Posted on August 11, 2009

CAMBRIDGE, MA – The New England Healthcare Institute (NEHI) today released new research showing that patients who do not take their medications as prescribed by their doctors cost the U.S. health care system an estimated $290 billion in avoidable medical spending every year. NEHI, a nonprofit health policy organization, recommends four key actions that can best improve medication adherence. 

NEHI’s research, contained in the new report, Thinking Outside the Pillbox: A System-wide Approach to Improving Patient Medication Adherence for Chronic Disease, notes that one third to one half of all patients do not take their medications properly. Patients with chronic diseases – which affect more than half of all Americans – are particularly susceptible to spotty adherence practices that leave them vulnerable to otherwise unnecessary hospitalizations and additional medical risks. According to one study of diabetes and heart disease patients cited by NEHI, mortality rates among patients who did not adhere to their medications were nearly double the rates of those who took their medications as prescribed. 

“This is a growing problem fueled by a growing population – those with preventable chronic illnesses,” said Valerie Fleishman, executive director of NEHI. “As we spend more and more of our health care resources and dollars on these patients, we must do what we can to ensure that they don’t become even sicker by skipping doses of critical medications.”

NEHI’s report cites several innovations that show promise in fostering adherence, including improving drug regimens, reducing cost barriers and tailoring programs to individual patients. From these innovations, NEHI identified the four most promising solutions for public and private policymakers to pursue in addressing the issue of patient medication adherence as part of health reform efforts, including:

•    Creating Health Care Teams – Although physicians play a key role in improving medication adherence by their patients, the issue is often too complex for the physician alone, necessitating additional support through the creation of care teams – incorporating nurses, care managers, pharmacists and other clinicians – either within or outside the physician’s practice. These teams increase the number of touchpoints for patients, offering repeated checks on their adherence as they move through the health care system.

  • Patient Engagement and Education – Counseling by primary care providers and pharmacists to ensure that patients understand their disease and the important role of their medication in improving their condition is critical to motivating patients towards sustained adherence.
  • Payment Reform – Realigning reimbursement incentives away from rewarding volume and towards rewarding good outcomes would encourage providers to strive for improved outcomes by way of improved adherence, as would performance-based or global service reimbursements. Payment reform would encourage providers to invest in resources such as counseling services that would improve patient outcomes by increasing medication adherence.
  • Leveraging Health Information Technologies – Secure, reliable and robust information flows via technologies such as electronic health records, e-prescribing and clinical decision support systems would ensure that complete and accurate medication data are shared among all the key players, including patients, prescribing physicians and pharmacists. For instance, a patient medication profile available through a health IT system would give providers a full sense of a patient’s current medications and, if linked to a pharmacy system, would indicate whether a patient filled or refilled a given medication. 

“The most effective initiatives for improving medication adherence tend to combine one or more of these strategies into a holistic program,” said Fleishman. “Just as this problem is complex – driven by a wide range of cultural, educational and health condition factors – the solution, too, must be complex to address all of these factors.”

The goal of NEHI’s initiative is to first identify and then test strategies for improving medication adherence by chronic disease patients while creating cost savings. NEHI will now conduct in-depth research on the key strategies with the goal of creating a detailed roadmap for private and public policymakers to improve patient adherence.


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

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