Medication Adherence and Deprescribing Programs Aren’t Enough for Today’s Polypharmacy Patients

As the Boomer generation ages, the prevalence of polypharmacy — patients taking multiple medications to manage chronic conditions — is surging. Nearly 40% of older adults take five or more medications, a number that has tripled in the last two decades. While polypharmacy can be necessary, it also significantly increases the risk of adverse drug events (ADEs), with up to 30% of hospital admissions among older adults linked to medication-related complications. However, when speaking to health system leaders about how they handle polypharmacy patients, they often focus solely on mitigating problems by highlighting programs they use to drive adherence or deprescribe certain medications.

But, in today’s healthcare ecosystem where providers are increasingly under value-based care (VBC) contracts, health systems, accountable care organizations (ACOs) and pharmacy leaders must go beyond traditional approaches to medication management. While ensuring that patients take their medications correctly and avoiding harmful drug interactions are important, a broader strategy is needed. Effective medication use is not just about keeping patients on track with their prescriptions — it’s about appropriately using medications as a tool for a patient’s overall health in both the short term and long term. Without this mindset, providers risk missing critical factors that contribute to poor outcomes, including medication-induced complications, redundant treatments and overlooked underlying conditions.

Deprescribing is a necessary tool but is not the whole solution

Reflecting on conversations with more than 100 healthcare organizations last year, one common theme emerged: a strong focus on deprescribing. And it’s not without good reason. Research has suggested that as much as 60% of older Americans may be on a drug they don’t need. In a study of more than 200,000 older veterans with diabetes, researchers found that more than half were candidates for dropping a blood pressure or blood-sugar control medication.

While deprescribing is an essential component of medication optimization, it’s important that any reduction in medication burden includes a thorough review of the patient’s overall health. In fact, research has shown that simply stopping medications without a broader clinical strategy can lead to unintended harm, particularly when done without careful monitoring.

Many providers view deprescribing as a cost-cutting measure or a response to polypharmacy concerns, but may not fully consider that stopping one medication could increase reliance on another. For example, consider a patient managing chronic lower-back pain with long-term opioid therapy. Over time, that patient also has developed insomnia and anxiety, which their physician attributes to both his underlying pain and possible medication side effects. To help with his sleep disturbances, the patient is prescribed a benzodiazepine.

After a medication review, the healthcare team decides to deprescribe the benzodiazepine due to concerns about falls, cognitive impairment and dependence. However, they may overlook how discontinuing the benzodiazepine could impact the patient’s ability to tolerate his chronic pain. Without the benzodiazepine, the patient may experience worsening sleep and heightened anxiety, leading to increased pain perception. As a result, the patient may begin to rely more heavily on opioids to cope with increased pain and worsening sleep, raising the risk for opioid-related side effects, including sedation, falls and respiratory depression.

This example illustrates why deprescribing must be part of a thoughtful, patient-centered strategy that ensures medications work together to improve overall health. But, understanding these risks ahead of time and coming up with a plan – especially when providers are responsible for thousands of patients – is an incredible challenge, one that is nearly impossible at scale without a technology-assisted approach.

Medication optimization focuses on holistic health and can improve value-based care (VBC) performance

True medication optimization also means evaluating whether each medication is appropriate, effective, aligned with the patient’s broader health goals and isn’t going to be problematic over the longer term.

For example, a patient on two blood pressure medications may appear well-controlled, but their treatment could be silently contributing to renal failure. Without a holistic medication review, only focusing on adherence and/or describing in isolation may not consider this complication, creating gaps in care or even worsening health outcomes.

Scenarios like these are more prevalent than you might expect, and when a provider (especially those treating Medicare populations) is responsible for thousands of patients, it’s simply impossible to manage at scale.

A comprehensive medication management strategy is particularly critical for providers operating under VBC agreements, where financial incentives are directly tied to patient outcomes and cost containment. Poor medication management contributes to preventable emergency department visits, hospital admissions and complications — all of which drive up costs and negatively impact performance metrics in risk-based contracts.

To succeed in value-based care, providers must move beyond traditional medication adherence programs and ensure that prescribed treatments actively contribute to better health outcomes and cost efficiency. A holistic medication management strategy should include:

• Regular medication efficacy assessments — not just for interactions but for overall impact on patient health.
• Evaluating treatment goals holistically, ensuring that medications are not only managing conditions but also preventing further complications.
• Proactive identification of risks — beyond known drug interactions, including potential long-term organ damage, nutritional deficiencies, and cognitive side effects.
• Leveraging technology to synthesize vast amounts of clinical data and identify more personalized medication adjustments.

The ability to optimize medication regimens proactively — rather than reactively responding to adverse events — positions providers for stronger financial and quality performance under value-based models.

Elevating the standard of care

Optimizing medications is not just about compliance — it’s about ensuring that every prescription contributes to better patient health. Providers who don’t embrace this mindset may be treating conditions on paper but risk overlooking the bigger picture of patient well-being.

By moving beyond adherence and drug interactions to a holistic, outcomes-driven approach, health systems and providers can redefine how medication is used — not as a rigid protocol but as a dynamic, patient-centered tool for achieving better health. The future of medication management lies not in reducing pill counts or enforcing adherence alone, but in using every medication decision to drive measurable, meaningful improvements in patient outcomes.

Photo: Stas_V, Getty Images

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