A member’s ability to access, understand and take prescription medication as instructed is vital for improving health outcomes and reducing healthcare costs. Chronic conditions like hypertension and diabetes can contribute to increased hospitalization rates and emergency room usage when members are not able to take medication as prescribed. However, there are several complex factors that prevent members from improving adherence rates, from social determinants of health (SDOH) to a lack of health literacy to financial barriers.
Medication adherence is a major healthcare challenge that impacts health plans in all markets. Nearly one-third of Medicare Star Ratings scores are driven by medication adherence measures, which many Medicare Advantage and Part D plans saw scores drop in the 2023 ratings. Medicaid, Affordable Care Act and Commercial health plans all must contend with the financial strain of low chronic condition management, and enabling members to easily access and take prescribed medication can have a powerful impact on revenue and plan performance.
The challenge health plans face is understanding the causes of non-adherence at a member level. The most common barriers members face with taking medication are poor communication with providers and pharmacies, a lack of education surrounding managing medication and side effects, and the high costs of some prescriptions. Developing a more comprehensive view of how these different scenarios map out for members is vital to developing meaningful interventions.
Improving medication adherence rates begins with accessing the right data and metrics regarding member experiences. Claims data allows plans to monitor adherence rates, but understanding the forces that drive high or low rates may remain a mystery without further insights. Through Pulse Surveys, health plans can develop a deeper understanding of member experiences and begin building strategies to improve health outcomes.
What is a Pulse Survey?
Pulse Surveys are short surveys that use well-crafted questions to rapidly capture feedback from members. These surveys follow a simplistic methodology that focuses on being light, fast, customizable and easy to complete. One of the most valuable elements of a Pulse Survey is how low effort it is for members to complete, ideally improving your completion rates and, as a result, the quality of your member data. Pulse surveys can be sent any time of the year at any frequency for any reason, including evaluating member sentiment and program effectiveness.
Since Pulse Surveys are not restricted to a standard format, plans can use multiple channels to deliver them to members. Omni-channel surveying should be tailored to a member’s preferred channel and allowing plans to reduce the cost of physical outreach by incorporating a digital-first approach with email and text message surveys.
Plans can model Pulse Surveys on traditional healthcare surveys like health risk assessments (HRA), mock-CAHPS and health outcome surveys, but these surveys are ideally shorter and designed to address a specific topic. By refining a survey down to a maximum of two to three questions, plans make it easier for members to quickly complete surveys and improve response rates. Plans in all markets can also design surveys to specific demographics, communities and languages to improve member data stratification.
How Health Plans Benefit from Medication Adherence Surveys
Packaging specific questions about medication adherence into Pulse Surveys allows plans to understand why care gaps occur at a member and community level. Understanding why members are non-adherent is vital for designing interventions that empower members to access, understand and manage their medication.
When supported by the right tracking and survey metrics, plans can stratify member responses to understand how individual communities contend with pharmaceutical issues and chronic diseases. For example, stratifying survey responses alongside race, ethnicity and language data may accelerate a plan’s ability to identify health disparities and advance equitable access to care. Plans may also determine that members in certain zip codes live in pharmaceutical deserts and have limited access to medication, contributing to low adherence rates.
Pulse Surveys open up more opportunities to engage members at different stages of their health journey without having to rely on time-sensitive interactions like mock-CAHPS or content-heavy HRAs. Plans can choose to target certain sections of their populations to collect community or demographic-specific data or incorporate follow-up questionnaires months down the line to evaluate the impact of their interventions. This flexibility can inform further improvements in survey capabilities and data collection.
Valuable Questions to Ask Members to Evaluate Adherence Rates
Asking the right questions during a member’s healthcare journey can inform valuable insights into member adherence rates, such as what factors are contributing to low adherence rates.
When designing a Pulse Survey to evaluate adherence rates, plans should focus on questions that are judgment free and relevant to the member. Members may already know they have issues taking medication but are not aware of how to bring them up with providers, insurers or pharmacies. Giving them an opportunity to share their feedback without casting blame can contribute to higher response rates.
Plans should consider incorporating the following medication adherence questions into Pulse Surveys:
- How often do you take your medications as prescribed?
- How many different prescription medications are you taking on a regular basis?
- How often was it easy to use your prescription drug plan to get medicines your doctor prescribed?
- Would you be interested in filling your prescription through the mail?
- Do you have a way of getting to and from doctor appointments or the pharmacy?
- Do you struggle to afford your medication?
It is important to always keep in mind the specific data gaps that need addressing when drafting questions and the potential pain points they might shine a light on. A well-crafted survey will not only address adherence rates and the degree to which a member is non-adherent, but also member experiences with pharmacies, providers, health plans, SDOH and community programs.
Leveraging the Insights of Pulse Surveys
Once a survey has been completed and processed by a plan, the responses should be synchronized with member records. Aligning results with a member’s medical and wellness history, claims data, demographic information and pharmaceutical records will allow plans to surface member-specific insights.
For example, if members shared negative experiences with local pharmacists, plans can leverage pharmaceutical data to identify specific pharmacies where these issues occurred to develop better provider engagement strategies. Alternatively, stratifying questions regarding transportation barriers alongside zip codes may show that certain communities are living in pharmaceutical deserts and would benefit from prescription deliveries.
When contending with the common, but challenging causes behind non-adherence, there are still creative solutions available to plans. Members may respond to surveys stating that they are struggling to afford their medication, with some splitting pills to make a prescription last as long as possible. In these scenarios, plans can reach out to members to:
- Help them access cost-efficient generic or therapeutic alternatives
- Encourage them to attend a comprehensive medication review with their doctors
- See if they are eligible for rebates or incentives
- Perform a medication synchronization to convert the member to a more affordable and conducive option
It is also important to pay attention to SDOH that might drive non-adherence and consider strategies to address barriers to care. Asking members if they have difficulties affording utilities may inform outreach that connects members to government assistance programs, such as the Affordable Connectivity Program or Low Income Home Energy Assistance which are often available for Medicaid members. These programs may enable members to reduce their monthly utility bills and indirectly allow them to afford their prescriptions.
Address Medication Adherence from a Single Survey Platform
Empowering members to fill their prescriptions and improve health outcomes relies on the ability to rapidly understand and address medication adherence pain points, but the right survey solution allows plans to do so much more. Many plans are forced to design and implement unique survey tools to evaluate every chronic condition, quality measure and scenario. Fragmenting your surveys in this manner is costly, time-consuming and resource heavy.
With Healthmine’s Pulse Survey solution, you can access a single platform for developing, distributing and analyzing surveys. Our platform enables you to choose:
- Which members to contact: Input a targeted outreach list to develop community-level insights or survey your entire population.
- How you wish to contact them: Engage members through their preferred channels, including emails and text messages.
- What questions to ask: Select your questions from Healthmine’s survey library or create your own.
Throughout this process, you can trust in the guided support of a dedicated account manager and leverage up to four hours of consulting time with our Expert Advisory Services team to develop meaningful interventions.
Launch medication adherence Pulse Surveys in just 60 days and begin accessing results two weeks after implementation when you partner with Healthmine.