Medical experts agree: better engagement with personal health decisions can have a significant impact on health outcomes, while also reducing catastrophic health events and preventable hospital readmissions. But patient engagement isn’t always that straightforward. One of the biggest culprits – for both preventable hospital admission and readmission is medication discrepancy. Medication discrepancy is the mismanagement of medication or complications that stem from medication use that isn’t optimized and patients who are not engaged in their treatment plans.
I spent 15 years working in pharmaceuticals and know firsthand the complexity of the medications that individuals are prescribed – not to mention the fact that they are prescribed by multiple providers across multiple specialties from various pharmacies, with systems that don’t necessarily talk to each other. There is significant room for conflict between medications, and undesirable and mismanaged side effects if patients aren’t properly educated or engaged in managing to desired outcomes.
Medication management demands patient education and engagement to be effective because service providers – especially hospital or emergency care providers – won’t be supervising patients use of their medications following discharge and aren’t necessarily taking a look at the whole picture, including any other supplements or medications a patient might already have at home.
Even primary care doctors who engage with patients following discharge may not have the full context as to how or why a hospital physician may have prescribed or replaced a certain medication. Engaging patients at discharge to proactively seek medication reconciliation and optimization opportunities, as well as offering this service directly post-discharge is necessary to fill gaps in the system.
This disconnect drove me to my current role at MOBE where we are taking steps to bridge the gap between health care services and self-management tools in order to support individuals in achieving their best health outcomes and reduce over-utilization. MOBE is additive to an individual’s health care experience, helping them connect the dots to see and understand the full picture of their health. Our goal is to help individuals make more informed decisions about how each aspect of their health, including medications, influences all others, and how to address gaps. In our experience, patients want support in their health care decisions, they’re just not sure where to turn for help. The following are some effective methods we’ve found for promoting greater engagement among a patient population that is prone to readmissions.
1. Identify risk and opportunity
One of the most critical moments in a patient’s care experience is the point at which they are discharged with a new prescription. According to a 2017 Consumer Reports survey, more than half of Americans now take prescriptions regularly, and on average, those who take prescriptions are taking four of them at once. In addition to prescriptions, a 2012 Consumer Healthcare Products Association study found that most people are managing their health with over-the-counter medicines and herbal and vitamin supplements, which can increase the risk of medication-related problems.
With this being the current medical climate, providers and payers are beginning to recognize the importance of transitions of care medication reconciliation as a standard process at the point of admission and discharge. With claims data, payers also have enormous opportunity to proactively identify and support individuals who are frequent users of the healthcare system and are at risk for suboptimal health outcomes with their current medications. At MOBE, we work with health plans to identify this group, which represents between 15-20 percent of the health care spend within a commercially insured population. These are patients with unresolved health issues that cause continuous events, but rarely hit the threshold that triggers traditional care management. Knowing that medication related readmissions or visits to the emergency department can be preventable, we can seek to identify attributes related to a person’s recurring conditions to intervene on earlier.
2. Treat the individual, not just the ailment
Everything about our health is connected – body, mind, effects of medications, diet, sleep habits, happiness and beyond. When we’re sick, injured or just running at less than full capacity, often there’s more than one culprit. To optimize our response to medications, it’s critical to balance other areas and consider the full picture of our health. Too often we address our ailments acutely rather than taking a broad look at how seemingly unrelated health decisions – even things like sleep or nutrition – affect our most obvious symptoms and therefore medication needs and, more importantly, changes in our health.
With a narrow lens, we may prescribe or treat specific issues without understanding some of the root problems affecting or perpetuating it for a particular individual. If we address issues acutely, without considering the whole picture of our health, we may keep pouring water into a leaky bucket and prescribing more medications when an existing prescription or supplement may be the problem.
MOBE’s experienced health professionals help individuals understand how various aspects of their health are more connected than they might think – sleep, nutrition, movement, medication and happiness. Some of our participants have found relief from complex medical issues or chronic pain when they addressed poor sleep or eating habits that were causing inflammation or hindering the body from healing properly. Not every situation is that simple, but it’s important that we continue to seek opportunities to understand the full picture of someone’s health to know how to best treat the individual, not just the ailment.
MOBE takes a similar approach to helping individuals optimize their medication situation. We can help people ensure all medications, across all providers, are working in a positive way for them, thinking through questions such as: Is my medication doing what it’s supposed to, and how would I know? What might be keeping me from taking my medications the way that I need to for them to work? Has anything changed with my body that could affect how my medications work or make me feel? Am I taking any supplements or herbals that could affect my other medications? How does my diet affect how my medications work? Am I doing what I can to boost my body’s own ability to be healthy and heal?
3. Educate and inspire better health care choices
Our health care system will continue to fall short of optimal outcomes and cost savings if individuals aren’t educated and equipped to take ownership over their own health and make decisions that lead to increased wellbeing. By creating solutions that address individuals needs long before they become an emergency – and doing so through a holistic and relational approach - individuals have a much better chance of achieving long term success and reducing the risk of readmission. Through MOBE’s personalized approach, a population facing unresolved health issues is experiencing significant breakthroughs. This isn’t because they have more experts prescribing behaviors or medications, but rather, they are supported by experts who are journeying with them – listening, relating, educating and guiding by sharing suggestions.
As a medical community, we know that addressing problems at the root is critical for future health. The same is true for individuals and patient engagement. More experts, more specialists, more research, more medication, more information will not automatically result in improved patient engagement, education or health. To improve outcomes, we must prioritize supporting individuals in a way that meets them where they are at, is highly relational and fuels their intrinsic motivations to pursue wellbeing.
Leslie Helou is the Vice President of Guided Medication Programming at MOBE. Prior to MOBE, she worked as a clinical pharmacist in the pharmaceutical industry for over 15 years.