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How Data Informs Patient-Centered Medication Adherence Work

Data is just a tool to help providers deliver humanized, patient-centered medication adherence guidance.

For Armando Hinojosa, MD, the data used to flag medication adherence isn’t the end-all, be-all.

Indeed, medication trackers are important tools for making sure his patients at the Laredo, Texas-based SeniorMed get the treatments they need, but at the end of the day, they’re just that: tools.

What has really moved the needle on medication adherence at his 2,000-patient practice, which serves mostly low-income, Hispanic-American seniors, are the people and the processes that get to a patient-centered result.

“Everybody thinks that data is going to solve the world’s problems. It's not going to, but it can leverage what other people do,” Hinojosa, also a board member at Texas's Valley Organized Physicians (VOP), said in a call with PatientEngagementHIT.

“What I've learned through the years is that you really have to have your workflows and technology has to be integrated into your processes as opposed to overlaid over it,” he continued. “How can we incorporate good, appropriate technology that's actionable at the point of care, and how can we leverage what we do so we can do it better and more efficiently?”

Hinojosa serves mostly the Medicare Advantage crowd, an older group who are mostly in value-based care arrangements for which outcomes sway reimbursements. Throughout his time treating this population, Hinojosa has realized the importance of medication adherence—the practice of patients taking their pills as prescribed—to achieve good outcomes.

But as healthcare has become more data-driven, Hinojosa and his peers across the country have come to realize that medication adherence doesn’t always happen, and rates can be low.

This much became apparent when CareAllies and Cigna Healthcare, with which SeniorMed is contracted in value-based care arrangements, released their Medication Adherence Tracker. The system uses health data analytics to flag patients within a single organization—in this case, SeniorMed—who have not filled the prescription their doctors have prescribed them.

Organizations like SeniorMed get these reports every other week to enable patient outreach and engagement.

The Medication Adherence Tracker has spurred a nearly 20-fold increase in medication adherence among high-risk patients, SeniorMed can report, but Hinojosa insisted that the tool isn’t the only factor at play in this success. The data certainly gives SeniorMed staff a leg up in patient outreach, but it’s the people and the process, not simply the technology, that fuels change.

Improvement Is About People & Processes, Not Technology

Practice improvement does not happen the day after a healthcare organization obtains a technology. If that were true, health IT vendors would be selling out of their products, and outcomes would be near-perfect.

For SeniorMed, success came from seamlessly integrating the Medication Adherence Tracker tool within the organization’s existing workflows. That part was easy, Hinojosa said, because SeniorMed didn’t have a specific workflow tailored for improving medication adherence until Cigna and CareAllies sent the tracker data. Still, much of SeniorMed’s success with the tool came from its payer partners’ flexibility in rolling out the tracker.

“The Medication Adherence Tracker has had several evolutions, and the big deal here is that they actually allow physicians to be at the table and give them appropriate feedback,” Hinojosa said.

For example, the Medication Adherence Tracker used to send data to SeniorMed every two weeks on a few standard sets of paper, listing patients who were flagged for not filling their prescriptions in alphabetical order. It’s understandable why developers might organize data this way, but Hinojosa said it didn’t work well with how his office worked on patient outreach.

The staff member in charge of that project needed that information grouped by pharmacy, he explained, a change Cigna and CareAllies were quick to make. Without the flexibility and collaborative relationship between the payer and the provider, it would be impossible for the Medication Adherence Tracker technology to weave seamlessly into workflows, Hinojosa stressed.

From there, SeniorMed staff members can facilitate patient outreach calls to discuss the medications, which Hinojosa said are instrumental for a patient-centered approach to care management.

Trust & Cultural Competency Inspires Patient-Led Change

Improving medication adherence rates is anathema to the archaic, paternalistic approach to medicine that some doctors took decades ago, Hinojosa explained. Instead, it’s about a patient-centered and oftentimes patient-led approach to care management.

“We used to say that these patients were ‘non-compliant,’ which is a bad word because it means that we are almost in a paternalistic relationship and patients are not doing what we ask them to do,” Hinojosa said. “Now, we talk about medication adherence.”

“Medication adherence is more than just noncompliance,” he added. “There are usually barriers to taking medications, whether it's financial, socioeconomic, social determinants of health, lack of communication with patients.”

Most providers agree that it’s not easy to find out this information from patients. Financial challenges and social needs can be difficult for patients to discuss because it may make the patient feel embarrassed or uncomfortable. Some providers do not broach these topics because they fear making the patient uncomfortable.

But according to Hinojosa, these discussions are critical for getting at the root of medication adherence and chronic disease management as a whole. The key is patient trust.

“My cohort of patients is 95 percent Hispanic-American in a community that has about a 30 percent poverty rate, so cost is always an issue,” Hinojosa said. “I'm very comfortable talking about cost, and so is my team. It's never done in a judgmental way. It's always framed as, ‘how can we improve your health? Cost is one of the things that might prevent you from getting the medications you need.’”

Getting to the root of social determinants, like transportation access problems, requires a similar set of patient-provider communication skills. While not every patient will know why a provider needs to know whether they have a car, clinicians can instill patient trust by explaining the “why” behind their inquiry and how it connects back to medication access and health.

“And then we just build that relationship and we find out if it's a social determinant, if it's a medication side effect, if it's lack of understanding," Hinojosa stated. "And then we have protocols built into my system here. Staff can answer some of that stuff, and then if they cannot, they come to me. And it's just this ongoing engagement with the physician and the physician's team with the patient on why it's important for them to take these medications over time.”

Although cost is one of the leading barriers to medication adherence, Hinojosa said it’s not the only cause, especially for patients who’ve already raised the cost issue and gotten that taken care of.

“A lot of these pills are preventative, and a lot of people say, ‘well, if I'm not sick, I don't need to take a medication,’” he explained. “It's education. ‘This is medication so that you don't have the heart attack.’”

Those discussions still require a high level of trust, and it’s something that comes from longitudinal patient relationships and cultural competence, Hinojosa said. Many of his staff look just like the patients they serve, which makes it easier for them to meet patients where they are.

“We're the same people in the same community enduring the same things,” he remarked. “It's an attitude of the culture that we've created and then knowing that we're accountable for the patient and truly being accountable for the entire experience. Medication adherence is only one part of that.”

For example, Hinojosa knows to ask patients what language they want their prescription in. Even if the patient’s primary language is Spanish, their adult child who manages their care might prefer English. The physician has also learned that it’s helpful to print on the label the exact health issue a medication targets.

That’s not the data working; that’s the people, Hinojosa said.

Although the data is a tool to flag patients for medication adherence, it’s the providers, the patients, and their trusting relationships that drive improvement.

“We build trust first, and we build trust in multiple ways. And then we help them with the medications, understanding why they need to take it in the education, and what are we trying to prevent?” Hinojosa said.

“What is capability, comfort, and calm for these people? That is not data-driven,” concluded. “We use data, but we interpret it in a way that is human. And we leverage technology to get the outcome that we want, which is ultimately providing value, increasing outcomes by decreasing costs. And not outcomes that matter to the insurance plan, outcomes that matter to the patients.”

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