Improving Medication Adherence During a Pandemic

BY DOROTHY LOCKHART, MBA, MSN, RN

When the COVID-19 pandemic arrived in Central Kentucky in March 2020, CHI Saint Joseph Health Partners (Health Partners) recognized the need to develop new strategies to make a difference in our populations. Like many areas of the country, provider offices temporarily closed, appointments were canceled, and patients postponed treatment and preventive screenings even after provider offices reopened.

Health Partners leadership knew that a strategy focused on pharmacy quality measures would make an impact, even while patients were not accessing care from providers. As a care management team, we believed that medication adherence was paramount to keeping our patients out of emergency rooms and avoiding unnecessary hospital stays during the pandemic.

PARTNERING WITH PAYERS

We began the effort by using data from contracted payers to identify patients who had failed the medication adherence measure the previous year or years. Once the current year data was available, our clinical pharmacist partnered with the payer’s clinical pharmacist to obtain medication reports for each Health Partners market.

Once the patient was entered into the measure, the Health Partners clinical pharmacist was able to determine the last date that an intervention could make an impact before the patient would fail the measure for the current year.

We then used these reports to monitor adherence on a monthly basis. The streamlined strategy was to first reach out to those identified patients— understanding that if a patient failed the measure in the previous year, he or she would likely fail the measure again. Regional market clinical directors disseminated the reports to our RN ambulatory care coordinators (RN ACCs) and ambulatory care assistants (ACAs).

PATIENT OUTREACH

The assigned RN ACC or the ACA called all patients on the monthly list who had a “last impactable date” occurring that month. During these outreach calls, the RN ACC also addressed other quality measure needs, including diabetes control, A1C testing, and the importance of medication adherence.

Staff acknowledged that patients may have previously failed the medication adherence measure due to social or economic barriers preventing them from accessing medications. If the patient was unable to obtain medication due to a social determinant of health, a referral was made to the Health Partners social work ambulatory care coordinator to assist the patient in overcoming any obstacles.

Dorothy Lockhart, MBA, MSN, RN

“Medication adherence was paramount to keeping our patients out of emergency rooms and avoiding unnecessary hospital stays.”

When appropriate, staff assisted patients who wanted to switch their prescription medications to a mail-order pharmacy system. Patients often wanted to do this because of concerns about COVID-19 and entering the pharmacy in their local community. If patients needed a new prescription, staff were able to schedule them for a telehealth appointment with their provider to address any acute care concerns.

5-STAR ADHERENCE

Health Partners was able to overcome the multitude of barriers arising from the pandemic and still achieve 5-star medication adherence for our largest Medicare Advantage population in all three categories: diabetes, hypertension, and cholesterol. Data show an increase in adherence over the previous year by an average greater than 2.3%.

Acknowledging that complications from untreated diabetes can have many detrimental consequences, we gave additional focus to diabetes patients—resulting in a more than 3% improvement in medication adherence in 2020.

Through this effort, Health Partners displayed innovation by utilizing claims information and partnering with each payer to reach the patients most at risk. We improved medication adherence compared with previous years— even in the midst of a pandemic. As the impact of COVID-19 continues, the opportunity exists to impact additional Kentucky populations as we continue this same medication adherence model in 2021.

Health Partners is committed to coordinating evidence-based, cost-effective services across the lifespan of those we serve. This means we will do our very best to ensure that the right care is delivered at the right time and at the right place. It includes a promise to communicate clearly to our patients, our providers, and our stakeholders and to coordinate services correctly and proactively. o

Dorothy Lockhart, MBA, MSN, RN, is Market Vice President of CHI Saint Joseph Health Partners. She is an active member of APG and participates in the Risk Evolution Task Force (RETF). She can be reached at 714-878-5173 or at dorothylockhart@sjhlex.org. For more information about CHI Saint Joseph Health Partners, please visit CHISaintJosephHealthPartners.org.

ABOUT HEALTH PARTNERS

CHI Saint Joseph Health Partners (Health Partners) is a physician-led clinically integrated network based in Lexington, Kentucky. Established in 2012, Health Partners is currently affiliated with 10 Kentucky hospitals, their associated medical groups, and other independent providers. This allows Health Partners to have a unique position to make a real difference in healthcare for those in Central to Southern Kentucky.

Through these partnerships—and our alignment with CommonSpirit Health—we are leading the way in value-based care by measuring, reporting, and rewarding excellence in healthcare delivery. Our efforts recognize that long-term solutions to disease management include understanding and managing social determinants of health.

The Health Partners team implements advanced data analytics to connect all available wellness resources for a more organized and individualized healthcare experience. By analyzing the health data of our populations, we stratify health risks and work alongside provider offices to deliver customized care to the patient. By focusing on patients who incur the highest medical costs and addressing those at risk for developing more serious health complications, we utilize our skilled multidisciplinary care management team to meet each individual’s needs.

Our solutions, designed for a person-centered approach, encourage a 1:1 relationship between local care coordinators and the individual patient. This holistic model integrates an individual’s health, medication management, nutrition, exercise, and stress reduction, which may affect the ability to improve and sustain better health. Our integrated approach improves outcomes and reduces healthcare costs by identifying and monitoring high-risk populations, encouraging adherence to treatment plans, providing patient education, and promoting preventive screenings that can help to prevent further complications and worsening disease conditions.