Changes to Primary Care Could Help Chronically Ill Follow Prescriptions

Andrew Kitchenman | November 24, 2014 | Health Care
Improved compliance cited by healthcare analysts as key to reducing healthcare costs

Linda Schwimmer, vice president of the New Jersey Health Care Quality Institute.
One of the chief factors behind ballooning healthcare costs in New Jersey and elsewhere is the rising number of patients with by chronic diseases like diabetes. And while there are medications available to treat many of these diseases, getting patients to follow the prescription is a major challenge.

Nationally, there are $214.2 billion in avoidable annual healthcare costs related to medications, according to a recent report by the IMS Institute for Healthcare Informatics, a Connecticut-based research firm. These costs result from patients not using medicine they’ve been prescribed; delays in providing patients with treatments whose effectiveness has been proven; misuse of antibiotics; errors in medications given to patients; suboptimal use of generic drugs; and mismanagement of patients using multiple drugs.

But while there is much room for improvement in addressing these costs, healthcare policy analysts and advocates say progress is already occurring in New Jersey. The accountable care organizations and other reforms to the healthcare delivery system encouraged by the Affordable Care Act have led to new efforts to follow up with patients to make sure that they’re taking medicine as prescribed. Not only that, but wider trends in medicine — in which doctors and patients share in decision-making — also are likely to improve patients’ compliance, experts said.

The costs extend beyond the direct expense of providing healthcare and reflect indirect drains on the families who provide care at home for those with chronic diseases. For example, caregivers for New Jersey residents with Alzheimer’s disease alone spent an estimated 505 million hours of unpaid time to provide care last year.

Larry Hausner, former CEO of the American Diabetes Association, described the growth in chronic diseases as the “greatest threat for the future of the healthcare system,” noting that more Americans are being diagnosed with diseases like diabetes. If current trends prevail, one in three adult Americans will have diabetes in 2050, according to CDC projections.

“The crisis is clear,” Hausner said at a recent policy forum hosted by life-science industry trade group the Healthcare Institute of New Jersey. “Chronic diseases are crushing our healthcare system, taking a heavy toll on its ability to handle this load.”

New Jersey Health Care Quality Institute Vice President Linda Schwimmer said ACOs — which provide financial incentives for providers and insurers to better coordinate patient care — ultimately lead to a greater focus on the needs of patients. They look to engage patients through care coordinators, who help patients schedule appointments and talk with patients about the medications they’re taking.

Schwimmer added that basic framework that defines how providers interact with patients is changing in a way that will help patients better comply with prescriptions.

Historically, providers determined the course of treatment, sometimes with little input from patients. More recently, some providers offered options to patients, who picked the treatment they wanted. But Schwimmer pointed out a major problem with this second approach: Patients frequently weren’t given the context to make a decision.

“They don’t know why they should pick A vs. B,” Schwimmer said.

Increasingly, providers and patients are following a path between the two approaches, in which they share in the decision-making — with a focus on meeting the patients’ goals. If the patients understand why the prescriptions they receive will help them achieve their goals, then they’re more likely to comply with them.

In addition, public-health experts are recognizing the importance of addressing the social factors that cause many chronic diseases, Schwimmer said. She noted research by Lourdes Health System in Camden that found that some patients often have major barriers in their lives that prevent them from focusing on following their prescriptions.

Programs like Housing First, in which homeless patients receive housing before receiving healthcare and other social services, are a good way of reaching a population that has a high rate of chronic disease and low compliance with prescriptions, she said.

Along with increasing care coordination, the Affordable Care Act is improving access to preventive care by requiring free annual physical exams and mammograms, which may allow doctors to prescribe treatments to more patients before their illnesses become chronic problems, according to experts.

But a worrying trend could undercut this progress, including the increase in high-deductible insurance plans, forum participants said. Employers are shifting to plans that require workers to pay $1,000 or $2,000 annually before the insurance plan covers healthcare costs.

Ultimately, there’s only so much that can be accomplished through medications. Hausner said that changing Americans’ behavior would be essential to reversing the long-term trend of a rising number of chronic diseases. This primarily means eating better diets and exercising more, as well as continuing to reduce the number of people who smoke, he said.