and Co-Founder, Sebastian Seiguer, engaged in a timely discussion on this topic with a panel of health plan experts: Tom Manetti, the Associate Vice President of Quality Products at CareSource; Molly McGraw, PharmD the BCPS Manager of Clinical Pharmacy at UPMC Health Plan; and Suzanne Moxham, the Director of Quality, Accreditation, and Government Programs at CareFirst BlueCross BlueShield. 

During the conversation, they explored the following innovative tactics to promote medication adherence: 

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Providing members with extended supplies of their medications

“If we have a provider who is prescribing for 30 days. We also work very diligently to convert 30-day prescriptions to 90 days or even 100 days…So obviously, that’s pretty basic thinking, that if we can decrease the amount of time someone has to go retrieve their medications, they’re going to be more likely to take the medications that they have on hand. So it’s a simple concept, but it’s gone a long way.” - Suzanne Moxham, Director, Quality, Accreditation, and Government Programs at CareFirst BlueCross BlueShield

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Using video Directly Observed Therapy to ensure medications are being taken

“If you really want to understand, on a day-to-day basis, if somebody is taking their medication, taking their inhaler, taking it properly. One approach is Directly Observed Therapy (DOT)—known as the gold standard for really understanding if somebody is actually takes their medication on a daily basis.” - Sebastian Seiguer, CEO and Co-Founder of Scene Health

“[Through Scene’s video strategy], we see improvement in our outcomes and not just the A1C control, but the other parts of things that need to be done for members with diabetes. We’re seeing that they are more compliant with their eye exams, and they’re more compliant with other items of care that they need. So we do see a better rate of the people that participate in [Scen’s] program and have engaged in the program compared to those that haven’t…We’re also seeing that they are utilizing the right care, they're receiving care at the right places, so they're not showing up in our ERs as much and they are having those PCP visits. So it's really great when you can see the whole picture coming together; they're more compliant with all of the things that we need them doing, not just the medication.”  - Suzanne Moxham, Director, Quality, Accreditation, and Government Programs at CareFirst BlueCross BlueShield

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Focusing on value-based care models that remove barriers

“In general, in healthcare. What we want to do is make sure that these drugs, these medications, actually are used by the patient to improve their health. That's the point in the end. So all these delivery mechanisms are wonderful, but we just have to make sure that we get the benefit of all the expense that goes into that. And so Directly Observed Therapy is a value-based strategy in general. You're trying to make sure that the benefit of what the physician ordered is actually executed by the patient. And it turns out there's a lot of barriers to doing that.” - Sebastian Seiguer, CEO and Co-Founder of Scene Health

“When we think about value-based care, right, we really think about the member and how we can really surround the member with support. And a lot of the members that we go through, they’re disadvantaged. One of their biggest struggles is not being able to pay for their drugs…We’ll call them up, and they’re on tier 2, tier 3 of an expensive diabetes drug. So, when we think of med adherence. It’s a team sport…CMS is actually a player in this, too. So there is something called the VBID value-based insurance design model, and we were able to do a lot of innovations around drug benefits. As an example for DSNP members, because a lot of them are disadvantaged, for this very specific population, this coming year, our members will pay nothing for drugs across all tiers. They will pay $0.00 as co-pays, and that is a huge, huge deal for our members.” - Tom Manetti, Associate Vice President, Quality Products, CareSource

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Leveraging the value of pharmacists who can connect with members

“We leverage pharmacists across many health plan programs and initiatives. Our care management pharmacist team is a dedicated team of 20-plus pharmacists that we have that provide support to and interact with our members on a daily basis through various clinical programs that we offer, including chronic condition management, transitions of care, medication reconciliation, obviously, medication adherence programs and other quality initiatives that we run daily. And with these programs anywhere where a pharmacist is embedded in these programs, our outcomes have shown really amazing results in terms of approving improving medication adherence medication use while also helping to decrease medical costs and total cost of care.” - Molly McGraw, PharmD, BCPS, Manager, Clinical Pharmacy, UPMC Health Plan

“We have an internal pharmacy team as well like Molly described, but we also have been engaged with Scene Health for my whole time here, my 2.5 years at CareFirst. So with that, it was really a great opportunity for us because one of the things involved in Scene’s program is a comprehensive medication review process that was not occurring for us in our Medicaid plan, and during that process, we found, commonly, that the members were not receiving enough medications to control their chronic conditions. And then, the outreach that Scene does is the physician-to-physician interaction to get those therapies and medication regimens reviewed and getting the right things prescribed to help improve the management of the member's chronic conditions. So, I think that was a really exciting opportunity for us to have that part occurring for the members because that was something that my internal pharmacy team was not able to take on just because of resources. So that was a great win for us.”  - Suzanne Moxham, Director, Quality, Accreditation, and Government Programs at CareFirst BlueCross BlueShield

“We have an RX solutions center in our pharmacy department. And this pharmacy team is very much like Molly described: we have pharmacists, we have pharm techs, we have nurses, we have a variety of folks of different capabilities. They’re able to connect with members and not only connect with members but escalate different issues. So, as an example, let’s say that there is a prescription problem. They can connect with the physician, and we even have physician-to-physician escalations where we can improve the medical care of our patients. So, this is absolutely critical in this RX solutions center. It’s very important to have a customer service outreach tracking module, very much like a CRM. And what this does is it allows you to get reports, and it allows everyone to see what the other person is doing. So that care is fully coordinated. So this, combined with the VBID free prescriptions that we give, no co-pays to our members, it’s been doing wonders for our patients.” - Tom Manetti, Associate Vice President, Quality Products, CareSource

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Connecting to people where they are to identify and address SDOH barriers

“It is well known that social risk factors and social determinants of health are a main barrier to medication adherence. So, across all of our member interactions, we have embedded social determinants of health assessment to better enable problem-solving and triaging to both the community and our health plan resources that we have. We've also implemented several tools proactively to close the gap on health disparities in our interactions…Just to name a few of those, leveraging data sets that we have available to target and prioritize numbers that are high risk by race, ethnicity, language preferences, and area deprivation index and incorporating that into our programs. We’re also personalizing and digitizing our recommendations when applicable, training our pharmacist not only in motivational interviewing but also in cultural humility.” - Molly McGraw, PharmD, BCPS, Manager, Clinical Pharmacy, UPMC Health Plan

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Engaging in care coordination to link members to the care and support they need

“If you think about it holistically, what do you need for a member to succeed on medication? You've got at least three major components, and this is oversimplifying it. But they've got to see a provider because otherwise, they're not going to get prescribed medication. They have to have lab results in order for you to understand that they have a medication adherence problem…And then, finally, as we've heard, they need to have their medication. And that whole continuum, it's been called the cascade of care or securing it is called linkage to care…Along the way, if you're not going upstream and fixing problems at their root cause and making these linkages, you are not going to succeed with the medication adherence strategy.” - Sebastian Seiguer, CEO and Co-Founder of Scene Health

“A lot of coordination of care is being done through this environment, through our “Ask a Pharmacist” modality. Patients have trouble getting to the pharmacy. What can we do to connect them? So, we have resources to be able to put them in place with high-touch pharmacies and medication synchronization. Obviously, converting 90-day prescriptions, as Suzanne already commented on, and free delivery services. So, really trying to connect them to care in a more comprehensive manner and this basic base virtual engagement has really proved to be effective. We're seeing repeat members sign up for appointments and members recognizing pharmacist names. Creating that relationship has really helped and benefited us.” - Molly McGraw, PharmD, BCPS, Manager, Clinical Pharmacy, UPMC Health Plan

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Working with providers and incentivizing adherence

“Med adherence really can’t happen without the provider. The provider is the key cog in helping patients to stay adherent. So it's so important we work with our provider groups because our provider groups have a lot of resources. They not only have physicians, they have pharmacists, they have support staff. And with this support, we can continue to circle the patient and provide them the care that they need…We have to make it financially worth it for them, right, because they're partners. But they have to pay rent. They have to pay their medical assistants. So it's important that when we look at value-based agreements, we look at a very comprehensive approach. We don't look at just HEDIS. We look at other things as well, too; when we can incentivize for med adherence, it's important that we do. So that if we win, the provider wins, we win together.” — Tom Manetti, Associate Vice President, Quality Products, CareSource

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Looking ahead

The discussion provided actionable insights for health plans and organizations looking to enhance medication adherence and, in turn, improve the overall well-being of their members. If you’re interested in understanding how we help health plans implement these tactics through one comprehensive strategy, contact us.

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Watch the full live episode recording

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