The Noncompliance Epidemic

Can We Get Patients to Be More Compliant?

Neil Chesanow


January 16, 2014

In This Article

Improving Compliance as a "Business Imperative"

At about the same time, while the research methods used in clinical trials continued to be unhelpfully diverse, consistent methods for measuring compliance were finally being developed within the healthcare industry itself.

Around 2009, for example, the Pharmacy Quality Alliance, an influential trade group, adopted an improved formula -- the proportion of days covered (PDC) -- for calculating prescription fills and refills for a given drug, notes Kristi Rudkin, PharmD, Senior Director of Product Development - Adherence at Walgreens.

The PDC brought a new level of accuracy to pharmacy data on patient compliance and standardized how it is defined, measured, and assessed.[13]

"If you have a uniform measure, you can begin to compare apples to apples," Oyekan observes, which alleviates a huge frustration with much of the literature on compliance. Once a statistically compelling case for doing one thing or another can be made, targeted interventions can then be designed, implemented, and measured.

The ACA provided the economic impetus needed to get the ball rolling, with bonuses for meeting compliance targets and penalties for missing them, such as those levied against hospitals when Medicare patients are readmitted within 30 days of discharge. Such readmissions cost $15 billion-$25 billion a year.[14]

At the ACA's behest, the Centers for Medicare & Medicaid Services introduced a 5-star rating system for Medicare Advantage plans. Plans that meet their compliance targets for controlling certain chronic diseases in their members are awarded bonuses.[15] Those that underperform receive fewer stars. They thereby risk losing members, because comparison-shopping patients can go online and easily discover which plans have the best ratings.

"People started to realize that adherence was not just about pharmaceutical companies trying to make more money or retail pharmacies wanting to push more meds," Oyekan says. "They began to see it as a business imperative."

It's now 4 years later. What initiatives to improve compliance are being tried? How are they working? What's intriguing on the horizon? Let's take a look.


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