Program helps patients adhere to regimen

Members targeted have chronic conditions

Recognizing that patients who don't take medication for chronic conditions as prescribed are more likely to have poor control over their independence, Blue Cross has launched a program to coach people on medication adherence.

"We know that adherence to medication is an important part of managing a chronic disease. Members who have a chronic condition and don't adhere to their treatment have a greater potential for hospitalizations and outpatient care as well as a decrease in the quality of life," says Kimberly Siejak, manager of population health and wellness for the Philadelphia-based health plan.

The medication persistence program, launched in July as part of the Independence Blue Cross Connections Health Management Program, targets members who have not been adherent in taking medications for coronary artery disease, heart failure, diabetes, and/or hypertension.

"We targeted these conditions because they often can be controlled with medication and patients typically experience long-term complications if they don't take their medication regularly," Siejak says.

Many of the patients in the program have heart failure, a condition that frequently results in rehospitalization, she adds.

"Often when heart failure patients are in the hospital, they are discharged with a new medication and they're not sure if it is different from the one they were taking before they were hospitalized. Our health coaches can contact them and discuss whether they were prescribed a new medication, if they have a follow-up visit scheduled with their physician, and to answer any questions they have," she says.

The health plan included hypertension in the program because people with hypertension may stop taking their medication and not experience any immediate symptoms and can experience severe long-term complications such as strokes, she points out.

Independence Blue Cross uses medical claims data and pharmacy claims data to identify members with chronic conditions and members who have been refilling their prescriptions for chronic diseases less than 50% of the time.

"We don't know what happens after members fill their prescriptions. We hope they are actually taking it. The data we use for this program do give us a measure of the refill rate, which may be a proxy for the member's medication adherence," she says.

The health plan's proprietary algorithm risk stratifies members into low, medium, and high risk categories. Each category receives a different type of outreach.

Health coaches also make outreach calls to patients with chronic conditions who have been discharged from the hospital to make sure they understand their discharge instructions.

"We want to balance our resources appropriately and reach the members where we can have the biggest impact," Siejak says.

Low-risk members are those who fail to refill only one type of medication. They receive periodic automated telephone calls that include the program's telephone number if they want to contact a health coach with questions or concerns.

Members at moderate risk are those who fail to refill two or more medications. Automated telephone calls give them an opportunity to transfer directly to a health coach.

"The health coaches love the calls they get when the members make the choice to speak with them. This means that something in the automated call has hit home with them. They are primed and ready to make changes. It can be a much different response from what they get from many of the outbound calls to members," she says.

The automated calls include general information about the medication types the members are taking, why it is important to take it as prescribed, and what complications may occur if they don't.

"We always ask the member to verify his or her identify before the system launches into the message," she says.

The automated calls encourage members to talk to a health coach or call their physician if they have any questions about their medication regimen.

"All of our interactions reinforce the members' relationship with their physician and encourage members to adhere to their treatment plan or talk to their doctor if they're having trouble with adherence," she says.

High-risk members receive an outbound telephone call from a health coach who educates the members about the importance of taking their medication and tries to engage them in health coaching to help them adhere to their physician's treatment plan.

Reasons the members give for not refilling their medication include side effects, forgetting to get it filled, and lack of information about why they are taking it.

Most members have a drug prescription plan, so cost is often not a factor, except in the case of Medicare beneficiaries who may have hit the donut hole in their prescription plan or who are having difficulties with copays.

"Sometimes when patients are prescribed a beta-blocker after a heart attack, they don't understand why they should continue taking it since they have completed cardiac rehabilitation and are feeling fine. They don't understand the risk in not taking it," Siejak says.

The health coaches discuss the individual issues with the member and emphasize the importance of taking the medications. They can also provide tools and resources to members to help them understand and keep track of their medications.

During the telephone call, the health coach works with the member to set goals for medication adherence and to develop strategies for meeting the goals.

They help the members prepare for a follow-up visit with their physician by discussing what questions the member should ask the doctor and what concerns they may want to bring up.

"The goal is to interact with the members and educate them to understand why it's important to adhere to their medication plan and to be an active partner with their physician," she says.

The health coaches work with the members to determine if they need follow-up calls and to set up a convenient time.

"The program is very member-centric. If the member seems to be doing well, the health coach may make only one telephone call. If someone is having a lot of problems, the health coach may call on a regular basis," Siejak says.

The health coaches, who are employed by a vendor with which Independence Blue Cross contracts, are health care professionals with 10 to 15 years experience. About 90% are registered nurses. The others are pharmacists, registered dieticians, and respiratory therapists who are called in when patients have specialized needs in their field.

The health plan conducts monthly data mining to identify members who are not filling their medication.

"We have checks and balance to monitor outreach efforts so the members don't get the same kind of calls over and over," she says.

In most cases, the same health coach works with the member but since the program is staffed by health coaches 24-7, if a member calls in the middle of the night or on the weekend, his or her health coach may not be at work.

The health coaches work on the same platform, which gives the coach who talks with the member the ability to access member information and leave information for the primary health coach.

"Greater than 80% of the time, the member talks to the same health coach," she says.

Since the medication persistence program was launched in July, 2009, the health plan has targeted 12,402 members with at least one automated outreach. About 90 of those members have been engaged in one-on-one health coaching.