Magellan Health, a healthcare payer organization in Scottsdale, Arizona, needed to address adherence to oral medication therapy.
Non-adherence is one of the factors contributing to non-optimized medication use – the latter a term that describes all the reasons an individual doesn’t take medications including costs, lack of ability to pick up the prescription and many others.
While the numbers are widely variable, a 2018 analysis showed that costs attributed to “all causes” non-adherence ranged from $5200-$52,000 per person, said Dr. Caroline Carney, chief medical officer at Magellan Health Rx management.
“In many cases, taking medications could lead to substantially less morbidity and even mortality,” she explained. “For me, the greatest driving factor here is providing support to ensure the best health outcome. In order to better understand this, one has to look at the lifecycle of treatment to see where non-adherence takes place.”
Start with the medication being prescribed by the doctor. The prescription is most commonly called in, electronically sent, or hand carried by the consumer to the pharmacy. If the consumer never picks up the prescription, or never drops off the handwritten prescription to be filled, the first “opportunity” for non-adherence occurs.
“If the consumer does fill the prescription, that’s where technology comes in to ensure that the consumer actually takes the medication, and to link that consumer with a case manager who can assist with questions and concerns,” Carney said.
“That case manager will also do outreach and work with the consumer if we find that the consumer isn’t taking the medication. It’s a very proactive approach to support the consumer in getting the best health outcomes and to reducing medication waste.”
For that point where technology can step in, Magellan Health selected health IT from vendor AiCure. AiCure uses an artificial intelligence platform to see, hear and understand how people respond to treatment through a patient’s smartphone. This technology captures and analyzes behavioral data – video and audio patient information that shows how people respond to medical conditions and treatment.
“AiCure uses app-based smartphone technology, coupled with case management, to ensure that orally delivered medications are taken according to schedule,” Carney explained. “This goes a step beyond the usual medication possession ratio metric typically used to measure adherence. By using the AiCure technology, we can be certain that the pill has actually been swallowed. If not, we can better engage the consumer to understand why he/she is not taking the needed medication.”
Then, Magellan Health can work individually with a consumer who misses doses, or fills, doesn’t ever start taking a medication, or stops due to side effects or other issues, she added.
There are other vendors with similar technologies on the health IT market today. For example, to help overcome the challenges it faced with directly observed therapy, the Guam Department of Public Health and Social Services turned to a healthcare technology from Baltimore-based emocha Mobile Health.
Patients use emocha, a HIPAA-compliant mobile application, on their smartphone to video record themselves taking their medication, report side effects and receive medication reminders. They have access to two-way, HIPAA-secure messaging to communicate with their healthcare provider.
Guam uses the technology for TB patients. Magellan Health uses its technology for Hepatitis C.
MEETING THE CHALLENGE
Magellan Health uses AiCure technology for individuals with Hepatitis C. Hepatitis C is thought to be curable if the full course of medication is taken. If the medication is filled, but not actually taken, the economic impact of wasting that unused drug can be in the tens of thousands of dollars.
“But more importantly, we can’t get that person to a cure,” Carney said. “Hepatitis C leads to further cirrhosis, hepatic cancer, and ultimately end stage liver disease leading to liver transplants. My goal would be that for individuals appropriate for hepatitis C treatment, that we support them in getting to a cure.”
“Because the technology helps us understand who does or does not need assistance, human resources can ultimately be better targeted.”
Dr. Caroline Carney, Magellan Health Rx management
The technology involves the consumers using the app to video themselves taking and swallowing the pill.
“We support the use of the app with an incentive and support the member with case management,” Carney said. “Each dose is recorded and uploaded to the app where the image is read to ensure compliance. The program worked very well. Our outcomes showed a statistically significant difference between those using the app versus those not using the app – the practical outcome is that more people reached the level of adherence required for reaching cure.”
Magellan Health’s hard metrics include proportion of days covered (PDC) – the metric that defines that the medication was taken. Individuals using the technology had a higher PDC (mean PDC 0.962) versus those that did not (mean PDC 0.876) with p-value <0.02.
“Future metrics will include satisfaction with the technology and satisfaction with case management,” Carney said. “We are expanding with AiCure into other disease states where the ability to prevent morbidity and downstream costs are well matched to this technology.”
ADVICE FOR OTHERS
“Behind every outstanding technology should be a healthcare professional for the member to connect with as needed, and for that healthcare professional to support the consumer during the trajectory of treatment,” Carney advised. “Because the technology helps us understand who does or does not need assistance, human resources can ultimately be better targeted.”