Health systems like Magnolia Regional Health Center are boosting patient engagement and reducing wasted prescriptions with new services at the point of care.
Medication adherence is a significant pain point for healthcare providers, contributing to wasteful expenses, physician stress, and reduced clinical outcomes. Some health systems are turning to digital health technology not only to help patients take prescribed medications, but to make sure those drugs are the most appropriate and economical.
At Magnolia Regional Health Center in Corinth, Mississippi, clinicians are using a digital tool developed by DrFirst within their Meditech EHR to identify prescription benefits and therapeutic alternatives (ranging from other treatments to lower-priced generic medications) with patients at the point of care. The myBenefitCheck tool enables clinicians to reduce the chances of a patient deciding not to fill a prescription or follow dosing instructions.
"We've had some challenges over the years," says Brian Davis, CHCIO, the hospital's chief information officer.
A 2017 study estimated that 69% of patients with at least $250 in annual medication costs are abandoning their medications, a percentage that had risen steadily due to rising out-of-pocket costs, and undoubtedly has gotten worse because of the pandemic. Health systems like Magnolia are now using new tools to address that issue at the point of care.
Where clinical decision support tools originally allowed care providers to research symptoms and identify treatments, new technology taps into the EHR and other databases to expand that palette. Providers can now access the entire patient record, including claims data, to better understand how a specific patient might react to a specific treatment (including whether a patient can afford that treatment) and collaborate with the patient on treatments that would work.
To study the tool's effectiveness, Magnolia Regional analyzed medication adherence and prescription fill rates for 417 patients living with congestive heart failure (CHF) between July 2020 and September 2021. They found that first-fill prescription abandonment rates for expensive antithrombotics was higher for patients readmitted to the hospital (50%) than for patients who didn't have to return (35%), while there was little difference between the two groups when less expensive anticoagulants were prescribed. The evidence indicated that patients were not filling their prescriptions or not following doctor's orders when cost was a factor.
Brian Davis, chief information officer for Magnolia Regional Health Center. Photo courtesy MRHC.
Davis says these tools allow doctors to talk with patients at their most vulnerable moment—when they're being diagnosed and given a course of treatment. That's when clinicians may have the best chance of ensuring long-term care management.
"If providers had access … at the point of care, they could have better conversations," he says. "This allows our care providers to get in front of medication adherence."
Magnolia Regional's experience is one example of how innovative technologies and strategies are being used to improve medication management. Some providers use digital pill boxes, telehealth platforms, or mHealth apps to track medication adherence at home, while others are deploying technology to give clinicians the resources to discuss adherence with patients as they're being treated.
The advances extend to eprescribing as well. At the recent HIMSS22 conference in Orlando, First Databank (FDB) unveiled FDB Vela, a cloud-based platform that integrates with the EHR and, according to its makers, "enables the seamless flow of critical medication prescription information, benefits verification, and clinical decision support between prescribers, payers, pharmacies, and other constituents."
"Drug information needs to be integrated into the EHR" to give clinicians tools at the point of care, says Robert Katter, FDB's president.
Katter says much of the innovation these days is tied to patient-centered care. Consumers are asking for that information, he says, when they meet with care providers, so that they can make informed decisions about their care.
The new technology and strategies address several concerns in care management. Aside from aiming to reduce the amount of wasted or unused prescriptions, care providers want to know whether the treatments they're prescribing are working, and that only happens if the patient is following doctor's orders. Pharmaceutical companies would also like to know that information, which they could use to design more effective medications.
Then there are the clinical outcomes. If a patient doesn't follow treatment, the condition might worsen, perhaps leading to more treatments and even hospitalization. The same outcomes might be seen in a patient that is taking the wrong medications, or not taking the right doses.
Davis says that care providers have the opportunity to talk with patients not only about the different types of treatments available, but the varying degrees of effectiveness. One drug may be more expensive than a generic alternative, but it's more likely that the first drug is more effective, while the generic drug may get the job done but over more time. The doctor might also find more information in the patient's medical record on the potential for side effects.
Branded, higher-cost medications "do tend to show better outcomes," says Davis. But that doesn't mean a generic medication isn't effective. And if a patient can afford only the less expensive drug, there's a much better chance that he or she will fill the prescription and follow doctor's orders.
"It has led to several changes in medications," he says.
These tools also affect patient engagement, or activation. A clinician who has more specific information at the point of care stands a better chance of having a meaningful conversation with the patient, one that gets the patient involved in his or her care. A more engaged patient would then most likely follow the care management plan, or be more inclined to work with the clinician to make sure the course of treatment is effective.
Davis sees these new tools and strategies as the first step in a more comprehensive care management program, particularly for patients with chronic conditions. And they point to the need for a robust EHR that includes a patient's complete medication history and integration with both the health plan and the pharmacy.
Beyond that, there's an opportunity on these platforms to identify social determinants of health, such as why a specific patient won't take certain medications or can't afford them. A clinician who has insight into a patient's home and family life, financial concerns, and other pressures would then be able to design an appropriate care management plan that offers a better chance of being followed.
"There's some work there in balancing these things out," he says.
“If providers had access (to digital health technology) at the point of care, they could have better conversations. This allows our care providers to get in front of medication adherence. ”
— Brian Davis, CHCIO, chief information officer, Magnolia Regional Health Center.
Eric Wicklund is the associate content manager and senior editor for Innovation at HealthLeaders.
KEY TAKEAWAYS
Roughly two-thirds of people with at least $250 in prescription expenses in a year aren't taking their prescribed medications or aren't filling them, leading to wasted healthcare costs and reduced clinical outcomes.
New strategies in patient engagement and digital health tools that improve clinical decision support are helping care providers work with patients at the point of care to improve medication management.
These strategies and tools help providers improve care management, while helping patients improve clinical outcomes and giving pharma a better look at whether drugs are working. They're also becoming an attractive benefit for health plans.