One of the evergreen concepts in preventing hospital readmissions is monitoring patients for medication adherence after they leave the hospital. This blog, originally published in July 2019, is a good reminder of the importance of including medication adherence monitoring in post-discharge care.
Reducing readmissions has long been a national priority for payers, providers, and policymakers alike. As health systems move towards value-based care, it becomes increasingly critical to find actionable solutions that can help patients and reduce burdensome costs: such as pinpointing the pervasive issue of medication nonadherence, and how it ultimately impacts a patient’s risk of rehospitalization and a health system’s medical costs.
Assessing quality care in health systems
Health systems use readmission rates as a quality benchmark metric for value-based care. This aligns with the formal decision by the Centers for Medicare & Medicaid Services (CMS) to include 30-day hospital readmission rates in reimbursement decisions as part of the Affordable Care Act, with specific penalties for health systems that experience higher than expected readmission rates through the Hospital Readmission Reduction Program.
The implementation of this penalty has spurred the integration of additional programs to incentivize health systems to reduce 30-day readmissions and determine the root causes of patient readmission criteria. Given that 33-69 percent of medication-related hospital readmissions in the U.S. correlates with poor medication adherence, there is a growing need for health systems to implement feasible strategies that reduce 30-day readmission rates—and mechanisms that bolster patient adherence.
Linking medication adherence and rehospitalizations
A study published in Patient Preference and Adherence assessed whether medication adherence could identify patients at higher risk of readmission. Researchers found that better adherence was independently associated with reduced 30-day hospital readmission rates, indicating the potential for targeted interventions to improve adherence. Findings show that patients with either low or intermediate medication adherence had greater than a 2.5 times higher chance of being rehospitalized within 30 days. Additionally, considering a patient’s medication adherence history improves the predictably of hospital readmissions.
Additional research confirms the correlation between nonadherence and rehospitalizations, particularly with chronic illnesses such as cardiovascular disease. With 31-58 percent of cardiovascular patients nonadherent in taking medications, the consequences of nonadherence lead to 20-64 percent of these patients experiencing heart failure readmissions, at enormous costs to the health system. Notably, improved adherence among heart failure patients can lead to a decrease in emergency department visits and rehospitalizations, and lower mortality rates. In a similar study published in the Journal of the American Heart Association, researchers found that the ubiquity of poor adherence among heart failure patients leads to higher risk for hospital admission and death—and that “medication adherence interventions were found to significantly reduce mortality risk among heart failure patients…and decrease the odds for hospital readmission.”
While there is no single solution to reduce hospital readmissions, it is indisputable that better medication adherence among all participants in the health care system can help enhance patient outcomes and reduce costs. Through improved coordination and communication, each player in the hospital framework can help advance toward a future in which the overall system—and patients—reap the greatest health, quality, and financial benefits.