As healthcare continues to advance through accountable care organizations and value-based care models, the industry is starting to see some real interest after a decade of groundwork in the form of CMS claims for Medicare Shared Savings Program.
There are some critical elements that drive success here. The role of medication adherence and patient engagement are pivotal to continuing to achieve ACO and VBC goals. Even modest improvements in medication adherence can lead to significant economic impacts on health systems.
These strategies translate into real-world benefits from a “prescribing perspective,” says Dr. Colin Banas, chief medical officer at DrFirst, a medication management technology company. We spoke with him recently to better understand some of the progress being made.
Q: What did the first decade or so of seminal work in value-based care look like, and where do we sit today?
A. The journey of value-based care spans more than two decades, and early efforts have been marked by significant challenges. Initially, organizations struggled with difficult systems interoperability, data sharing, and the high cost of technology upgrades—barriers that complicated the shift from fee-for-service to value-based models, which rely heavily on data analytics and electronic health record systems. .
Initially, the focus was more on reducing costs rather than improving patient outcomes. Health systems had to contend with two conflicting financial models: fee-for-service, which incentivized volume and procedures, and value-based care, which prioritized preventive care and keeping patients healthy.
Organizations using single-payer models, such as Kaiser, had an early advantage because they were not financially dependent on large procedure volumes. At the same time, small providers have been reluctant to adopt value-based models due to the financial risks and limited resources to upgrade infrastructure.
Progress requires that forward-thinking innovators take on the growing pains and prove the viability of value-based care. Over time, pioneers achieved success, and payers like CMS improved metrics and offered incentives for quality care. These efforts have gradually shifted the focus from reducing costs to improving patient outcomes, with increasing recognition of the importance of engaging patients in their care.
Today, value-based care emphasizes collaboration between providers, payers, and other stakeholders to share best practices and improve care coordination. Although steady progress has been made, reconciling fee-for-service and value-based models remains a challenge, as financial incentives often remain conflicting.
S. What role do you believe medication adherence plays as a factor in continuing to achieve accountable care organization and value-based care goals?
A. Medication adherence is essential in any chronic disease management strategy. We’ve all seen the statistics on the high costs of non-adherence: readmissions, ER visits, and complications that arise when patients don’t take medications as prescribed. We know intuitively – without needing detailed data – that if people with diabetes stop taking insulin, their next stop is likely to be the hospital.
Outcomes of conditions such as congestive heart failure, chronic obstructive pulmonary disease, hypertension, and cardiovascular disease are closely linked to medication adherence. Unfortunately, evidence shows that many patients only adhere to their medications for chronic conditions about half the time, meaning their treatments will not be effective.
When patients continue to adhere to prescriptions, the risk of serious complications decreases, which is exactly what value-based care aims to achieve. Even small improvements in adherence can have a big impact, especially when dealing with large numbers of patients. Boosting adherence by just a few percentage points can result in far fewer hospitalizations and better outcomes.
However, achieving this requires a dedicated, multidisciplinary team including nursing, pharmacy, telemonitoring and social work to address real-life barriers to access, affordability and adherence.
Sometimes, patients have difficulty sharing what gets in the way of taking their medications or don’t fully realize the impact non-adherence can have on their health. This is where asking the right questions becomes extremely important – it helps uncover those barriers.
Education and open communication are key. Patients need to understand their treatment plan, and providers need to realize that the challenges patients face may change over time. Staying connected and adaptable is what makes a difference in helping them adhere to their medications.
I would also add that accurate data is crucial – you can’t manage what you can’t measure. So, while adherence is the cornerstone of value-based care, it depends on the right team, tools and tools Targeted patient engagement to be effective.
Q: How can even modest improvements in medication adherence lead to significant economic impacts on health systems?
A. Improving medication adherence even modestly can be financially transformative for health systems, especially when it impacts quality measures such as those associated with CMS star ratings for Medicare Advantage plans. The difference between a four-star plan and a five-star plan – where five stars bring greater incentives and better marketability – is often a 1% or 2% improvement in adherence for conditions such as diabetes or heart failure.
Even with some uncertainty about how incentives might change with new management, if plan adherence rates jump from 80% to 85% or even 90%, that creates a measurable advantage over competitors. Higher ratings attract more plan enrollments and help maintain loyal members.
The financial incentives are obvious, but so are the benefits to patient care. By raising adherence rates, health systems not only gain a competitive advantage but also advance value-based goals with real, measurable results.
S. What role does patient engagement play as a factor in continuing to achieve ACO and VBC goals?
A. Patient engagement is critical, and today, ACOs have more tools at their disposal than ever before. Ten years ago, telehealth was more of a concept than a reality, and smartphones weren’t nearly as ubiquitous. Interoperability between health IT systems has been, at best, a work in progress.
Now, interoperability is improving, and patient portals, digital health platforms, and even asynchronous communications with mobile devices are proliferating. Providers and patients alike have become comfortable with engagement outside of in-person visits.
Today’s digital health tools allow for continuous patient engagement. For example, digital prescription therapies can guide a patient after surgery or through chronic condition management, offering reminders and tasks to complete on specific days.
Imagine a knee replacement patient receiving prompts to perform mobility exercises or track blood thinner use. This keeps the patient on track and sends data back to providers, allowing for proactive adjustments if a patient’s recovery is not going as planned.
This data, known as patient-reported outcomes, can be collected via mobile devices to highlight a patient’s functional status, symptoms and health behaviors, which is vital to objectively assess a patient’s progress. Through these insights, providers gain an understanding of patients’ physical health, pain and overall experience, and how these measures change over the course of care.
Importantly, the data is collected in real time, so a doctor does not need to wait until a patient has been followed up for one month to find out that he or she is not taking blood-thinning medications, for example, or not doing physical therapy. .
A decade ago, this would not have been possible. Today, interaction with patients extends beyond online portals to SMS reminders sent to mobile devices and sensor-based medication tracking systems, which alert both patients and providers if doses are missed. These trackers make a difference by narrowing the gap in data between the time patients fill prescriptions and the time they actually take the medication.
If a patient is supposed to take 30 pills during a month, but the pill bottle is opened only 20 times, the provider can expect that the patient is not taking their medications as prescribed. This multimodal approach allows healthcare providers to meet patients where they are, using tools already available.
As healthcare continues to adopt these technologies, we are building the kind of seamless ecosystem that other industries have enjoyed for years, from banking to retail. It is promising to see healthcare finally catching up in this regard.
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