If nonadherence is a “health condition”, use big data as preventive screening tool

seven day pill box showing Wednesday pills

Many companies are taking a crack at the intractable and expensive problem of medication nonadherence. The question is how to get people to take their prescription medications regularly so there is no interruption to their care regimen.

Not to mention no interruption to the revenue stream of pharmacy benefits management firms and pharma companies.

There are startups like AdhereTech and MediSafe Project that are aiming to change behaviors. And then there is Vitality, which makes bottles whose caps glow different colors when they start to run low.


But pharmacy benefits management company Express Scripts, like RxAnte, is taking a different approach to tackling this problem. The company wants to be able to predict who will become noncompliant in a six- to 12-month period and then tailor intervention approaches to individual patients. The predictive capability comes from big data — not only claims history of a patient but several hundred other variables to create what is known as the Express Scripts Adherence Index.

Heather Sundar, VP of Product Development, Express Scripts

Heather Sundar, vice president of product development, Express Scripts

In a conversation with MedCity News, Heather Sundar, vice president of product development at the company, described looking at medication nonadherence as a medical condition and then use preventive screening to see who might be vulnerable to it.

The idea is akin to performing routine, preventive medical screening that can provide advance warning of the onset of a particular medical condition.

Thus the Express Scripts ScreenRX tool was born.

Using big data, ScreenRx analyzes 400 variables and how they interact to determine with 98 percent accuracy which patients are likely to become nonadherent within six to 12 months, Sundar declared. The tool is used for specific disease states — for example, diabetes, high blood pressure, high cholesterol, asthma and osteoporosis.

The data reveals some expected and some curious results. For instance, ScreenRx has shown that in families that have children, the parents are likely to not take their prescription medications regularly; also, if one partner falls prey to nonadherence, the contagion spreads to the other.

While those two examples are not a surprise, here’s one that ScreenRx revealed that’s less intuitive: Men whose providers are female tend to be worse offenders in terms of taking their medications on time, compared with men patients with men physicians.

Sundar said that a pilot of about 600,000 members was so successful that the company has now rolled out the ScreenRx tool as a product for its customers: employers, health plans and even government entities. Sundar declined to say how many or who have signed up as paying customers.

Simply identifying potential nonadherent members is not enough, however.

After identifying those who may develop nonadherence, Express Scripts actively engages patients to figure out how they can be made to comply with their medication regimens. They are contacted primarily through the telephone, but sometimes by a letter and even online. If it is determined that a patient needs a reminder device, then that is sent to him, Sundar said. For instance, in a separate pilot, Express Scripts rolled out a program by which patients picking up their last refills, get a bottle where a message that is etched on the bottle cap using a laser reminds them that they need to contact their provider to renew their prescriptions.

If patients are not adhering to the plan because they have a clinical question, then Express Scripts can connect them to a specialty pharmacist. And if patients need to transition their prescriptions to a home delivery pharmacy, Express Scripts can perform that as well.

And this has provided a powerful lesson.

“There are very different causes for nonadherence,” Sundar said. “You need multiple solutions. There is no one-size-fits-all solution. There is no silver bullet at improving adherence.”


[Photo Credit: Seven-day pillbox from Big Stock Photo]

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