Guest Blog by NEHI's Nick McNeill on New Adherence Report

Guest Blog by NEHI's Nick McNeill on New Adherence Report

11.15.12 | By Kaelan Hollon

One of the most important aspects living with diabetes is adherence. When a diabetic fails to take care of themselves, an otherwise manageable disease can quickly turn into a hospital admission, or worse. As part of Diabetes Awareness Month and our focus on keeping people healthy, we have a guest blog post from policy analyst Nick McNeill from NEHI, a national health policy institute. He breaks down a new NEHI report about the link between adherence and hospital readmission rates.

Improved Medication Management and Adherence: Essential to Reducing Hospital Readmissions

A PhRMA Blog Post by Nick McNeill, Senior Health Policy Associate, NEHI

It is no secret that high hospital readmission rates are a key contributor to rising health care costs in the U.S. Preventable hospital readmissions cost as much as $25 billion annually, according to NEHI research, and new government payment reforms are trying to tackle the problem by penalizing hospitals with high readmissions rates.

That's a good start, but perhaps even more important than financial penalties is the role that medication management and improved adherence can play in reducing readmissions. Indeed, as providers begin to respond to the "stick" of financial penalties for readmissions, the most innovative among them are also offering the "carrot" of better discharge planning and follow-up care after a patient leaves the hospital. And medication management and improved medication adherence are core components of those new discharge strategies.

This represents a dramatic change from the status quo. Historically, efforts to reduce readmissions and improve adherence have been treated separately. However, NEHI's new report, "Thinking Outside the Pillbox: Improving Medication Adherence and Reducing Readmissions," suggests that the two can be mutually supportive if they are combined appropriately and effectively. The timing for doing so could not be better: as of Oct. 1 of this year, hospitals began facing new federal penalties from CMS if their Medicare patients were readmitted for heart attack, heart failure or pneumonia within 30 days of discharge.

Given intensifying efforts to reduce readmissions, hospitals should look towards proper medication management and adherence for help, as they have proven effective in keeping patients healthy and out of the hospital. A review of successful models of advanced discharged planning and transitional care published in 2011 found that medication reconciliation and medication management, along with services for patient self-management, were key components of nearly all the models. Similarly, a Commonwealth Fund review in 2011 of similar evidence found that "...medication compliance is critical for discharged patients to remain stable at home." These studies, as well as many others, underscore just how central medication management and adherence interventions are to achieving reductions in avoidable hospital readmissions.

The NEHI report also found that these new models of transitional care involve multiple steps that occur both pre- and post-discharge from the hospital, and involve multi-disciplinary health care teams. Furthermore, we found that although these models tend to differ in how and when they use various care team members, as well as in the emphasis placed on certain steps, the models shared five core attributes:

  • Accountability for essential medication-related tasks, in which care coordinators own the medication management process;
  • Teamwork to actively coordinate disparate health care professionals, both inside and outside the hospital and in the broader community;
  • Medication reconciliation at the hospital and in the home to reconcile medications the patient might be taking unbeknownst to hospital staff, discharge planners and primary care providers;
  • Direct engagement with the patient and with family caregivers to teach, counsel and motivate them around appropriate use of the patient's medications; and
  • Follow-up after discharge with the patient and key care providers - such as the hospital, primary care physician and pharmacist - to provide feedback on the patient's progress.

These core attributes of medication management in successful models of transitional care represent the building blocks of fundamental change in medication practices that currently allow an unacceptably high rate of poor patient adherence as well as unacceptably high rates of adverse drug events and patient safety risks. Taken together, these building blocks could form a self-reinforcing system, or what University of Connecticut pharmacy educator Marie Smith, speaking at NEH's recent roundtable in Washington, DC, called an improved "medication ecosystem."

To be sure, we are far from that vision today. Medication management and adherence is still often fragmented and inconsistent, accountability for outcomes is still limited and half or more of patients with prescriptions still fail to take them as prescribed. However, our nation's coming experience with hospital readmissions initiatives may be the impetus needed to spur far-reaching action throughout the health care system to achieve a fully functioning medication ecosystem.

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