Medication Adherence Isn’t a Checkbox. It’s a behavior. Let’s Treat It That Way.

For all our advances in healthcare — more precise medications, greater access to care, smarter technology — one issue stubbornly persists: medication nonadherence. Nearly half of people with chronic conditions don’t take their medications as prescribed. That single fact continues to drive avoidable hospitalizations, poor outcomes, and billions in unnecessary costs.

So why haven’t we solved this? 

Because we keep treating medication adherence like a checkbox — something that can be assessed during an annual visit, fixed with reminders or a few nudges. But those tools miss the mark. They don’t address the real-life emotional, cognitive, and psychological barriers that get in the way of taking medications consistently. 

Patients don’t live in checkboxes. They live in the real world, where jobs are lost, stress piles up, caregiving duties overwhelm, and side effects make a condition feel worse than the cure. These complexities require more than outreach. They require understanding.

As a behavioral scientist, I see adherence for what it really is: a dynamic, context-driven behavior. A person who’s adherent today may fall off track next month — not due to lack of information or because they forgot, but because something in their life changed. Maybe they lost transportation. Maybe they developed side effects. Maybe they couldn’t afford both groceries and copays. 

These aren’t outliers; they’re patterns we see every day, especially among patients with multiple chronic conditions, low income, and limited support.

That’s why we must stop treating adherence as a static measure and start treating it as a dynamic process — one that requires continuous support, real-time adaptability, and trust.

This doesn’t mean abandoning existing strategies like call centers or educational outreach campaigns. It means enhancing them with behavioral tools and frameworks that allow us to understand why a patient isn’t adhering — and intervene in ways that resonate. You have to meet people where they are — with the right questions, the right tone, and the right tools.

For payers and providers, this means three things:

• Shift from outreach to engagement. A reminder is not the same as a conversation. Equip care teams to use behavioral techniques — like motivational interviewing — to uncover the real barriers. It’s not about checking in; it’s about checking beneath the surface.
  
• Support the whole patient. Adherence falters when social and emotional factors go unaddressed. Someone managing depression, food insecurity, or caregiver stress needs more than a refill reminder — they need coordinated, person-centered support.
  
• Invest in adaptive systems. Static protocols don’t work in a dynamic world. Leverage data to spot early signs of disengagement, personalize outreach based on health literacy and communication preferences, and escalate support as circumstances shift.

When we support people in ways that reflect their real lives, the benefits go far beyond the clinical. They’re financial, too.

Every dollar invested in improving adherence can generate more than $2 in avoided medical costs and productivity losses. And in a value-based environment, where outcomes and experience directly shape reimbursement, those savings are only part of the equation. Better adherence can also mean higher Star Ratings, fewer preventable admissions, and stronger engagement between members and their care teams.

That’s not just encouraging — it’s proof that centering behavioral insight is both the compassionate and economically sound thing to do.

The bottom line: Improving adherence isn’t about doing more. It’s about doing what works — consistently, compassionately, and in context.

Photo: grThirteen, Getty Images

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