Bethany’s migraines and extreme fatigue were brushed off as the toll of being “just a tired mom.” Dusty was juggling a mortgage banking career and the busy sports schedule of twin boys when she was blindsided by the diagnosis of multiple sclerosis. Miguel, diagnosed with hemophilia as a child, used to hide his bleeding – too embarrassed to ask for help.
These patients’ experiences highlight a critical truth: behind every complex diagnosis is a system that must work in sync to provide compassionate, coordinated care. Physicians, nurses, pharmacists, and health benefits all have a role to play. But not every patient receives this level of integrated support.
Today, about 129 million people in the United States live with a chronic disease like diabetes, cancer, or heart disease, according to the Centers for Disease Control and Prevention (CDC). Alarmingly, the CDC states that 42% of Americans live with two or more chronic conditions, and 12% manage at least five.
Being in the healthcare space, I see firsthand the urgent need to reimagine chronic care delivery for patients like Bethany, Dusty and Miguel, who are a part of those 129 million Americans. As healthcare leaders, we have a responsibility to deliver care that is connected, affordable, and accessible. From my perspective, there are three key opportunities to drive meaningful, measurable impact:
- Simplify Access and Affordability
Access to high-value, affordable care must be streamlined to meet patients where they are. Equipping patients with guidance to navigate the increasingly complex care landscape is a key lever. By proactively educating members on clinically appropriate, cost-effective sites of care, organizations can improve access, reduce delays in treatment, and avoid unnecessary hospitalizations. - Enhance Medication Adherence Through Precision Engagement
Medication adherence is crucial from both a clinical and financial standpoint. Nonadherence leads to an estimated 125,000 preventable deaths and hundreds of billions of dollars in avoidable healthcare costs annually, according to the American Heart Association. By applying predictive analytics and real-time member-level data, healthcare organizations can create highly personalized outreach programs that include refill reminders, pharmacist counseling and 90-day supply optimizations, to name a few. These strategies not only improve health outcomes, they also help health plans advance Star Ratings, meet HEDIS quality benchmarks, and reduce total cost of care across diverse populations. - Elevate the Role of the Pharmacist
Pharmacists are a powerful, yet often underutilized, clinical asset in the management of chronic and complex conditions. Embedding pharmacists directly into care teams, particularly through comprehensive medication therapy management, can help close persistent gaps in therapy, address dangerous polypharmacy risks, optimize therapeutic regimens, and reduce adverse drug events. Pharmacists can also act as critical connectors across the healthcare ecosystem, ensuring medication plans are aligned with broader clinical goals and social determinants of health.
As we continue to confront the growing burden of chronic disease, we must challenge ourselves to build a more coordinated, patient-centered system. One where no individual faces their diagnosis alone or without integrated support. Pharmacy has a pivotal role to play, connecting the dots between data and care, cost and access, and most importantly, between people and better health.
Amy Mulderry is the president of CarelonRx, Elevance Health’s pharmacy benefits manager.
