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Why providers must do more to see that patients get their medication


Healthcare organizations must ensure patients can afford their prescriptions to reduce the risks of complications, Nele Jessel of athenahealth suggests.

Many patients aren’t getting their medications, or taking them as prescribed, because they can’t afford them.

It’s estimated that as many as 125,000 deaths annually occur in the United States because people aren’t adhering to their medications. It’s also costing the healthcare industry hundreds of billions of dollars annually, because people are at higher risk of hospitalizations and health complications.

While medical adherence is a complex problem, providers can help alleviate the problem by engaging with patients about their ability to pay, said Nele Jessel, chief medical officer of athenahealth, an electronic health record company.

“I think the most important thing to help patients with medical adherence is actually to make sure they can afford the medication,” Jessel told Chief Healthcare Executive in an interview.

More than one in four Americans (26%) didn’t fill a prescription in the past 12 months because of the cost, according to a Qualtrics survey released last month. About one in five medications are never filled, according to the Centers for Disease Control and Prevention. Half of the prescriptions that are filled aren’t taken correctly, either in dosage or duration, the CDC said.

“It is really important to have those types of conversations with the patient at the point of care, and involve the patient in a shared decision with respect to their prescription,” she said.

Jessel talked with Chief Healthcare Executive about improving medication adherence in a recent interview. (See excerpts of our conversation in this video. The story continues below.)

Having the conversation

Too often, providers aren’t aware that a patient hasn’t picked up a prescription or is taking smaller doses to stretch it out longer, Jessel said. Patients typically don’t have an idea of the cost until they go to the pharmacy.

“Oftentimes, patients get caught off guard by the actual cost of their prescription,” Jessel said. “And in the worst case scenario, it can lead to them actually not picking up the prescription and not telling their provider that they have not picked up the prescription, or patients will sometimes try to stretch out prescriptions and make them last a little bit longer.”

If the patient ultimately decides against getting the prescription, “the physician certainly does not get a notification that the patient has not picked up the prescription,” Jessel said.

“We may actually never find out until they come in for the next office visit when we see the history downloaded from the pharmacy that the patient actually had not filled the prescription,” Jessel said. “So we've now lost three months of time in the best case scenario. In the worst case scenario, the patient had a worsening of the illness in those three months.”

“So it's easy to see why it's important to shift that knowledge to the point of care, and actually provide the provider with insight at the point of care when the patient is actually sitting across from them in the exam room, what the anticipated cost of that drug is, if there's a better cheaper alternative,” she added.

Health systems should consider investing in technology that allows physicians to quickly see the cost of a given medication, as well as less expensive substitutes that are clinically sound, Jessel said.

In addition to technology, physicians are going to have to take the initiative to have the conversations of affordability with their patients, she said.

Some people who are struggling financially are embarrassed about it and reluctant to disclose their struggles.

Jessel pointed to reports about patients with diabetes that are trying to stretch their insulin supplies because they can’t afford to get it as prescribed. At a recent panel discussion, a pharmacist learned that a patient was picking up insulin every other month because of the cost.

“I guarantee you that many, many providers aren't aware of that because patients are often not comfortable sharing that type of information with their provider,” Jessel said. “You can imagine that that's not an easy thing to disclose, that you actually can't afford to pick up your insulin every month.”

Providers can also determine if there are any other potential obstacles to getting the prescription filled beyond the cost. For example, providers can find out if a patient has difficulties in traveling to a pharmacy and needs the prescription sent to them directly.

Taking extra time

Most physicians are pressed for time as it is, and many say they find it difficult to spend as much time with patients as they’d like.

While technology can help providers see prices and lower-cost alternatives quickly, Jessel said physicians are going to have to spend a bit more time engaging with their patients on affordability.

“As the provider, yes, it adds time,” Jessel said. “However, in the grand scheme of things, it saves time for my entire practice.”

If the physician can help a patient find the prescription that’s affordable, then that avoids a scenario where the patient goes to the pharmacy and finds out the drug is too expensive. Often, the pharmacy ends up calling back the practice, and then the physician is tasked with ordering a different prescription.

“At the end of the day, yes, it may be a couple of more seconds during that visit,” Jessel said. “But I've saved time in the long run not just for myself, but for my office staff. But most importantly, I have increased my chances that my patient will actually take their medication and actually get their illness under control. That's the ultimate goal of mine and well worth an extra couple of clicks.”

Ultimately, those earlier conversations can save administrative hassles for practices, she said.

“Every minute they're not spending on the phone, clarifying something or asking for a change in prescription, or asking for a less costly prescription, is actually time they can spend with patients face to face,” Jessel said. “So there's a pretty dramatic administrative benefit to this as well, in addition to medication adherence and improvement of outcome benefit.”

A complex problem

While technology can help practices in identifying less costly alternatives to prescriptions, improving medical adherence remains a complicated challenge.

It’s one that healthcare leaders must focus on to improve patient outcomes.

“Medication adherence is obviously a very big topic for everybody,” Jessel said. “And it's also multifaceted. There's no easy solutions. You have to keep chipping away at it.”

Healthcare organizations can use tools like remote patient monitoring to help check on patients. Providers can also send reminders electronically about refilling prescriptions. In some instances, a human touch is required, Jessel said. It could involve chronic care managers getting on the phone with the patient to ensure they are taking the medication as prescribed.

“I think investing in technologies that help with medication adherence is absolutely important, because it will already get you a pretty significant way towards optimal medication adherence,” Jessel said. “But then there's other additional opportunities that have to or that could be pursued to improve medication adherence.”

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