Study: Medication misuse is driving $200 billion in healthcare costs. What’s being done?

pills overtreatment medicationMost of us are aware of that medication adherence is a costly problem, but a new report puts it in alarming context and sheds some light on other factors under the [broad] category of medication misuse that are driving up healthcare costs to the tune of $200 billion.

The complications stemming from medication misuse lead to an estimated 10 million hospital admissions, 78 million outpatient treatments, 246 million prescriptions and 4 million emergency room visits annually, according to a new report by IMS Institute for Healthcare Informatics. The report highlights the biggest pain points and what’s being done to reduce the costly problem.

Although adherence accounts for about half of the costs,  other factors that are boosting medication misuse costs are:

  • Poor management of patients taking five or more medications
  • Delays in evidence-based treatment for hepatitis C, Type 2 diabetes, atrial fibrillation and coronary heart disease
  • Treating viral infections and respiratory tract infections with antibiotics — particularly in adults where it’s linked to C. difficile
  • Medication errors
  • Not enough use of generics

So what is being done? The report points out that medication adherence among people with three of the most prevalent chronic diseases –- hypertension, hyperlipidemia and diabetes –- has improved since 2009 by about 3 percent. Why? Because cheaper medications (generics) and interventions by different healthcare stakeholders are being helped by technology to identify high-risk patients earlier. It recommends tracking prescription drug market changes and linking that data to adherence rates. People prescribed antibiotics for viral infections has fallen from 20 percent to 6 percent since 2007.


Improving care coordination with patients and each other are also expected to make a difference. Among the programs the report highlights are CareFirst’s Patient Centered Medical Home. It worked with primary care providers and used financial incentives for achieving better cost and outcomes to treat chronic conditions such as higher reimbursement, fees for creating and maintaining customized patient care plans, and bonus payments.  It saved $40 million in 2011 — its first  year — according to the report.

CVS Caremark’s Pharmacy Advisor program is a predictive analytics tool designed to improve adherence and reduce care gaps by identifying patients with chronic conditions. It uses call centers or face-to-face interactions for counseling. It also reviews the member’s current treatment to determine if there are gaps in care or issues with medication adherence. Diabetes was the initial focus but that has since been expanded to other conditions such as congestive heart failure, asthma, breast cancer, chronic obstructive pulmonary disease and osteoporosis.

Walgreens, the first drugstore to set up an accountable care organization, uses nurse practitioners and physician assistants to offer services such as blood pressure and blood glucose monitoring, screenings, smoking cessation programs and providing referrals for additional testing to help patients with asthma, diabetes and high cholesterol better manage their conditions.

Murry Aiken, the executive director for IMS Institute for Healthcare Informatics, notes that the Affordable Care Act is helping to cut costs through coordination of care, performance-based payment and integrated care delivery. “These are all elements we believe will be positive forces,” he said.

[Photo from Flicker user Boots Mckenzie]

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