Long-term savings for health care cannot be ignored

WHAT IT MEANS AND WHY IT’S IMPORTANT — Almost $8,000 a year in healthcare savings, per patient. That’s how much patients with congestive heart failure could save the U.S. healthcare system simply by taking their medications as prescribed, an exhaustive, three-year study by CVS Caremark concluded.

(THE NEWS: Adherence among chronic disease patients can lead to big savings. For the full story, click here)

Patients with other such chronic diseases as hypertension and diabetes also could generate eye-opening cost savings just by adhering to their prescription drug regimens, the study found: Nearly $4,000 per patient in reduced emergency room visits and acute-care incidents.

It’s the kind of finding that should have policymakers, congressional lawmakers and concerned health officials within the Obama Administration sitting up at their desks and reaching for their health-reform megaphones. For a nation battered by ever-rising health costs, a Medicare and Medicaid health safety net frayed by an unsustainable and out-of-control cost structure, and a population increasingly alarmed about the exploding national debt, the cost-saving potential of improved medication adherence rates should be trumpeted with parades and banner headlines.

CVS reported its findings Thursday in the journal Health Affairs. Company researchers based the study, “Medication Adherence Leads to Lower Health Care Use and Costs Despite Increased Drug Spending,” on a careful, long-term analysis of pharmacy and medical claims data for 135,000 patients with congestive heart failure, diabetes, hypertension and dyslipidemia to determine the direct effect of adherence on costs.

Their conclusions are dramatic. Even with the additional costs associated with full adherence — patients with those chronic conditions who comply with their prescribed medication therapy can generate up to $1,000 in additional drug costs per year — hospital and acute-care expenses for those patients were way down in relation to their nonadherent counterparts.

Consider the ramifications. “Almost half of all Americans, approximately 133 million people, live with at least one chronic disease,” noted the study report’s authors in Health Affairs. “Because ongoing use of prescription medication is a key component of treatment for chronic conditions, medication adherence — or making sure that patients take the drugs prescribed for them — is a matter of great importance to policy makers, insurance plan sponsors, physicians, and patients.”

Indeed, if such federal health programs as Medicare and Medicaid gave adequate support to an aggressive program for boosting adherence rates, it could mean thousands of dollars in reduced health costs for millions of chronic-care patients enrolled in those programs. And if Congress or the White House made adherence a core component of the reformed health system now taking shape through community-based concepts, including medical homes and accountable care organizations, those savings to the beleaguered U.S. health system could accrue to hundreds of billions of dollars a year.

Health regulators and policymakers need to pay heed when CVS lobbyists come calling this winter. The study’s findings should be enough to yank the last bricks out of the foundations underpinning the silos that kept different decision-makers in the healthcare system from looking at the big picture; i.e., public and private healthcare plans that cut pharmacy benefits to achieve short-term savings, without regard for the long-term acute-care costs that result. Under the fast-disappearing silo structure that used to dominate the health payer and provider landscape, those long-term implications were somebody else’s problem.

In an integrated health system, where all stakeholders and, for that matter, all taxpayers and patients are linked in a web of increasingly unsustainable costs, there’s no such thing as “somebody else’s problem.”

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