Improving Medication Adherence in a Medicare Population With Personalized Outreach

Getting patients, especially in the Medicare population, to adhere to taking prescribed medications is key to preventing future complications. One health plan used personalized outreach to call Medicare beneficiaries to educate them about adherence and find out more about what barriers might exist to taking medications as prescribed by a healthcare provider. The interventions improved fill rates 18% to 23%.

The undisclosed health plan, a customer of Welltok, a health engagement company, used integrated voice recognition software to make customized calls to the plan’s 78,000 Medicare beneficiaries taking multiple medications a day with a proportion of day covered (PDC) rate between 65% and 80%, according to AnneMarie Gramling, senior vice president of engagement services.

Efforts to increase adherence to medications are on the rise, given the burden of chronic conditions in an older population. For example, a study in The American Journal of Managed Care^® found adherence to glucose-lowering drugs was associated with a significant decrease in the use of acute care resources without any increased total medical costs.

Other efforts to increase medication adherence include 2-way text messaging and medication synchronization programs, which aim to simplify the process of picking up medications, refilling prescriptions, and making pharmacist appointments for an older population.

“PDC is a way of measuring someone's adherence on their medications,” Gramling said. Someone with a PDC rate of 80% would be taking their medicine 80% of the time.

The patients were taking medications for diabetes, hypertension, and/or high cholesterol.

“It gets a little trickier to see if someone’s adherent because they’re on multiple meds,” she said.

The outreach to members happened in an end-of-year push for the health plan.

The automated calls are recorded by professional voice actors and individually customized to each patient. Each message includes a personalized greeting and they are asked several questions about the medications they are currently taking (up to 3). The calls are designed to figure out what is standing in the way of taking medicine, and then give what Gramling calls a “barrier-breaking tip” to help increase adherence.

Someone with a PDC below 80% is “close, but they’re not quite there yet” in terms of being adherent, she said. “They just need a little help.”

After identifying and authenticating that the right person is on the line, the call seeks to educate the patient and then asks about their intent to keep taking and refilling the medication. If the patient gives an answer that suggests that they are not going to refill, the call would suggest the tip based on their response.

Gramling said the most common barriers to not taking medications as prescribed are:

• Cost
• Patient did not understand something about the drug, or how often to take it
• Side effects
• Forgetting to take it

Welltok said the results showed that intent to fill predicts adherence, and that those with medicine available are more likely to refill.

Using these calls, the health plan achieved:

• 18%-23% improvement in fill rates for those contacted vs. those not reached (out of the 78,000 patients)
• 1 and 2 stars improvements across medication categories

Specifically, there was an 18.4% increase in fill rates for patients on hypertension drugs, a 22% increase for those on statins, and a 22.6% increase for those on diabetes medications.

“It’s a really nice way to leverage technology to talk to everyone and then use your care managers to talk to those that are at highest risk,” said Gramling.