Cost is a major determining factor for patients when they are deciding whether or not to pick up their prescriptions from the pharmacy. When medications are too expensive, patients may abandon them, regardless of how important they are to their health.
The impact of nonadherence plays a large factor in patient outcomes, with up to 125,000 avoidable deaths attributed to nonadherence every year. But what if prescribers and patients could view prescription drug costs and discuss options at the point of care to avoid sticker shock at the pharmacy counter? Would patients who are prescribed affordable medications be more adherent than patients who are prescribed expensive medications? Could better adherence result in fewer avoidable emergency department visits and inpatient readmissions?
These are the questions we asked ourselves at Magnolia Regional Health Center (Corinth, MS) as part of an initiative to improve outcomes for congestive heart failure (CHF) patients, who are the highest source of our hospital's readmissions. Physicians commonly prescribe antithrombotic or anticoagulants for these patients to prevent cardiac events, such as heart attack and stroke. If patients don't adhere to their medication regimen, it may result in hospitalization and readmission.
Collaborating to improve outcomes
In an effort to improve these outcomes and measure the impact of our technologies, we collaborated with DrFirst, which provides healthcare technology solutions and consulting services. They worked with us to create a study testing whether price transparency tools at the point of prescribing and prescription fill data could equip hospitalists and care navigator staff with vital information that would improve care for CHF patients.
Our teams collaborated to integrate DrFirst’s real-time price transparency tool with our MEDITECH electronic health record. By connecting with the largest pharmacy benefits managers, the tool provides pricing information within the EHR's prescribing workflow during the patient encounter. This enabled us to test how affordability would impact patients’ likelihood of adhering to their care plans.
In addition, we utilized DrFirst’s medication history technology to give providers visibility into the prescription fill activity of patients in the study. This would give clinicians access to 12 months of medication history data from multiple trusted sources and an AI engine to convert that data into the EHR, reducing the need for manual entry.
Meeting the challenge
Our hospitalists, care navigators and primary care providers worked together to roll out a three-step approach to better understand the impact of having drug costs available to physicians and patients at the point of care.
- Establish a baseline of clinical outcomes
Many studies have shown that lower medication adherence leads to much higher odds of CHF patients being readmitted to the hospital, and that interventions to improve medication adherence reduce readmission rates. With this in mind, the first step was to determine the baseline levels of medication adherence by patients who were readmitted versus those who were not readmitted.
All 417 patients in the study had been admitted to the hospital with a diagnosis of CHF. Of those patients, 84 (20%) were readmitted to inpatient care and 35 (8%) presented at the emergency department as a recurrent visit, but were stabilized and sent home.
- Determine which medications patients were not filling consistently
It was also important to determine the adherence levels of specific medications by patients who were readmitted versus those who were not readmitted. Antithrombotic or anticoagulant medications are commonly prescribed to CHF patients following a hospitalization because they are very effective, but some can have high out-of-pocket costs to patients.
To keep CHF patients out of the hospital, adherence to these medications is critical. Our team theorized that if patients knew their out-of-pocket costs in the exam room, they could ask the provider to switch to a less expensive drug, and the lower cost might make them more likely to fill the prescription.
- Implement new technologies
To test the impact of price transparency on how well patients adhere to their medication regimens, we collaborated with DrFirst's applied clinical research team to gather and analyze medication history data. Then we installed myBenefitCheck into the real-time benefit check (RTBC) workflow in our EHR, which made more prescription benefit information and therapeutic alternatives available during the patient encounter. From there, we used MedHx to gather complete patient medication history so we could track whether patients in the study had filled their prescriptions.
From July 2020 to September 2021, we studied medication adherence and prescription fill rates for 417 patients with CHF. When medications were broken down by drug class, first-fill prescription abandonment for more expensive antithrombotics was higher in readmitted patients (50%) than in non-readmitted patients (35%).
Results found little difference in first-fill prescription abandonment for less expensive anticoagulants: 31% in readmitted patients versus 32% in non-readmitted patients. Readmitted patients were 10% less adherent to antithrombotic agents, however, and 17% less adherent to anticoagulants than patients who were not readmitted.
By measuring prescription abandonment and adherence for these medications, which are vital to keeping patients out of the hospital, our team validated its assumption: Having price transparency at the point of prescribing and access to prescription fill data can equip our hospitalists and care navigator staff with crucial information that can improve care for CHF patients.
With prescription drug prices rising, patients need price transparency and the ability to discuss options with their doctors during office visits. To address this need, starting January 1, 2023, the Centers for Medicare and Medicaid Services will require insurers that offer Medicare Part D health benefits to use an electronic drug cost and health benefit comparison tool that's compatible with at least one EHR system.
Magnolia Regional is dedicated to empowering our providers with innovative technologies that support their ability to provide the highest quality of care to patients. Leveraging the right tools gives prescribers up-to-the-minute, patient-specific information on drug costs while they are face-to-face with patients, helping to minimize the financial obstacles that keep patients from filling their prescriptions. We can then track fill rates for these patients, pinpoint gaps in adherence and identify those at risk of readmission.
Our goal is to allow patients to compare the costs of prescription drugs, request a similarly effective option, and better understand what they will need to pay before they are standing at the pharmacy counter. Enabling providers to initiate that conversation promotes better rapport, cost-effectiveness, and may ultimately save lives.
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