$290 billion a year—a study by the New England Healthcare Institute found this to be the amount spent in the United States as a result of medication non-adherence and other avoidable issues. An analysis by Capgemini Consulting estimated that $188 billion account for pharmaceutical industry losses in the United States for the same reason. With such considerable monetary losses in addition to the health risks associated with non-adherence, the profitable future for health information technology (health IT) is becoming increasingly apparent.
After recognizing the significant financial costs associated with non-adherence, many insurance providers are utilizing new initiatives based on health IT that aim to predict non-adherence in an effort to proactively address the issue. In early 2011, CVS Caremark introduced its Pharmacy Advisor™ Program, which pays special attention to patients with chronic conditions like diabetes, who are likely to be non-adherent. In April of 2012, Express Scripts® launched a similar predictive tool called ScreenRx, which detects risk for medication non-adherence and then subsequently provides personalized interventions for those patients. Additionally, companies like RxAnte© and Allazo Health© apply behavioral science, predictive analytics and claims data to formulate algorithms that will allow them to determine which patients would be at an increased risk for non-adherence. They then take it a step further by tailoring interventions according to patient characteristics.
So since there’s no magic crystal ball one can look into to predict medication non-adherence, how do these companies determine who to monitor and intervene with? The key to the above-mentioned initiatives is the incorporation of patient behavior in forecasting non-adherence.
One commonly used model in analyzing health behavior is the Health Belief Model (HBM). This model explains that a patient’s behavior when it comes to health is motivated and influenced by varying perceptions. In essence, the HBM finds that perceived susceptibility, perceived benefits, perceived barriers and perceived seriousness all contribute to decision making when it comes to health, which in this case, would be in reference to taking their medications.
So how relevant is patient behavior when it comes to medication non-adherence? Express Scripts® found that 69% of medication non-adherence was attributed to patient behavior factors including simple procrastination and forgetfulness. With even more advancements in health IT, providers will be able to dissect and rationalize reasons for non-adherence and further analyze patient behavior to formulate optimal regimens that will save billions of dollars all while promoting better health outcomes.
Anita A. Pothen, PharmD’14