Understanding one of America’s costliest health care problems
Up to half of Americans don’t take their medications as prescribed. Nonadherence to medication continues to be our nation’s costliest healthcare challenge. The U.S. wastes hundreds of billions of dollars annually from treating medical complications that could have been avoided if patients had taken their medications as prescribed.
Nonadherence is associated with approximately 125,000 deaths, 10% of hospitalizations and 16%—or $500 billion—of health care spending in the U.S. every year. These emergency room visits, hospitalizations and extra tests not only add zeros to healthcare bills, but often result in poorer health outcomes for patients. Breakthrough and even curative drugs won’t work if patients don’t take them.
Related: How to improve specialty drug adherence for patients with inflammatory conditions
The reasons for this nonadherence vary, and are intricately linked to personal circumstances and individual health journeys. Contributing factors include high medication costs, forgetfulness, side effects, or misconceptions regarding the importance of the medications. Efforts to help patients start and stay on the right medication are crucial to help address existing barriers to adherence and improve overall outcomes.
Solving for medication nonadherence to improve health outcomes
Evernorth is committed to fighting nonadherence with help from Health Connect 360®, by bridging social determinants of health, pharmacy, medical, lab and patient engagement data daily, with precise analysis to make sure no member falls through the crack.
It’s not just enough to know who is nonadherent. It also requires proactive member intervention. Health Connect 360 provides a transformative solution by connecting the right people with real-time data. Health Connect 360 utilizes the Care Insights Hub, a first of its kind platform, to help determine which patients are most in need of outreach and helps clinicians tailor their approach according to what is and isn’t working.,
If a patient identifies behavioral factors such as procrastination or forgetfulness, Evernorth may send the patient a medication adherence device, offer 90-day fills, or suggest auto-renewals.
If a patient has clinical questions or concerns about the medication, the patient can speak with a pharmacist. If cost is the primary concern, the patient can speak with a benefit specialist regarding payment assistance programs, lower cost medication alternatives and lower cost pharmacy options such as home delivery.
To date, a population subset at Evernorth saw a 107% increase in improving and maintaining medication adherence versus standard of care. 87% of patients diagnosed with diabetes, specifically, maintained or improved medication adherence.
Insights from population health managers
At no point does Health Connect 360 rest on automated processes alone. Our entire care coordination team is made up of clinicians specially trained in providing care to your members and coordinating with their providers as needed. The key driver ensuring member care coordination is your Population Health Manager.
Population Health Managers are trained data- analysis clinicians using Health Connect 360’s proprietary platform at the patient- and population- level. The Population Health Manager carefully studies recommendations generated by our advanced patient-level insights, then recommends the right clinical care support at the right time to meet customized client goals. Driving complete care coordination, the Population Health Manager may suggest adjusted therapies that may work better for individual members, while closely monitoring clinical performance to ensure Health Connect 360 delivers the value we promise.
What it means for plan sponsors
For plan sponsors, Health Connect 360 will deliver the assurance of clinical outcomes, backed by a guarantee. Evernorth Health Connect 360 has proven to improve adherence and reduces avoidable medical costs with early detection to identify at-risk patients, patent engagement strategies, and tailored solutions that address patient-specific behavioral, clinical, and cost barriers.
With integrated pharmacy, lab, medical and biometric data, Health Connect 360 identifies relevant, actionable gaps-in-care and health opportunities 14 times faster.
From a cost perspective, enrolled plans saw an average savings of $399 PMPY.1 And we’re not just impacting pharmacy costs.
On average, enrolled clients saw:
- $62 PMPY overall reduction in medical costs1
- $50 PMPY overall reduction in ER costs1
- $90 PMPY overall reduction in inpatient visit costs1
- Increase in primary care visits per year1
1 Express Scripts PBM, Health Connect 360 book of business results 1/1/2020—12/31/2020 results may vary
