This article appears in the January/February 2014 issue of HealthLeaders magazine.
Billions of dollars are wasted and thousands of lives lost each year through inefficient or ineffective medication management. It has been estimated that the misuse of prescription drugs in our healthcare system is up to a $300 billion problem annually.
From the doors of the emergency room to the drawers of patients' home nightstands, medications are mixed up, misremembered, overdosed, underdosed, and laboriously documented or misdocumented.
But things are changing: E-prescribing is now the rule, not the exception. Data analytics is red-flagging areas of concern from the doctor's office to the pharmacy and all throughout the chain of care. And technology is allowing providers to earn hard cash for meeting medication adherence targets.
Coventry Health Care, a division of the insurer Aetna, is a Bethesda, Md.–based managed healthcare company with 5 million members across the nation. Coventry uses predictive modeling technology from RxAnte to target a population of patients who could most benefit from improving their medication adherence. Then, Coventry offers physicians $50 per medication class per quarter in bonuses to make it happen. The bonuses target three classes of medications and use predictive modeling to narrow the focus.
"Providers are getting bombarded by a bunch of noise, and the worst thing you can do is send them a mile-long list of patients, most of whom are going to be adherent on their own," says Michael Kavouras, vice president for Medicare Stars for Aetna.
"Nothing will frustrate providers more than wasting their time and the time of their office staff and their nurses," he says, "so one of the things we've done is we've used the RxAnte algorithms to skinny down the lists and get to providers and communicate to them that we're not going to do this the old-fashioned way where we're just going to send you every patient that is currently nonadherent."
So far, 570 practices have committed to participating in Coventry's initiative during the third and fourth quarters of 2013, which account for almost 20,000 of Coventry's Medicare Advantage members out of 300,000 total Medicare Advantage beneficiaries.