Patient nonadherence is a costly problem to solve, especially for patients with chronic conditions. Nonadherence is the term we use when a patient either does not fill a prescribed medication or does not follow instructions for using the medication or generally adhere to physician orders. While many in the medical field still use the term “compliance,” others have seen this term as negativistic and synonymous with victimization, powerlessness, and the inability to self-determine. Alternatively, the term “adherence” more positively considers the patient’s pattern of behavior in following treatment plans and medical instructions.
Nonadherence is most easily seen in how patients fill and use prescription medications. As many as 20% to 30% of prescriptions for medication are never filled, and up to 50% of medications for chronic disease aren’t taken as prescribed, according to an article in the Annals of Internal Medicine. The analysis notes that the patients’ failure to comply with medication prescriptions—for a variety of reasons—costs the U.S. health system between $100 billion and $289 billion a year.
The Cost of Patient Nonadherence in Chronic Illness Care
First, we must understand that there is always a reason why a patient isn’t following doctor’s orders or taking medication as directed. It’s up to the healthcare provider to find out what it is. Understanding a patient’s personal and social circumstances is crucial to caring for the patient and will ultimately drive down costs, however, busy practices and healthcare systems don’t always have the staff or resources to focus individually on a single patient.
For example, Type 2 Diabetes accounts for the second largest amount of avoidable healthcare costs in the United States — an estimated $24.6 billion in wasteful and avoidable spending. Diabetes is a lifelong disease that is highly dependent on patient self-management, however, studies demonstrate that almost 50% of patients with diabetes fail to reach the glycemic goal of glycated hemoglobin <7% (source: American Journal of Managed Care). Patient nonadherence poses a significant barrier to effective management of diabetes and can place a significant burden on the patient and the healthcare system, resulting in even greater increases in costs, morbidity, and mortality.
The American Diabetes Association defines adequate adherence as 80% compliance (percentage of medications taken divided by the number of medications prescribed by the physician within a given time period). Approximately half of patients with T2D in their first year of therapy fail to take at least 80% of prescribed doses. Estimates show that 47.8% of adult patients with diabetes are not meeting the glycemic goal of glycated hemoglobin (A1C) <7%, illustrating that poor glycemic control in patients with T2D is very common. Conversely, clinical studies show that improved adherence is associated with improved glycemic control and decreased healthcare resource usage.
How a Collaborative Care Model Can Reduce Costs
Higher adherence has been shown to be associated with overall decreased costs, specifically lower acute care costs that lead to total cost reductions. Each 1% increase in adherence among 1,000 patients with diabetes 65 years and older was associated with $65,464 all-cause cost savings over three years (source: American Diabetes Association).
Effective treatment and long-term management of chronic conditions like diabetes requires a patient-centered collaborative model of care with an understanding of the factors associated with nonadherence. Developing patient-, provider-, and system-focused strategies that help increase the rates of medication adherence, reduce complications associated with uncontrolled chronic illnesses, and lower the overall cost of management is key to successfully overcoming barriers to adherence.
Patient centered also means relationships matter. Dr. Ronald Dixon, CareHive’s CEO said that “We believe that meaningful conversations with our guides and gentle nudges can help improve adherence in the long run.”
In at least one integrated health care system, Kaiser Permanente Northern California, a combination of approaches centered on the electronic health record has improved medication adherence rates to above 80%. Other approaches from Kaiser included data collection and risk stratification (NCBI, 2018).
Just as healthcare providers play a key role in treatment adherence through their relationship with the patient, CareHive partners with healthcare providers as a patient-focused, high-touch service that works for providers and practices to serve patients on the frontline. As a white labeled service, CareHive is more than telemedicine. It is an extension of a healthcare practice as well as a partner that can access and update electronic health records, educate patients about symptoms and side effects, ensure that patients understand how to take medications properly, meet follow up appointments, and have adequate support and follow-through that encourages treatment adherence.
“By leveraging the relationship with their healthcare provider, CareHive impacts adherence without adding burden to an already full plate,” said CareHive CEO Dr. Ronald Dixon.