(201) The implementation and evaluation of a medication adherence program segmenting by social and clinical risk

Background: : A cornerstone of effective management of chronic conditions is medication adherence. Interventions addressing barriers to timely medication refills are essential due to a significant impact on health outcomes and costs, and can be augmented by segmenting the population of interest to focus resources for the most comprehensive intervention to the individuals who would most benefit.

Objective: : Describe the medication adherence impact of assessing and supporting health related social needs (HRSN) within a medication adherence program for individuals at high risk for overdue or missed refills across three chronic conditions.

Methods: : The quality improvement program focused on Medicare Advantage (Part D) members of a major health plan with prescriptions for diabetes (non-insulin), hypertension (RAS agonists), and hyperlipidemia (statin), including techniques such as high-touch outreach from a clinical pharmacy care center, with telephonic and text outreach. A subset of participants (SDOH cohort) received HRSN screenings to identify resources and aid in management of health conditions and ensure timely refills, identified by the lowest quartile of composite Whole Health Index (WHI) and its Social Driver domain. WHI is a reliable and valid measure of whole-person health, covering clinical and social drivers. 78% of the SDOH cohort had social risk factors as identified by the Centers for Medicare and Medicaid Services, compared to 67% among non-SDOH.

Results: : 38% of the SDOH cohort were reached and 28% were engaged, compared to 29% reached and 21% engaged in the non-SDOH cohort. Members in the SDOH cohort participated in the program at a rate of four percentage points (pp) higher than non-SDOH. Year-end adherence among engaged compared to nonengaged for cholesterol, diabetes, and hypertension was 16.0, 12.3, and 15.5 pp higher in the SDOH cohort, respectively. These values were 12.8, 10.1, and 11.7 pp higher in the non-SDOH cohort. This yields a difference-in-difference estimate for the SDOH program of 3.2, 2.2, and 3.8 pp, respectively. Overall, SDOH cohort members had both lower baseline adherence rates and greater improvements in medication adherence compared to the non-SDOH across all three conditions.

Conclusions: : High-touch outreach, including screening for and addressing social needs is an effective intervention for improving medication adherence in a population with a high prevalence of social risk factors. Utilization of measures of health such as WHI to segment the population allows for optimal distribution of resources for maximal impact.

Sponsorship:: Elevance Health