4 Tips for Successful Health Plan Adherence

Medication adherence is often headache-inducing for health plans, both big and small. Whether it stems from plan members failing to pick up prescriptions or taking medications incorrectly, the estimated annual cost of drug-related morbidity and mortality resulting from non-optimized medication therapy is staggering.

A few alarming statistics include:

  • More than 275,000 deaths per year occur due to non-optimized drug therapy.
  • 33-69% of all medication-related hospital admissions result from poor adherence.
  • Half of all Americans currently suffer from at least one ongoing or chronic health condition, but over 50% don’t take their medication correctly.
  • An estimated cost of over $500 billion was lost due to poor medication adherence.

A great way to reduce these negative impacts is to develop a member engagement program for your health plan users.

In this blog, we’ll explain what a member engagement program is, which plan members are at the biggest risk for non-compliance, and what steps your health plan should take towards making the best program for your users.

What is a Member Engagement Program?

In the most basic sense, a member engagement program is something your health plan staff can cultivate to help boost member awareness, involvement, and participation in their own care. Since patient compliance is one of the most impactful variables when it comes to patient outcomes, being able to help individuals manage their medications is key to preventing unnecessary hospital visits, complications of chronic conditions, and even death.

Why Do Health Plan Members Fall Victim to Medication Non-Adherence?

There are a number of reasons that health plan members fail to take their medication as prescribed. The most common ones include:

  • Socioeconomic conditions that prevent them from accessing consistent, comprehensive care.
  • A lack of health literacy that leaves them confused by or frightened of their medication regimen.
  • The absence of reliable transport to and from their in-plan providers.
  • Forgetfulness due to age or dementia.
  • A language barrier between health plan-provided materials and the users themselves.

If your members exhibit one or more of these risk factors, it’s likely that medication adherence will be difficult for them. To combat this, your health plan needs to develop a strategy to make these barriers manageable.

4 Steps for Improving Member Adherence

There are 4 steps your health plan can take to ensure improved rates of member medication adherence. They are as follows:

  1. Encourage understanding: The key to this step is in the name of the program—engagement. The absence of an open, trusting relationship between your health plan and your members can make medication compliance impossible. It’s important to develop multichannel, multi-touchpoint strategies to better understand why members aren’t taking their medications properly. Asking them questions such as the following:
    • What are your concerns about your current medications?
    • What do you need to feel more comfortable or knowledgeable about them?
    • Can you name 3 reasons why you’ve been unable to take your medication as prescribed?

The answers to these questions—and others like them—can help your plan be more aware of risk factors and barriers to successful medication adherence.

  1. Be a resource after a member has left their provider: Most members have no problem bringing home a medication but may not fully understand what its purpose is or if they “really” need to take it. Your health plan can serve as an after-visit resource, ensuring that members know why their doctor prescribed them their medication, how it should be taken, and why it should be taken. Knowing that your health plan is there to help them can greatly improve the chances of members following their prescription instructions.
  2. Provide members with a variety of payment solutions: The cost of medications is one of the most common barriers to adherence. Even financially stable households can be blindsided by unexpectedly high costs of prescriptions. Health plans can address this challenge by creating personalized options that best fit members’ financial status and needs. Things like…
    • Offering generic drug brands instead of their higher cost, “big-name” counterparts.
    • Mail-order options, alleviating the strain of travel for those without consistent transportation.
    • Payment plans that can be done in installments over time.

This will, of course, take considerable effort on the part of your team to determine what sort of payment options will best benefit your members. However, with options like these in place, the potential for continued adherence success greatly increases.

  1. Boost member confidence: Let your members know that you’re here to help them achieve medication adherence. The previous 3 steps mentioned are wonderful tools, but if your members don’t know about them, how much good can they truly do? Sharing comprehensive information regarding the support you can provide them throughout their medication usage can boost their overall health and their perception of your health plan.

Is your health plan looking to enhance member medication adherence? Enhance Medication Services is here to help! With years of industry experience of working with health plans and members alike, we know what it takes to boost your rates of adherence. Contact us today to learn more!

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