Key Facts Matrix

Key Facts Matrix- Frontier Innovation

Topic

Sub-topic

Relevancy

Data Type

Trends in Aging

Chronic Disease, Diabetes, Arthritis

Relevant

Statistic

Trends in Aging

Population on the Rise

National Health and Aging Trends Study

NHATS

Relevant

Statistic

National Health and Aging Trends Study

Mortality Rates

Definition

Relevant

Definition

Loss in Revenue

Relevant

Summary

Medical NonAdherence

NIH (National Institutes of Health) supported survey to study functional change in older adults

Non-Adherence

Loss of Possible Revenue

Medicare Beneficiaries Participate in Long-Term Study

Stakeholders

Relevant

Summary

Key Facts

Source

In the United States, approximately 80% of all persons aged >65 years have at least one chronic condition, and 50% have at least two. Diabetes, which causes excess morbidity and increased health-care costs, affects approximately one in five (18.7%) persons aged >65 years, and as the population ages, the impact of diabetes will intensify. Chronic conditions also can lead to severe disability. For example, in the United States, arthritis affects approximately 59% of persons aged >65 years and is the leading cause of disability The health-care cost per capital for persons aged >65 years in the United States and other developed countries is three to five times greater than the cost for persons aged <65 years. The number of persons aged >65 years is expected to increase from approximately 35 million in 2000 to an estimated 71 million in 2030 (3), and the number of persons aged >80 years is expected to increase from 9.3 million in 2000 to 19.5 million in 2030

Further Research

"Public Health and Aging: Trends in Aging Which chronic conditions are most --- United States and Worldwide." Centers common in ages 65+ for Disease Control and Prevention. Centers for Disease Control and Prevention, 14 Feb. 2003. Web. 01 Sept. 2013. <http://www.cdc. gov/mmwr/preview/mmwrhtml/mm5206a2. htm>. "Public Health and Aging: Trends in Aging --- United States and Worldwide." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 14 Feb. 2003. Web. 01 Sept. 2013. <http://www.cdc. gov/mmwr/preview/mmwrhtml/mm5206a2. htm>. 96% of persons ages 65 and older in the United States are Medicare Montaquila, Jill, Freedman, Vicki A., beneficiaries. According to the 2010 US Census, there are 40.3 million Edwards, Brad, and Kasper, Judith D. individuals ages 65 and older living in the United States (Howden and 2012. National Health and Aging Trends Meyer, 2011). CMS estimates Medicare enrollment for its aged Study Round 1 Sample Design and beneficiaries to be 38.8 million Selection. NHATS Technical Paper #1. Baltimore: Johns Hopkins University School of Public Health. Mortality rate estimates ranged from about 1.6 percent for those in the 65- Montaquila, Jill, Freedman, Vicki A., 69 age group to about 16.5 percent for those in the 90 and older age Edwards, Brad, and Kasper, Judith D. group. 2012. National Health and Aging Trends Study Round 1 Sample Design and Selection. NHATS Technical Paper #1. Baltimore: Johns Hopkins University School of Public Health. Non-adherence-not taking the drugs that have been prescribed by "NEHI: Medication Adherence Needs Better physicians, or not taking them as per their recommended regimen Coordination Among Stakeholders." NEHI: Medication Adherence Needs Better Coordination among Stakeholders. N.p., n. d. Web. 01 Sept. 2013. HealthPrize Technologies (www.healthprize.com) posits that non"NEHI: Medication Adherence Needs Better adherence costs industry nearly three-fifths of the revenue it could have. Coordination Among Stakeholders." NEHI: per Year a 10% boost in adherence could increase revenue by much more Medication Adherence Needs Better than 10%. That 10% loss is based on the higher revenue amount that Coordination among Stakeholders. N.p., n. could have materialized, not on actual revenue earned.” d. Web. 01 Sept. 2013. One of the most prominent statistics of non-adherence originated with the New England Healthcare Institute, which calculated a $290-billion cost to health care overall due to non-adherence. But that’s a health care cost, not an industry revenue figure. Various estimates, ranging from $30 billion to $100 billion, have been cited as a loss in revenue to industry; it has been likened to the “hidden blockbuster” within each company. This research will help scientists understand the social and economic consequences of late-life disability for individuals, families, and society. The level of disability among older people declined significantly between 1982 and 2004/2005. As they age, many people experience problems in caring for themselves. Inability to live independently will add to costs for long-term care and nursing home stays, and reduce well-being among older people. This poses additional challenges for the aging of the baby boom. Non-adherence affects three major constituents- patients, pharmaceutical manufacturers and the health care system. Patients have a reduced quality of life, shorter life spans and higher long-term health costs. Pharmaceutical companies forgo potential revenues worth billions of dollars, especially for medications used in chronic diseases.The entire health care system is burdened by increased health care costs, including increased hospitalization rates and physician consultation. Common failings of adherence programs have been to rely heavily on busy physicians for implementation.

"NEHI: Medication Adherence Needs Better Coordination Among Stakeholders." NEHI: Medication Adherence Needs Better Coordination among Stakeholders. N.p., n. d. Web. 01 Sept. 2013. "NIH News", Embargoed for Release, April 20, 2011. Web, Sep. 1, 2013.

"PATIENT NON-ADHERENCE: TOOLS FOR COMBATING PERSISTENCE AND COMPLIANCE ISSUES." Frost & Sullivan's global team of industry experts, consultants, market analysts, and research executives offer business consulting, market analysis, market research. Frost & Sullivan, n.d. Web. 1 Sept. 2013.

Key Facts Matrix- Frontier Innovation

Non-Adherence

Consequences

Reasoning

Relevant

Statistic

Adherence programs

Strategies

Relevant

Summary

Push for Adherence

Loss in Revenue

Push for Adherence

Limited Interaction Related

Opinion

Push for Adherence

Incentives

Push for Adherence

Incentives

Push for Adherence

Incentives

Push for Adherence

Incentives and Medicare

Push for Adherence

Incentives

Relevant

Summary

In the United States, patient adherence with chronic medications averages only 50 percent. It has been estimated that non-adherence to prescribed medications causes nearly 125,000 deaths annually. 10 percent of hospital and 23 percent of nursing-home admissions are due to medication non-adherence. One-third of all prescriptions are never filled, and over half of prescriptions that are filled are associated with incorrect administration.

Only 24 percent of respondents ascribed non-adherence to forgetfulness. As many as 20 percent of the respondents did not take medications due to perceived side effects,17 percent felt that drug costs were too high and 14 percent of respondents did not feel that they had to take the prescription, as it would have little or no effect on their disease.

Adherence programs that focus on modifying patient behavior are the most complicated, because they endeavor to address beliefs, intentions, and values to encourage behavioral and lifestyle changes. Simplifying dosing regimens increased adherence in seven out of nine studies, with a relative increase in adherence of 8 percent to 19.6 percent. Motivational strategies were successful in 10 out of 24 studies with generally small increases in adherence up to a maximum of 23 percent. Programs that involve personal contact with a health care provider are generally more effective than programs that rely purely on non-personal intervention. Pharmaceutical companies lose an estimated $188 billion annually in revenues in the U.S. because patients fail to take their prescribed medications Drug companies have limited direct contact with patients, compared to payers and pharmacists, and have struggled with how and when to intervene to make sure patients take their medications.

"PATIENT NON-ADHERENCE: TOOLS FOR COMBATING PERSISTENCE AND COMPLIANCE ISSUES." Frost & Sullivan's global team of industry experts, consultants, market analysts, and research executives offer business consulting, market analysis, market research. Frost & Sullivan, n.d. Web. 1 Sept. 2013. "PATIENT NON-ADHERENCE: TOOLS FOR COMBATING PERSISTENCE AND COMPLIANCE ISSUES." Frost & Sullivan's global team of industry experts, consultants, market analysts, and research executives offer business consulting, market analysis, market research. Frost & Sullivan, n.d. Web. 1 Sept. 2013. "PATIENT NON-ADHERENCE: TOOLS FOR COMBATING PERSISTENCE AND COMPLIANCE ISSUES." Frost & Sullivan's global team of industry experts, consultants, market analysts, and research executives offer business consulting, market analysis, market research. Frost & Sullivan, n.d. Web. 1 Sept. 2013. Moukheiber, Zina. "Drug Companies Need To Push For Medication Adherence." Forbes. Forbes Magazine, 26 Nov. 2012. Web. 01 Sept. 2013. Moukheiber, Zina. "Drug Companies Need To Push For Medication Adherence." Forbes. Forbes Magazine, 26 Nov. 2012. Web. 01 Sept. 2013. Moukheiber, Zina. "Drug Companies Need To Push For Medication Adherence." Forbes. Forbes Magazine, 26 Nov. 2012. Web. 01 Sept. 2013.

Interventions have mostly centered on free drugs, reminders, or lower copays. But in Western European countries, such as the Netherlands, where medications are fully covered, adherence is a still a major issue. Research sponsored by Aetna shows that waving drug co-pays for heart attack patients after hospital discharge improved adherence overall from 39% to 44%. Incorporate incentives which might prod patients to take their medications Moukheiber, Zina. "Drug Companies Need before they stop. To Push For Medication Adherence." Forbes. Forbes Magazine, 26 Nov. 2012. Web. 01 Sept. 2013. Co-pay cards offered by drug companies through doctors. Patients who Moukheiber, Zina. "Drug Companies Need respond to reminders receive a variable number of points; they score To Push For Medication Adherence." additionally for engaging in educational quizzes pertaining to their disease. Forbes. Forbes Magazine, 26 Nov. 2012. Patients receive the bulk of their points at refill, and rewards are Web. 01 Sept. 2013. determined by the pharmaceutical company. They can range from an Amazon to an iTunes gift card. Assigned individual patients a score which predicts their likelihood of Moukheiber, Zina. "Drug Companies Need adherence. It is up to the customer to decide whether or how to intervene. To Push For Medication Adherence." Medicare, for example, doesn’t allow rewards in the form of payments. Forbes. Forbes Magazine, 26 Nov. 2012. Monitoring patients might be more effective, but being selective keeps Web. 01 Sept. 2013. costs down. Predictive algorithms to help its clients– pharmacy benefit managers and Moukheiber, Zina. "Drug Companies Need Medicare plans, hone in on patients most likely to stop taking their To Push For Medication Adherence." prescriptions. “Seventy percent of the time reminders are wasted,” says Forbes. Forbes Magazine, 26 Nov. 2012. Joshua Benner, chief executive of RxAnte. “Most interventions don’t work Web. 01 Sept. 2013. well because of wrong targeting.”

Key Facts Matrix- Frontier Innovation

Adherence Program

Medication NonAdherence

Barriers

Non-Adherence Effects on Revenue of Industry

Relevant

Summary

Loyalty Programs

Incentives

Adherence Program

Stakeholders

The Future 65+

Implications

The Future 65+

Implications

The Future 65+

Implications

Relevant

Summary

The Future 65+

Dependency

Relevant

Summary

The Future 65+

Statistics

Relevant

Statistic

1) Sub-optimal organizational adoption: frequent changes in marketing and product management within pharmaceutical organizations can create a short-sighted branding approach to the detriment of adherence programs which need to be measured for a minimum of six months to determine effectiveness. 2) No standard ROI measurement: lack of consistency in determining ROI margins makes it tough to publicize and replicate adherence program successes within the organization. 3) Concern over privacy issues: companies perceive adherence programs as another avenue that could lead to potential violations of patient privacy. 4) Lack of adherence measurement gold standard: what is needed is more reliable data, more consistency in adherence assessment and longer duration of patient follow-up. 5) Lack of qualitative insights: most tracking methods do not provide insights into why nonadherence takes place based on the attitudes, beliefs and values of the patients. The revenue that pharma leaves on the table due to lack of adherence to prescription medications is much higher than usually thought. Ranging from $30 billion to $100 billion, have been cited as a loss in revenue to industry. Pharma companies usually have adherence programs as part of their disease-management services, but the programs tend to be relatively small. Lost revenue ranges from over 200% for respiratory agents to 10% for oncologics. The average lost-revenue percentage for all drugs is 59%. Non-adherence significantly increases health care costs as a result of disease-related complications. For pharmaceutical companies, pharmacies, and pharmacy benefits managers, non-adherence significantly erodes profit due to prescriptions never filled and medications not taken often enough. The use of financial incentives resulting in increased adherence was affirmed by 10 of 11 research studies.

"PATIENT NON-ADHERENCE: TOOLS FOR COMBATING PERSISTENCE AND COMPLIANCE ISSUES." Frost & Sullivan's global team of industry experts, consultants, market analysts, and research executives offer business consulting, market analysis, market research. Frost & Sullivan, n.d. Web. 1 Sept. 2013.

"PATIENT NON-ADHERENCE: TOOLS FOR COMBATING PERSISTENCE AND COMPLIANCE ISSUES." Frost & Sullivan's global team of industry experts, consultants, market analysts, and research executives offer business consulting, market analysis, market research. Frost & Sullivan, n.d. Web. 1 Sept. 2013. An ideal adherence program team should include members from "PATIENT NON-ADHERENCE: TOOLS Where are the designers? professional and consumer marketing, managed care, clinical affairs and FOR COMBATING PERSISTENCE AND trade relations, within the pharmaceutical company. On the outside, key COMPLIANCE ISSUES." Frost opinion leaders, patient advocacy groups, managed care organizations, & Sullivan's global team of industry experts, payers, drug distributors, nurses and pharmacists should be actively consultants, market involved. analysts, and research executives offer business consulting, market analysis, market research. Frost & Sullivan, n.d. Web. 1 Sept. 2013. 2050, the number of Americans aged 65 and older is projected to be 88.5 Vincent, Grayson K., and Victoria A. million, more than double its projected population of 40.2 million in 2010. Velkoff. "Social Security and Medicare. It Will Also Affect Families, Businesses, and Health Care Providers." (2010): Older Population will become more racially and ethnically diverse. Vincent, Grayson K., and Victoria A. Projecting the size and structure, in terms of age, sex, race, and Hispanic Velkoff. "Social Security and Medicare. It origin, of the older population is important to public and private interests, Will Also Affect Families, Businesses, and both socially and economically. Health Care Providers." (2010): Present challenges to policy makers and programs, such as Social Vincent, Grayson K., and Victoria A. Security and Medicare. It will also affect families, businesses, and health Velkoff. "Social Security and Medicare. It care providers. Will Also Affect Families, Businesses, and Health Care Providers." (2010): The total dependency ratio is projected to increase from 67 to 85 between Vincent, Grayson K., and Victoria A. 2010 and 2050, the result of a large increase in the old-age dependency Velkoff. "Social Security and Medicare. It ratio. The old-age dependency ratio sees a rapid increase between 2010 Will Also Affect Families, Businesses, and and 2030, from 22 to 35, as all of the baby boomers move into the 65 Health Care Providers." (2010): years and over category. Among those aged 65 and over in 2050, 77 percent are projected to be Vincent, Grayson K., and Victoria A. White alone, down from 87 percent in 2010. Within the same age group, Velkoff. "Social Security and Medicare. It 12 percent are projected to be Black alone and 9 percent are projected to Will Also Affect Families, Businesses, and be Asian alone in 2050, up from 9 percent and 3 percent, respectively, in Health Care Providers." (2010): 2010.

Key Facts Matrix- Frontier Innovation

The Future 65+

Further Questions to be Answered What other programs exist to combat medical non-adherence? What has worked and what hasn't worked?

Sex Ratios

Relevant

Summary

The gap between the number of women and men is expected to narrow. This narrowing is due to the more rapid increase in life expectancy for men that is projected over the next several decades. Among those 65 years and over in 2050, 55 percent are projected to be female, down from 57 percent in 2010. The changing sex ratios at the older ages may have implications on the social and economic well being of the older population. One implication would be on marital status and living arrangements of the older population. The changing sex ratios could also have an impact on the types of care that are available to the older population.

Vincent, Grayson K., and Victoria A. Velkoff. "Social Security and Medicare. It Will Also Affect Families, Businesses, and Health Care Providers." (2010):

In terms of race and gender, how do those factors effect medical nonadherence programs?

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