Improved medication adherence: A growing movement in search of a leader

Whatever happens with healthcare reform, there are many forces in play that can and should "converge to support better medication management and improved adherence," said Tom Hubbard, senior program director of New England Healthcare Institute (NEHI), a healthcare think tank in Cambridge, Mass., during a Capitol Hill briefing in late February. Hubbard is author of The Medication Adherence Roadmap: A Path Forward.

With the movement toward quality benchmarks, he said, medication adherence will be important in showing that clinicians are helping patients reach certain benchmarks. In addition, the current patient-centered medical homes (PCMH) experiments, including some developed by the Centers for Medicare and Medicaid, focus on team-based care and on delegating tasks to non-physician professionals.

Many PCMH accreditation standards don't explicitly address medication adherence, said Hubbard, and it's an open question as to whether they should. However, they all will "require physician practices to take a more formal structured approach toward medication management." In addition, he noted, the accountable care organization (ACO) standards now on the table for Medicare require more structure in medication management. And some private insurers have ACO-like payment systems, with a per-patient, per-month care coordination fee. Those arrangements, he said may give physicians the confidence to invest in medication management and adherence efforts.

Other opportunities include the streamlining and improvements in Medicare Part D medication therapy management (MTM); the star ratings of Medicare Part D prescription drug plans; bonus payments for improvements in medication adherence for Medicare Advantage plans; and value-based insurance designs undertaken by some major employers.

Even with all these influences converging, he cautioned, improvement may not happen without conscious coordination, including "close attention to quality metrics around medication management and adherence." A major problem, said Hubbard, may be that with the possible exception of the patient, "nobody in the system, historically, has really owned the adherence problem." The big question is, he said, "Are we going to look for ways to create some accountability for poor adherence performance going ahead?"