Recognizing the hospital’s role in changing patient behavior

Scene one: A patient enters the hospital either for a scheduled procedure or via the emergency department. They were admitted, treated while receiving leading patient care and sent on their way after their condition improved. The hospital's job is done, right?

Scene two: The patient is readmitted with the same condition less than 30 days later, causing further health complications for them and a loss of reimbursement for your hospital. However the reason has nothing to do with the care provided--- rather the effort the patient made (or failed to make) to avoid remittance.

Given that research shows 64% of readmissions within 30 days are due to medication issues, what could have been done to prevent this situation?

Beyond treating a patient in the inpatient setting, health systems need to ensure patients have the education and resources necessary to maintain good health after returning home to lower total healthcare costs. At the most basic level, this can be accomplished through successful medication management and improved patient adherence.

As reimbursement shifts to an outcomes-based model under the Affordable Care Act, healthcare organizations must be able to influence not only the physical environment where patients are treated, but also instill confidence and a responsibility in patients to take an active role in their own care. Poor medication adherence can have negative consequences for individuals, families and society because it significantly increases the cost and burden of illness.

Patients (start thinking of them as consumers), providers, and payers will demand new, nontraditional solutions to meet their healthcare needs. Add to this the great strides in technology and we have an environment rich to create new standards of care that will meaningfully impact adherence. A number of factors contribute to the increasing role adherence currently holds in the healthcare ecosystem:

  • Changing reimbursement models will reward organizations that add value both when a patient is healthy or sick. Keeping populations of people healthy is growing in importance, with the outcome replacing the prescription as the new commodity.
  • Increasing consumerism is moving healthcare from a business-to-business transaction to a business-to-consumer one. As patients increasingly seek value they will align with organizations that provide the tools and solutions that facilitate the achievement of their health goals and provide an exceptional customer experience. Patients will have increased access to ratings, quality measures and costs, which will provide transparency to make value-based decisions.
  • To maintain financial viability there is a need to build out a population health infrastructure that includes a scalable adherence platform. This will position an organization to maximize reimbursement, manage risk, provide patient centric offerings and capitalize on growth opportunities.
  • The transformation to accountable care is requiring healthcare organizations to manage Total Healthcare Costs in the growing risk share populations they serve. With over 80% of healthcare dollars are spent on chronic conditions and over 70% of office visits resulting in a prescription, possessing a well-developed adherence platform is a necessity. If you can't manage medications, you can't manage financial risk in a post healthcare reform world.

Adherence is a multifaceted problem and is an essential part of population health management. Additionally, studies consistently find significant cost-savings and increases in the effectiveness of health interventions that are attributable to low-cost interventions for improving adherence.
Developing an adherence platform by combining valuable adherence aiding components will allow for a thoughtful progression in the quest to provide comprehensive medication management to the populations you serve.

An effective adherence platform expedites the transition to value-based reimbursement leveraging the tools offered by a health organization, but also customized to each patient's specific needs. Whoever cracks the code on how to manage chronic disease will thrive in a value-based world, as one organization's efficiency gain is another's income loss. Given this, here are some tools health systems can use to better help their patients' improve medication adherence:

  • Adherence Packaging
  • Medication Therapy Management
  • Medication Reconciliation at Admission and Discharge
  • Medication Pass Alerts
  • Clinician/Physician/Patient Communication
  • Interoperability with Hospital Information Systems
  • Refill Management/Optimization

Adherence initiatives help de-institutionalize care, thus reducing total healthcare costs. For those who aren't sure if outpatient adherence is a hospital's responsibility, feel comfort in the fact we have oceans of data that correlate increased clinical quality and reduced total healthcare costs to adherence (2M results on Google right now).

While this is still a new role for health systems to play in the continuum of care, patients are continuing to align and remain loyal to organizations that prove value. In an age where consumerism is overtaking healthcare, the relationship with the patient is one hospitals need to continue to forge. To those who have an extreme case of data dependency, remember this - data only tells us about the past, to be innovative you need to create your own data.

Troy Hilsenroth, RPh, MHA, MBA, EMT-P has been with Omnicell for over 6 years, and currently serves as the Vice President and General Manager of the Non-Acute Care Division. He is responsible for leading the execution and market development of the national division focused on non-acute care environments. Prior to working at Omnicell, Troy served as a licensed clinical pharmacist for 14 years in a broad range of pharmacy environments, while also working as a firefighter and paramedic.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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