BETHESDA, MD 16 February 2010—Health insurer Cigna is exploring modern communication methods to improve medication adherence among plan members, and the company has enlisted its clinical pharmacists to help.
"Medication adherence is really a serious and costly issue," said Yi Zheng, assistant vice president of pharmacy clinical programs for Cigna. "This is really a big deal, especially with all the talk about health care reform and how we struggle with ways to reduce costs and improve the quality and health outcomes in our country."
An October 2009 report from the National Association of Chain Drug Stores, the National Consumers League, and other stakeholders cites an estimate that up to half of all patients do not take their medications as prescribed. An August 2009 report from the New England Healthcare Institute estimates that medication nonadherence, along with suboptimal prescribing, drug administration, and diagnosis, costs the nation up to $290 billion each year in health care expenses.
Zheng said improving medication adherence has been a Cigna priority for years and is viewed as a way to improve health outcomes and reduce total medical costs.
Last June, the company launched CoachRx. This medication adherence tool includes access to a Cigna clinical pharmacist for patients who take medication to control a chronic condition and use the company`s home-medication-delivery program.
In all, 6.5 million people receive pharmacy benefits through Cigna`s pharmacy management division, and about 600,000 of them are eligible to participate in CoachRx, according to company spokeswoman Lindsay Shearer.
Patients register for CoachRx using a Web portal that requires a brief self-assessment of issues Cigna has identified that may pose barriers to medication adherence. These include medication costs, forgetfulness, and beliefs about the importance and safety of the medication.
Once registered, patients can sign up for automated reminders to take medications, arrange for laboratory tests, see a physician, or check their blood pressure or blood sugar, Zheng said.
Reminders can be sent by text messaging—a method Shearer called a recent development in the insurance industry—or by phone, e-mail, or voice mail. The reminders can include recorded messages from family members about their desire for the patient to remain healthy.
The portal also provides an online form and telephone contact information for patients who want to discuss complex medication adherence issues or other problems with a Cigna clinical pharmacist.
Zheng said the pharmacist-coaches have been trained to use motivational interviewing techniques to help patients become engaged in their treatment plan.
He said CoachRx pharmacists talk to patients about a variety of issues, including drug-related adverse events that might occur during treatment. In some cases, the pharmacist will work with the patient`s physician to explore treatment alternatives.
The coaches also work with Cigna`s disease-management team to help patients meet their treatment goals, Zheng said.
Ultimately, he said, CoachRx works "to isolate potential barriers on an individual basis and then provide personalized and customized services and solutions to tackle this," Zheng said.
"We understand that there are so many factors that can lead to medication nonadherence," he said. "Instead of offering a cookie-cutter approach, we really wanted...to better understand what each individual`s needs are. And once we know what is the underlying barrier, then we can help align the specific services to what`s best in their individual situation."
He said patient education about medication adherence begins with a written, educational "onboarding packet" to encourage proper use of the medicine from the first dose. The packet describes the drug`s use, treatment goals, and possible adverse events and what to do if they occur, Zheng said.
"It`s triggered by new start of a prescription," Zheng said of the educational mailing. "Instead of waiting to discover someone becomes nonadherent after the fact...we really want to address the medication needs upon the start of the new medication regimen."
Shearer said CoachRx evolved from Cigna`s "gaps in care" medication adherence programs. Data from the insurer indicate measureable improvements in patient care, including an 11-percentage-point increase in adherence to dyslipidemia therapy that prevents 262 heart attacks each year, saving an estimated $6.6 million in annual medical costs.
Medication adherence for patients with diabetes improved by 23 percentage points for those enrolled in the program for that disease, according to the company.
