Consumer non-compliance with prescribed medications can lead to gaps in care which may impact quality of life, clinical outcomes, and overall plan cost. In fact, it has been reported that poor adherence costs the US Health Care system an estimated $300 billion annually and that 25% of hospital ER visits are related to medication compliance. Additionally, medication adherence is quickly becoming an independent quality measure as seen in Medicare Stars ratings, driving an immediate change in both provider responsibility and the payer reimbursement system.
Researchers have routinely found that improved medication adherence is associated with reduced total health care use and costs. Improving adherence requires tools that help identify instances of non-compliance, then provide the education and support necessary for patients to understand their condition, get the right treatment, and take their medications appropriately. Unfortunately, many of the programs offered today to assist health plans and providers in improving medication adherence merely apply a general approach to patient engagement.
The Argus Health Adherence program helps customers improve medication adherence across targeted chronic conditions. The overall goal of the program is to reduce total cost of care by improving Proportion of Days Covered (PDC) scores to 80% or higher and closing HEDIS gaps in care, with a focus on members flagged as high risk for hospitalization and increased utilization and cost.
The Argus Adherence program offers health plans an efficient and accurate process to identify and stratify members, while applying risk-based metrics to prioritize members into appropriate levels of engagement. This approach allows health plans to focus on the right members at the right time to help maximize drug therapy in conditions where improved adherence to treatment is most likely to reduce total cost of care and improve ROI.
We offer a core medication adherence program using pharmacy claims only, as well as a convergent solution for adherence and identifying gaps in care using pharmacy claims in combination with medical and lab claims. Our flexible and scalable programs can either be used independently or augment a health plan’s existing program to deliver better outcomes at a lower cost.