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Electronic Medication Adherence Collaborative

Poor medication adherence costs the healthcare system nearly $300 billion a year and takes the lives of 125,000 Americans annually. Solving medication adherences issues would have a significant impact on downstream costs and improve outcomes for patients. Current medication adherence initiatives are siloed and narrowly focused. Pharmacies, clinicians, payers, pharmaceutical companies and EHR vendors are spending money on adherence programs, but unsure of their effectiveness. Many of these silo efforts are disjointed and lack a multi-disciplinary approach. A forum is need to share information about efforts and coordinate across the spectrum of healthcare stakeholders.

The rational for the need for increased studies and collaboration in this space is clear. This is a high need area that is costing the industry billions of dollars annually, but moreover is detrimental to the health of patients. Here are some key facts for consideration:

  • Global Medication Adherence Market is forecasted to experience significant growth during 2016-2022. As per the United Nations Department of Economic and Social Affairs (UN-DESA) report on the global aging population, the population of people aged 60 years or above is growing with high rate. (P&S Market Research)
  • Nonadherence results in an economic burden of $100 to $300 billion per year. Annually, nonadherence costs $2,000 per patient in physician visits. (American College of Preventative Medicine)
  • Nonadherence to medications is estimated to cause 125,000 deaths annually (American College of Preventative Medicine)
  • Overall, about 20% to 50% of patients are nonadherent to medical therapy (American College of Preventative Medicine)
  • Up to 30% of prescriptions are not filled. (Express Scripts)
  • People with chronic conditions only take about half of their prescribed medicine. The rate of nonadherence is expected to increase as the burden of chronic disease increases. (American College of Preventative Medicine)
  • Patients with psychiatric disabilities are less likely to be compliant. (American College of Preventative Medicine)
  • Recent research has found medication nonadherence to result in: 5.4 times increased risk of hospitalization, re-hospitalization, or premature death for patients with high blood pressure (American College of Preventative Medicine)
  • The most typical customer-cited reasons for non-adherence are: complex therapies, cost, cultural or religious beliefs, disagreement with their diagnosis, forgetfulness, health literacy, irregular lifestyle and side effects. (Cigna)

Objectives

Foundation for eHealth Initiative (eHI) is launching a multi-stakeholder Electronic Medication Adherence Collaborative (eMAC) to identify how information technology and data analytics can be used to improve the adherence to medications. This initiative will take a consumer approach to understand the behavioral-economic factors that influence patient behaviors and preferences.

eMAC creates a forum for data transparencies to encourage stakeholders to work more closely together, and ensure EHR vendors have systems to facilitate the flow of data. The initial 9-month eMAC project would create a forum to share information about existing initiatives and recommend areas for sharing data and partnering.

The primary objectives of the eMAC project are to:

  • Introduce the medication adherence issue as a multi-stakeholder problem that requires a consumer-focused collaborative approach.
  • Harvest the work that has been done before by bringing key researchers and thought leaders to the table. Share best practice examples from the different analytical and behavioral approaches to educate different stakeholders on the effectiveness of current programs.
  • Identify areas where benefits could be gained by combining approaches, data and solutions across the continuum of care. 
  • Release consensus based industry and policy recommendations to combine solutions and launch a plan of action supported by the key collaborators. Recommendations will be publicly disseminated for general and professional audiences.

     

Project Milestones

In collaboration with leading stakeholders across the industry and under the guidance of experts from leading healthcare organizations, eHealth Initiative will:

  • Launch the project and outline the initiative. (Spring 2017)
  • Convene executive advisory board meetings of respected leaders to ensure the objectives are clearly defined and begin sharing best practice examples. (Spring 2017)
  • Executives will convene again to share best practices and participate in a consensus process to develop cross industry recommendations (Summer 2017)
  • Disseminate initial best practice findings virtually to public via webinar (Summer 2017)
  • Host a fall gathering to share consensus based recommendations and get industry feedback (Fall 2017).
  • Release and disseminate final recommendations (Winter 2017) through virtual event and press release.

Advisory Board

eHealth Initiative will convene an Advisory Board for eMAC with respected leaders to ensure the objectives and deliverables are clearly defined for the duration of the proposal. The committee will be comprised of multi-stakeholders from the private sector. This Board will meet in person at least two times during the duration of the project. Supporters will be recognized as founding members and serve on the Board.

Approach to Medication Adherence

Generally, there are two approaches to tackling the adherence issue: behavioral and analytical. Behaviorally, there have been programs focused on counseling at the pharmacy point, motivational interviewing techniques, or exploring barriers patient face.  Second, there is general consensus that analytic approaches have the capability to improve medication adherence. Analytic programs focus on:

  • Access to quality data
  • Permission to share the data
  • Interoperability
  • Provider’s ability to make use of the data analytics.

This collaborative will explore areas where analytical solutions might be valuable in assisting behavioral interventions of medication management. Specifically, identifying areas where stakeholders in the private sector might partner to share data or develop collaborative approaches across the continuum of care, in an effort to improve outcomes and reduce costs.

Stakeholders to Engage

Founding supporters of the collaborative will assist in identifying stakeholders to engage, including, but not limited to: providers, pharmacy benefit management (PBM) companies, payers, employers, patient medication information systems, analytic vendors, pharmaceutical manufacturers, patient groups, and other key partners.

APPENDIX A: Key Reports

There are many reports on medication adherence that investigate the casual factors and implication of noncompliance. The primary objective of this collaborative is to harvest the work that has been done before and understand where the gaps lie, so that the collaborative can choose a focus area to develop high impact solutions. The following key reports are recommended for review:

APPENDIX B: Organizations Working in this Area

Organizations active in Medication (put in appendix)

Stakeholder

Location

What they do

National Community Pharmacists Association (NCPA)

Alexandria

Represents America’s community pharmacists. Created the first National Report Card on Adherence.

American Heart Association Advocacy Department-

Washington, DC

The American Heart Association/American Stroke Association is committed to advocating for innovative approaches to help improve medication adherence.

Prescriptions for Healthy America(P4HA)

Washington, DC

Coalition of 30 organizations to identify ways of improving medication adherence rates in the United States.

 

American Academy of Family Physicians

 

Washington, DC 

AAFP joined P4HA a broad-based coalition that wants to improve patient care and save billions in health care costs by implementing strategies to improve the nation's medication adherence rates.

Express Scripts

St. Louis, MO

prescription benefit plan provider that makes the use of prescription drugs safer and more affordable for our members.

Institute for Genome Sciences and Policy, Duke University

Durham, NC

Pharmacogenetic (PGx) testing may serve as another tool to boost patients’ confidence in the safety and efficacy of prescribed medications. Here, we consider the potential impact (positively or negatively) of PGx testing on medication-taking behavior.

WRB Communications

 

Chantilly, VA

WRB designs and executes successful customized patient compliance and medication adherence programs to address each reason for non-adherence and encourage patients to take their prescribed medication as directed.

Merck

 

Washington, DC

American pharmaceutical company and one of the largest pharmaceutical companies in the world.

Patient-Centered Outcomes Research Institute (PCORI)

Washington, DC

An independent nonprofit, nongovernmental organization that funds research projects- some have been on medication adherence.

National Institutes of Health (NIH)

Bethesda, MD 

The nation’s medical research agency. Promotes medication adherence in diabetes- The National Diabetes Education Program.

National Council on Patient Information and Education (NCPIE)

Rockville MD

NCPIE has been working to advance the safe, appropriate use of medicines through enhanced communication since 1982.

American Pharmacists Association Foundation (APhA)

Washington, DC 

For over 60 years APhA has been a source of research demonstrating how pharmacists can improve health care. Their Appointment Based Model (ABM) is a patient care service designed to improve patients’ adherence to medications and build efficiencies in pharmacy operations.

American College of Preventative Medicine (ACPM)

Washington, DC

Provide a number of resources to educate patients and providers on medication adherence including the Clinical Reference Document, the Guide for Patients and Evaluation document.

National Consumers League

Washington, DC

They address the need for tools and resources to support improved medication adherence across the country and to open dialogue between health care professionals and patients about the health consequences of non-adherence.