Paula Bickley, Vice President of Market Access, Biologics by McKesson

Today, providers and patients face administrative and financial barriers that can make it difficult to access, afford, and appropriately adhere to complex and high-cost treatments. Without coordinated care to ensure proper adherence, the resulting costs can become downright staggering for health systems.

In the United States, medication non-adherence drives an estimated two-thirds of hospital readmissions, resulting in nearly $100 billion in hospital costs, $637 billion in revenue losses for pharmaceutical companies, and approximately $16,000 per patient in losses linked to reduced productivity.

To manage these costs and sustain our already strained health care delivery system, we must make more effective use of the health care ecosystem. Improving adherence is an essential part of this process. It’s impossible to overstate the value in providing exactly what a patient needs during their course of treatment or how this value can extend beyond the patient to benefit payers and manufacturers.

Although the subject matter experts in specialty pharmacy play a meaningful role in helping patients access complex care more effectively, the value of this function is often obscured by mutually exclusive medical and pharmacy benefit silos. The following is a look at effective patient management through the lens of the specialty pharmacy model, focusing on opportunities to reduce overall medical spending by promoting adherence and improved quality of living.

Effective engagement begins well before patients initiate their treatment. Biologics refers to this approach as “getting the first 2 inches right” because it helps lay the foundation for future compliance.

During this stage, the pharmacy team conducts a multidimensional risk assessment to gather critical background information about each patient. This involves financial and social evaluations, caregiver interviews, quality of life surveys, and candid discussions about a patient's personal goals for treatment.

Pharmacists must intimately understand the clinical mechanism of the new drug and all the other drugs the patient is taking (or has taken) before they initiate a new treatment.

They must also get a sense of how well patients understand their disease and whether factors such as cost or language could become potential barriers to adherence later on. This risk assessment will inform the clinical content and frequency nurses deploy to ensure patients are adhering to their treatment.

After the pharmacy team sets the stage for treatment success, a specialty-trained nurse takes the lead clinical role. Of all the strategies a provider can deploy to encourage medication adherence, a productive and trusting nurse-patient relationship has proven to be the single best predictor of compliance.

When patients feel comfortable reporting their symptoms to a nurse, their adherence extends 2 months longer compared with patients who do not, according to a recent pivotal study.

 This trend speaks to 2 critical factors in effective patient management: intentional and well-structured patient care and the value of patient-reported outcomes.

It also highlights the opportunity to develop a clear point of view related to interventions and outcomes in all patient touchpoints, including capturing why a provider is engaging with a patient, which data are being recorded, and how much impact the care is having on cost.

For patients taking oral treatment, for example, the journey can be long and filled with adverse effects. Optimizing their compliance is important as treatment continues. At least quarterly, pharmacy patients should discuss with a nurse to reset treatment goals and strategies as needed.

With this information, the clinical team can also make changes to patient education materials and adapt their initial assessment questions to identify patients who may be at risk for stopping treatment. When patients who are at risk for non-compliance receive customized care plans, the result in their time on therapy can be significant.

Patient centricity in specialized health care means connecting each patient to the right treatment at the right time. While this process may sound straightforward, it often becomes complicated by mutually exclusive legacy silos and models that equate value with discounts.

Consider this example: Not long ago, a disease-focused specialty pharmacy worked hard to get a pharmacy benefit manager (PBM) to approve a costly medication for a patient with life-threatening toxicity who’d been admitted to observation in a rural hospital. After hours of communication, the therapy was finally approved, and the patient was able to be discharged later that day.

Still, the PBM only recognized the therapy's high cost and not that the pharmacy had prevented an even more costly treatment episode. Without the treatment, the patient would have been transferred to another hospital, amounting to a far higher cost than the 1-dose antidote.

Because of these silos, only recently has the cost of non-adherence come into focus. Yet every stakeholder along the care continuum has an opportunity to influence patient access to treatment and help improve outcomes.

It’s time for a paradigm shift that focuses on doing the right thing for the patient — providing the highest quality care rather than focusing on the unit cost of each service. The evidence shows it costs us far more when we fail to put the patient first.

https://www.express-scripts.ca/sites/default/files/ESC_Adherence_Whitepaper_Final.pdf

Molina-Mula J, Gallo-Estrada J. Impact of Nurse-Patient Relationship on Quality of Care and Patient Autonomy in Decision-Making. 

. 2020;17(3):835. Published 2020 Jan 29. doi:10.3390/ijerph17030835

Basch E, Deal AM, Dueck AC, et al. Overall Survival Results of a Trial Assessing Patient-Reported Outcomes for Symptom Monitoring During Routine Cancer Treatment. 

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Without coordinated care to ensure proper adherence, the resulting costs can become downright staggering for health systems.