NEHI Proposes Strategies for Promoting Better Medication Adherence

April 7, 2010

BOSTON, MA (April 7, 2010) –The New England Healthcare Institute (NEHI) today outlined four promising strategies for combating the persistent and costly problem of patients not taking their medications as prescribed by their doctors, and said that the new health reform law should provide momentum to the effort.

In an article published in the New England Journal of Medicine (NEJM) , NEHI said that health reform will spur the kind of systemic changes needed to improve patient medication adherence, particularly in primary care and with continued investments in information technology systems and new health plan designs that focus on achieving improved health outcomes.

“We’ve known for some time that improved adherence can lead to improvements in health outcomes and reductions in health care spending,’’ writes NEHI President Wendy Everett with her co-author, Harvard Economics Professor David Cutler, who was senior health care advisor to Barack Obama’s presidential campaign. “What we haven’t known is where to start.’’

The article, titled Thinking Outside the Pillbox: Medication Adherence as a Priority for Health Care Reform, appears on the NEJM's website and will be published in the journal’s print edition on April 29.

Data show that as many as half of all patients fail to take their medications as prescribed in the 3.8 billion prescriptions written every year. A number of factors contribute to poor adherence, including the cost of medications, lack of care coordination, and patients’ personal factors such as lifestyle, health literacy, support systems and medication side effects. Poor adherence is a major source of wasteful spending, resulting in more than $100 billion in avoidable hospitalizations annually, the article says.

Key strategies for improving medication adherence include:

• Reducing financial barriers. There is growing evidence linking reduced co-payments for chronic disease medications to improved adherence. In addition, patients could be given financial incentives or other rewards for taking their meds appropriately.
• Investing in health information technology. Data and data infrastructure that support interventions to boost adherence should be a high priority of the country’s new HIT investment. The strategy should not only encourage the incorporation of accurate patient medication histories and prescription fill rates, it should also encourage sharing of the data across physicians’ offices, hospitals, pharmacies and home health care agencies.
• Implementing payment reform. The fee-for-service model should be shifted in favor of payment systems that reward care providers for better patient outcomes and encourage care coordination, both key to providing the incentives and investments required for improving adherence.
• Understanding the patient. There are proven screening and assessment tools, such as patient questionnaires and interviews, that can identify and target the patients who are at greatest risk for nonadherence. Assessment tools can also broadly predict a patients’ proclivity to adhere to treatment.

The article says that as the new federal health care reform law moves to implementation, the existing movements toward care coordination, payment reform and deployment of health information technology together provide momentum and infrastructure for improving outcomes through improved adherence.

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About NEHI
The New England Healthcare Institute is an independent, nonprofit organization dedicated to transforming health care for the benefit of patients and their families. In partnership with members from all across the health care system, NEHI conducts evidence-based research and stimulates policy change to improve the quality and the value of health care. Together with this unparalleled network of committed health care leaders, NEHI brings an objective, collaborative and fresh voice to health policy. For more information, visit www.nehi.net.