As adherence incentives expand, pharmacies weigh point-of-care options

Medication nonadherence is a major problem that results in significant consequences to our healthcare system. Between $100 and $300 billion of avoidable healthcare costs have been attributed to non-adherence annually. This represents 3-to-10% of total U.S. healthcare cost in the forms of increased service utilization, preventable hospitalization, and development of comorbidities.

Payers and PBMs have grasped this drain to the system, responding with incentives for medication adherence. Just last month [April 2018], Express Scripts announced a pilot program that rewards retail pharmacies that fill prescriptions and demonstrate an improvement in members’ medication adherence for such conditions as diabetes, high blood pressure and asthma.

These performance-based pharmacy incentives for better outcomes — which often include withholding payments, too — surely have your attention by now. Hopefully you are also paying close attention to the data that supports the use of medication adherence risk scores to segment member cohorts expected to have costly outcomes resulting from non-adherence.

Success of using SDOH

Studies show that social determinants of health (SDOH) — the conditions in which we are born, live, work and age, according to the World Health Organization — account for as much as 50% of health outcomes. This information provides insights into the social, economic, and environmental factors that influence health.

Med Care study looked at how SDOH impact diabetes patients. Researchers found that cost-related nonadherence was prevalent in people with diabetes—half of adults with the disease perceived financial stress, and 20% reported financial insecurity with healthcare and food. Nonadherence in these chronically ill patients brings significant complications much faster than if the disease was naturally progressing in coordination with treatment recommendations.

If the pharmacist could know his patient’s financial stress, perhaps, when filling the medications, he could go back to the physician asking about lower-cost options or discuss strategies for adherence with the patient. Screening to identify challenges is imperative for better communication as the pharmacist’s role on the patient care team continues to grow. Consider that the pharmacist sees these chronically ill patients monthly and can leverage the benefits of both frequency and ease of access. Since patients can walk right up to the counter, they may be more willing and likely to communicate with their pharmacist than with any other provider.

In another case, LexisNexis matched data attributes to SDOH categories identifying correlations with healthcare outcomes. Through public records data on individuals’ court records—including felonies, misdemeanors, liens, judgments, bankruptcies, and evictions—higher numbers of crimes or financial issues were associated with lower medication adherence. Other SDOH data, such as proximity to relatives and education level, can also be used with advanced analytics to provide additional information that could impact future outcomes.

Scores at the point of care

The SDOH information can be used to determine medication adherence risk scores, in the format of a numbered scale or color-coded system such as “red, yellow, green” indicating severe, moderate or low risk. Risk scores trend in the same direction with several outcomes dependent on medication adherence. LexisNexis found those expected to be nonadherent to have a three-fold increase in ER visits. On the other hand, those predicted most adherent were twice more likely to follow up with office visits two weeks after an acute event. These follow-up visits also reduce the likelihood of readmissions, decreasing overall costs.

These types of predictions and the associated scoring will be available at the pharmacy counter soon enough. Realistically, physicians and insurance companies do not have the bandwidth to follow up with every patient individually to remind them about taking their medication and determine if there are additional challenges coming into play. By identifying patients who may be at risk for nonadherence, pharmacists can easily grant them some added attention and communication that reinforces the importance of their medication regimen. As the frontline point-of-contact, pharmacists can help patients understand their condition and how and why the medicine helps them.

Already, we’ve seen through medication therapy management programs that pharmacists are expected to fulfill this role: From adherence to synchronization to reconciliation of medications, it’s the pharmacist’s responsibility to make sure that medications are working to improve health.

With just the click of a mouse, the pharmacist has the medication adherence score, as well as key information about the patient’s socioeconomic environment that enables him to quickly and easily determine what may be driving challenging behaviors and putting that patient (and his health) at risk. At the point of care, the pharmacist has better understanding about the patient’s risk and, therefore, what level of engagement would be optimal.

This all can integrate right into the pharmacy workflow at the point of care.  An example is the real-time prescriber verification solution VerifyRx that is used by the majority of retail pharmacies.

The future of healthcare demands an insightful understanding of patient challenges and the provision of accompanying solutions. For example, in March 2018, Allscripts and Lyft, a rideshare provider, partnered to provide non-emergency transportation for patients to get to medical appointments5.

What do our pharmacy patients need for support? If the adherence risk data indicates transportation is a challenge for a patient, could we seamlessly schedule a ride share for them in one month when their next prescription refill needs to be picked up?

Consider the potential of solving our patients’ biggest challenges with a synthesis of data, technology and the personal communication skills that got you into the business!

Dr. Anton Berisha is senior director of clinical analytics and innovation, health care, at LexisNexis.


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Which area of the industry do you think Amazon's entry would shake up the most?

Allergy ad spend kicks into gear

BY TS Kelly, Alphonso

A sneeze is no small thing. Neither are itchy, watery eyes or a stuffy nose. Not when they are due to seasonal allergies.

These symptoms translate into big dollars. In fact, a recent TMR report predicted that the demand in global allergy treatment will translate into $41.17 billion in revenue by the end of 2025 — that’s nothing to sneeze at.

March is traditionally the kick-off to ad campaigns designed to get people ready for the pollen that hits alongside the sunshine. And, taking a look at the top TV ads in the category for past month, it is clear that the top-selling over-the-counter allergy treatments are spending big to ensure that they continue being placed in consumers’ shopping baskets this spring season.

According to Alphonso data, GSK Consumer Healthcare’s Flonase was far and away the biggest allergy advertiser on television in March —  with S$11 million in total spend. The brand aired three distinct spots, not including 15-second variants. Two versions in particular nabbed the top two spots on the TV ad spend ranking for allergy medications.

The biggest slice of the budget — $5.7 million — went toward supporting the Flonase Sensimist product line, which includes a children’s variant specifically targeting moms on such parent-skewing networks as VH-1, Nickelodeon, and the Lifetime Movie Network.

ad spend But men weren’t left out of GSK Consumer Healthcare’s focus — with male sports fans specifically in its sights. The company ran an ad touting Flonase’s adult allergy relief products, with commercials airing on over 50 different TV networks, with the largest spend on Headline News, followed by NBC Sports Network and the NFL Network.

Bayer’s Claritin also spent big on television ads in March — in total $9.6 million — with three main commercial spots, as well as a children’s and Hispanic variants.

At $4.5 million, spend on Claritin D made up nearly half of the company’s TV budget that month, with airings on more than 50 various networks.  Discovery Family, Centric, and Spike led the pack. Diving into the programs they aligned with, it seems that Bayer is all about the laughter. Reruns of comforting sitcoms like “Two and a Half Men,” “Friends,” and “George Lopez” were their top three picks.

Claritin concentrated their other two commercial buys on the same three networks. And, although there were slight variations in the TV programming mix,  “Friends” was a constant.

It is telling to see that each allergy brand turns to distinct TV channels, shows, and audiences to maintain and increase marketshare—a recognition, perhaps, that pollen isn’t a problem isolated to one demographic and can affect us all.

TS Kelly of AlphonsoTS Kelly is senior vice president of research for Alphonso, a TV data company that provides real-time TV campaign analytics, one-to-one TV ad retargeting, and closed-loop attribution for brands and agencies. In his role at Alphonso, Kelly deep dives into television data and insights, giving clients guidance on how to optimize their TV spend.


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Which area of the industry do you think Amazon's entry would shake up the most?

Digital reinvention

BY Dan Mack, Mack Elevation

The Idea: Recent research by McKinsey has uncovered that only 8% of companies believe they will remain viable if digital continues at its current speed. Only 16% of companies have taken steps to exit declining businesses & invest in digital reinvention. And even more alarmingly, only 5% of companies actively seeking digital transformation report that they have met their goals. Why are so many companies failing with digital reinvention? We are not embracing fast learning or experimentation and are married to fatal perfectionism. Advantages don’t last forever.

Digital winners act differently and ask different questions. Digital and brick and mortar have become one; the very best brands and operators eliminate buying friction, which is why the price is less important to their customers. They measure digital traffic and awareness but it’s all about converting the right customers. Omni-channel customers spend 4 to 6 times more than store-only consumers.

Our most recent Digital Disruption Summit included ideas shared by Google, Facebook, IBM Watson, Bain, Kantar, One Click Retail, and L2 (Division of Gartner). I want to share 30 growth ideas from this special summit.

  • How to win today: hire “Hackers, Hipsters, and Hustlers.” Embrace outsiders.
  • Quit benchmarking brick and mortar brands; the new standard is “digitally-only” brands.
  • When you are competing against an algorithm, your advantage is “your humanity & your soul.”
  • Value is transient; we must constantly reinvent our current advantages.
  • Organizations today must embrace a “Start-up Mindset” to maintain an advantage.
  • Does your organization struggle with a “Gap in Imagination” or is it a problem with EXECUTION?
  • Move from “Business Plans” to “Roadmaps”; Be adaptable & address changes in context.
  • If you are unable to “flex,” you are operating with a competitive disadvantage.
  • Leaders must be astute at asking better questions to help their organizations get “unstuck.”
  • Does your brand tell emotional stories that inspire others to act? Facts don’t compel, stories do.
  • What new services should you be selling that support your tangible products?
  • Is your brand creating memories that last?
  • Perfection kills. Think Progress, not perfection in all aspects of your business.
  • We have an 8-second attention span. Are you grabbing other’s attention quickly enough?
  • Agility and speed are not options; they are requirements in this new world.
  • 84 percent of the world doesn’t use an iPhone. How does your brand show up on an Android?
  • Currently, 20 percent of search is activated by voice. Are you keeping up?
  • More than 80 percent of millennials EXPECT personalized offers.
  • Who are you looking to for inspiration outside of your business segment?
  • Your brand website is still your #1 brand advocate and is the most persuasive influencer.
  • Which competitors should you think about partnering with today?
  • “Search effectiveness” will drive the next group of brand winners.
  • B-to-B is still about one idea: “Can I Trust You?”
  • Winning the top 6 U.S. cities means winning the 4th largest economy in the world.
  • Build a human-centric, understanding culture. Focus on people’s internal needs, not consumers.
  • Create a learning-obsessed organization, allowing you to “out-think” and “out-listen” others.
  • Currently 79% of consumers would rather learn through video.
  • The Five P’s (Price, Product, Page, Promotion, Placement) leads to Performance (6th P).
  • The digital shelf: 90 percent of purchases begin with search; over 80 percent of clicks stay on first page, with 64 percent of the clicks on the top 3 items.
  • According to Bain, there are 36 elements to create value in the B2B world. Intangibles such as social responsibility, design, esthetics, reputational assurance, vision, reduced anxiety, flexibility, expertise and other valuable intangibles are how we win the price game.
  • Are we trying to sell them something or are we trying to listen intently to help them?

You can’t ignore the new rules. Learn to embrace the act of reimagining everything. Organizations need a wider lens, so they don’t miss new opportunities or partners. Embrace the excitement and ambiguity of the moment.

Digital Darwinism means technology & society are evolving faster than we can all adapt. Are you comfortable being uncomfortable?

To learn more about Mack Elevation’s coaching, consulting, training and leadership events visit


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Which area of the industry do you think Amazon's entry would shake up the most?