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NEHI offers ideas on how to increase adherence
August 19th, 2013
by Greg Jacobson
CAMBRIDGE, Mass. – NEHI has issued a report highlighting what it terms six “priorities for action” to improve patient medication adherence.
The report underlines the importance of increasing awareness of medication therapy management (MTM).
The NEHI report follows closely on the heels of efforts by pharmacy advocates, including the National Association of Chain Drug Stores and its members, to urge members of Congress to support the bipartisan MTM Empowerment Act, that was introduced in March. The legislation seeks to expand access to MTM services for seniors who are enrolled in Medicare.
The six priorities championed by the report emerged from a series of medication adherence roundtables held last year.
They include promoting the sharing of best practices and lessons learned from pilots of new medication management techniques; supporting large-scale implementation of promising, evidence-based tactics for improved medication management; continuing the development of metrics for medication use that will spur adoption of proven medication management strategies; continuing to improve MTM services in Medicare Part D, including improvements in program services and targeting, and consider wider adoption of medication management by other health care players; supporting the continued rapid adoption of electronic prescribing and electronic medical records (EMRs) with capabilities to support evidence-based intervention for improved adherence; and integrating medication adherence research, policy development and advocacy with broader efforts to improve medication use, including those focused on patient safety.
The report notes that innovative programs are often not published in peer-reviewed literature because of the urgency to implement them. It suggests that informal discussions and sharing of MTM best practices and lessons learned will be crucial to speed up learning from the work of health plans and provider groups.
The NEHI report also points to several emerging practices that appear to be effective tactics for improving medication management. For example, it says that nurses or pharmacists should follow up with patients after their discharge from hospitals to verify they have started their medication regimens correctly.
The report further notes that this and other tactics are most effective when combined and supported by such practices as e-prescribing.
According to the NEHI report, Star Ratings for Medicare Part D drug plans are driving adherence promotion by Medicare plans and the pharmacies in their networks.
The ratings are being determined, to a significant degree, by Pharmacy Quality Alliance metrics for adherence to diabetes, cholesterol-lowering and hypertension drugs. Those metrics, the report goes on, serve as proxies for patient behavior by tracking the percentage of targeted patients with 80% or higher Proportion of Days Covered.
NEHI contends that near-universal use of e-prescribing, EMRs and electronic patient medication data exchange is a key factor in improving medication adherence.
“The more providers adopt these capabilities, the more easily the health care system will be able to coordinate medication management and care for the chronically ill,” the report says.
It also notes that the use of e-prescribing has made rapid advances in recent years. According to Surescripts, the national e-prescribing network, 44% of scripts written in 2012 were transmitted to the pharmacy electronically — a 38% increase in just one year. Surescripts also states that 87% of e-scripts were written from an EMR, as opposed to a stand-alone e-prescribing program.
“All this suggests that a foundation has been laid for tighter medication management for chronic disease patients, including the ability to coordinate medication use among prescribing physicians, pharmacists, and other professionals,” the authors say.
However, the next level consists of using electronic prescribing data to coordinate medication use, and there remains ample room for progress on that score. The report cites an article in the New England Journal of Medicine that claims only about 18% of primary care providers are using EMRs even for basic functions such as assembling active patient medication lists.
In spite of the Medicare Modernization Act’s mandate for health plans to offer MTM services, the report finds wide variance in the quality and type of services offered, while many beneficiaries who might benefit from MTM are not eligible to receive such services. The report suggests that as Medicare’s MTM program improves, other payers — including Medicaid, employers and commercial health plans — should consider offering MTM services.
According to the report, medication-related goals and problems are often treated in isolation, even though they could, and should, be addressed through common systems and protocols.
The authors call for a common strategy or vision of improved medication use to provide linkage.