Lack of medication compliance is harmful to health care systems from both a clinical and economic perspective. This study examines the methods that disease management organizations employ to identify nonadherent patients and to measure effectiveness of compliance programs for patients with diabetes, hyperlipidemia, and cystic fibrosis. In addition, this study investigates the degree to which disease managers assume risk in their contracts, and whether compliance strategies are being coordinated with payers' use of value-based insurance design, in which patient cost sharing is a function of the relative value of pharmaceuticals. This study's findings suggest that disease management may be falling short in terms of: (a) comprehensive commitment to expert-recommended at-home devices used to self-diagnose and measure health indicators; (b) early adoption of expert-recommended new technologies to measure and improve compliance; (c) intensity of use of standard tests in outpatient clinics; (d) coordination of compliance strategies with payers' use of value-based insurance design; and (e) the proportion of risk assumed in disease management contracts. (Population Health Management 2012;15:20–28)
Get full access to this article
View all access options for this article.
References
1.
CramerJA, RoyA, BurrellAet al.Medication compliance and persistence: Terminology and definitions. Value Health, 2008; 11:44–47.
2.
BalkrishnanR. The importance of medication adherence in improving chronic-disease related outcomes: What we know and what we need to further know. Med Care, 2005; 43:517–520.
3.
CutlerD, EverettW. Thinking outside the pillbox—Medication adherence as a priority for health care reform. N Engl J Med, 2010; 362:1553–1555.
4.
New England Healthcare Institute. Thinking outside the pillbox: A system-wide approach to improving patient medication adherence for chronic disease. 2009. http://www.nehi.net/publications/44/thinking_outside_the_pillbox_a_systemwide_approach_to_improving_patient_medication_adherence_for_chronic_disease. 2010 October 30.
5.
MartinLR, WilliamsS, HaskardKB, DimatteoMR. The challenge of patient adherence. Ther Clin Risk Manag, 2005; 1:189–199.
6.
Centers for Disease Control and Prevention. Chronic disease prevention and health promotion. 2010. http://www.cdc.gov/chronicdisease/overview/index.htm. 2010 July 10.
7.
AndersonC. Chronic Conditions: Making the Case for Ongoing Care. Baltimore, MD: Johns Hopkins University, Partnership for Solutions, 2002.
8.
SabateE. Adherence to long-term therapies: Evidence for action. Geneva: World Health Organization, 2003.
9.
YeawJ, BennerJ, WaltJ, SianS, SmithD. Comparing adherence and persistence across 6 chronic medication classes. J Manag Care Pharm, 2010; 15:728–740.
10.
FogartyJ, YoungsG. Psychological reactance as a factor in patient non-compliance with medication taking: A field experiment. J Appl Soc Psych, 2000; 30:2365–2391.
11.
BennerJS, GlynnRJ, MogunH, NeumannPJ, WeinsteinM, AvornJ. Long-term persistence in use of statin therapy in elderly patients. JAMA, 2002; 288:455–461.
12.
OsterbergL, BlaschkeT. Adherence to medication. N Engl J Med, 2005; 353:487–497.
13.
HoPM, RumsfeldJS, MasoudiFet al.Effect of medication non-adherence on hospitalization and mortality among patients with diabetes mellitus. Arch Int Med, 2006; 166:1836–1841.
14.
National Council on Patient Information and Education Coalition. Enhancing prescription medicine adherence: A national action plan. http://www.intelecare.com/downloads/ncpie-adherence-report.pdf. 2010 September 2.
15.
QuittnerAL, EspelageDL, Ievers-LandisC, DrotarD. Measuring adherence to medical treatments in childhood illness: Considering multiple methods and sources of information. J Psych Med Settings, 2000; 7:41–53.
16.
FarmerK. Methods for measuring and monitoring medication regimen adherence in clinical trials and clinical practice. Clin Therapeutics, 1999; 21:1074–1090.
17.
NorellSE. Accuracy of patient interviews and estimates by clinical staff in determining medication compliance. Soc Sci Med, 1981; 15:57–61.
18.
LindenA, RobertsN. A user's guide to the disease management literature: Recommendations for reporting and assessing program outcomes. Am J Manag Care, 2005; 11:113–120.
19.
QuittnerAL, ModiA, LemanekK, Ievers-LandisCE, RapoffMA. Evidence-based assessment of adherence to medical treatments in pediatric psychology. J Ped Psych, 2008; 33:916–936.
20.
FellandLE, ReschovskyJ. More non-elderly Americans face problems affording prescription drugs. http://www.hschange.com/CONTENT/1039/. 2010 September 12.
21.
SafranD, NeumanP, SchoenCet al.Prescription drug coverage and seniors: Findings from a 2003 national survey. Health Aff, 2005Suppl Web ExclusiveW5-152–W5-166.
22.
ColemanK, MattkeS, PerraultPJ, WagnerEH. Untangling practice redesign from disease management: How do we best care for the chronically ill?Ann Rev Pub Health, 2009; 30:385–408.
23.
WennbergD, MarrA, LangL, O'MalleyS, BennettG. A randomized trial of a telephone care management strategy. N Engl J Med, 2010; 363:1245–1255.
24.
ShapiroR, MorenoL. Disease management technologies: User needs can guide decision making. http://www.mathematica-mpr.com/publications/pdfs/diseasemanagetech.pdf. 2010 October 1.
25.
HepkeKL, MartusM, ShareDA. Costs and utilization associated with pharmaceutical adherence in a diabetic population. Am J Manag Care, 2004; 10:144–151.
26.
ChernewME, JusterI, ShahMet al.Evidence that value-based insurance can be effective. Health Aff, 2010; 29:530–536.
27.
MaysGP, AuM, ClaxtonG. Convergence and dissonance: Evolution in private-sector approaches to disease management and care coordination. Health Aff, 2007; 26:1683–1691.
28.
Holtz-EakinD. An analysis of the literature on disease management programs. http://www.cbo.gov.doc.cfm?index=5909&type=0. 2010 August 11.
29.
MattkeS, SeidM, MaS. Evidence for the effect of disease management: Is $1 billion a year a good investment?Am J Manag Care, 2007; 13:670–676.
30.
FlumeP, SullivanB, RobinsonKet al.Cystic fibrosis pulmonary guidelines: Chronic medications for maintenance of lung health. Am J Respir Crit Care Med, 2007; 176:957–969.
31.
Kaiser Permanente Care Management Institute. Adult diabetes clinical practice guidelines. Oakland CA: Kaiser Permanente Care Management Institute, 2009.
32.
National Cholesterol Education Program Expert Panel. Detection, evaluation, and treatment of high blood cholesterol in adults. NIH Publication No. 01-3670. Washington, DC: National Institutes of Health, 2001.
33.
CohenJ, CheeJ. Pharmaceutical benefit managers' role in facilitating Medicare beneficiary access to pharmaceutical care. Dis Manag Health Outcomes, 2002; 10:221–227.
34.
ChernewME, ShahM, WeghAet al.Impact of decreasing co-payments on medication adherence within a disease management environment. Health Aff, 2008; 27:103–112.
35.
SipkoffM. Spend a little more on selected patients for payoff down the line. Manag Care, 2009; 18:20–22.
36.
CohenJ. Are commercial disease managers willing and prepared to enter the Medicare market?Drug Inf J, 2002; 36:445–452.
37.
CohenJ, PaquetteC. Impact of disease management on cost-effectiveness of Medicare spending. Drug Inf J, 2003; 37:329–339.
38.
FendrickAM, ChernewME, LeviG. Value-based insurance design: Embracing value over cost alone. Am J Manag Care, 2009; 15:S277–S283.
39.
DiamondF. Disease management grows, though under fire. Manag Care, 2010; 19:12–16.
40.
LindenAL. What will it take for disease management to demonstrate a return on investment? New perspectives on an old theme. Am J Manag Care, 2006; 12:217–222.
41.
BehlingC. The ghosts of disease management. Pop Health Manag, 2010; 13:57–58.
42.
ChenS, LevinR, GartnerJ. Medication adherence and enrollment in a consumer-driven health plan. Am J Manag Care, 2010; 16:43–50.
