For decades, poor medication adherence has been recognized as a significant and persistent problem in the healthcare system. Since a report published in 2000 by the U.S. Department of Health and Human Services, numerous studies have shown that up to 50% of patients exhibit varying degrees of non-adherence and non-persistence.

Poor adherence and persistence contribute to negative health outcomes, particularly for patients with chronic illnesses, such as cardiovascular disease, diabetes, HIV, and depression.

Telehealth services can be deployed as a tool to improve medication adherence and persistence.

Here, medication adherence refers to the extent to which a patient acts in accordance with the prescribed interval and dose of a dosing regimen, while medication persistence refers to the duration of time from initiation to discontinuation of therapy.

The coronavirus crisis has been a catalyst in substantially broadening telehealth services and reimbursement. As the coronavirus pandemic spread across the nation, healthcare systems needed to adapt to circumstances in which physical distancing rules applied. Besides routine care, telehealth offers a feasible and safe alternative for multiple clinical services provided to chronically ill patients.

Telehealth utilizes digital health platforms that manage patients’ medication adherence at home. Incorporating electronic health records, these platforms can update healthcare providers in real time on patients’ adherence to prescription regimens.

The continuous collection of medical data from patients at home, followed by the electronic transmission of information to healthcare providers is crucial for ongoing assessment, diagnosis, and (revision of) treatment recommendations.

Last year, the Centers for Medicare and Medicaid Services (CMS) began reimbursing a limited number of telehealth services for Medicare beneficiaries. In March of this year, as the coronavirus pandemic took hold, CMS started to reimburse telehealth services (computer and telephone) across the board for all Medicare and Medicaid patients. The commercial sector has followed suit, often under the direction of state regulators.

Going forward, telehealth reimbursement may become a permanent feature in healthcare coverage. And, now that telehealth is being reimbursed by public and private payers alike, there is perhaps a silver lining to the coronavirus crisis.

Medication Therapy Management

Chronic disease management is defined broadly as a “system of coordinated healthcare interventions and communications for populations with conditions in which patient self-care efforts are significant.” A core area of focus for disease management has been medication therapy management (MTM), specifically addressing the issues of patient adherence and persistence in select sub-populations.

Usually, these sub-populations comprise high-cost or high-risk patients with multiple co-morbid diseases. MTM offers a range of services to help patients maximize benefits derived from their medications. These services include medication-related patient education and drug utilization reviews by prescribers, health plans, and pharmacies.

Telehealth is integral to MTM services. With telehealth at their disposal, patients can utilize digital information and communication technologies to remotely access healthcare services.

Multiple technologies can be used to boost patient adherence and persistence, including text messaging programs delivered to smartphones, wearable devices, digital pillboxes and personal assistants. Even the simplest form of telemedicine – the telephone – can deliver essential support to patients who are otherwise at high risk of non-adherence.

Leveraging data from self-management tools – for example, continuous glucose monitoring devices used by diabetic patients – can enhance the efficacy of telehealth services by tailoring dosing according to an individual patient’s needs. The inclusion of monitoring data and subsequent dosing changes in electronic health records facilitates the creation of personalized treatment guides that are communicated with patients digitally or by telephone.

Coupled with telehealth, simplifying pill burden may also improve adherence and persistence. To illustrate, HIV patients who are on single tablet regimens have been shown to be more adherent and persistent than those on multi-tablet regimens. Several studies have demonstrated that patients receiving single tablet regimens were significantly less likely to discontinue therapy and were more adherent with their regimens than those on multi-tablet regimens.

Ideally, MTM and telehealth are complemented by value-based insurance design programs implemented by payers. Accordingly, co-payments are reduced, and in some cases eliminated, for medications that are proven to be clinically and cost-effective.

Poor adherence to and persistence with prescription drug regimens constitute an omnipresent and complex problem, especially for chronically ill patients. With patient non-adherence to prescription regimens stuck at nearly 50% telehealth may offer a path forward.