How a Whole-Health Approach by Pharmacists Can Improve Medication Adherence
Key Highlights:
- CarelonRx Clinical Pharmacy Care Center pharmacists help members stay on track with their medications while also identifying broader health barriers, such as a lack of transportation.
- Guided by Whole Health Index insights, pharmacists help members access benefits and connect with resources that can help improve health and make treatment easier to maintain.
- Research shows that pharmacist outreach coupled with this type of whole-health support can improve medication adherence.
Chantal Ahwah and Elaine Edwards know the importance of medication adherence. As pharmacists with the CarelonRx Clinical Pharmacy Care Center (CPCC), they understand that helping people obtain their medications and take them as prescribed could be the difference between healthy living and a serious health crisis.
But they also know the reasons someone might miss a dose or fail to pick up their prescription can include more than just forgetfulness. Sometimes, other barriers arise — such as difficulty affording nutritious food, securing transportation, or covering the cost of a prescription.
“It could be more complex than just not taking a pill every day,” Ahwah said. “And some members don’t know where to go to find help.”
As part of CarelonRx — Elevance Health’s pharmacy benefit manager — CPCC pharmacists routinely reach out to members of Elevance Health-affiliated health plans who may need extra support managing their medications. The pharmacists help members better understand why they’ve been prescribed certain medications and partner with them to ensure those medications are being taken as directed.
Often, though, other challenges surface, and the pharmacists step in to help address them. Edwards recalls providing local food bank information to a member who was experiencing difficulty buying food due to limited resources. Another member without transportation was taking a $20 round-trip taxi ride to pick up her medications at a local pharmacy — an expense that can add up over time. Edwards set her up with 90-day supplies by mail, saving her money on prescriptions and the cab fare.
Edwards also recalls speaking with a member who understood her medicine, was connected with medical care, and had family support from her son. As their conversation progressed, however, Edwards learned the member needed a referral for behavioral health care. She was afraid to leave her home or to open the door for food deliveries, and she had not been out of her home for approximately two years.
“It’s really about building that trust, and once you’ve established that trust, it kind of just opens things up,” Edwards said. “When you can support them in finding something they really do need, it's really going to keep them healthier.”
Helping members stay healthier is the goal, and research shows the whole-health approach practiced by CPCC pharmacists like Edwards and Ahwah can help achieve it. An analysis by Carelon Research focused on people with chronic conditions who were at risk of delayed or overdue prescription refills and, as a result, poorer health outcomes. It found increased medication adherence among those who both engaged with supportive outreach from the CPCC and received assessments to identify and help address health-related social needs.
Other patients at risk of poor health outcomes who engaged with the outreach program and didn’t receive the assessment also showed increased adherence. But the improvements associated with the outreach were even greater among those who also received the additional support to help address social factors that could be barriers to better health.
The study focused on select members with Elevance Health-affiliated plans, and individuals received the additional assessment based on Whole Health Index (WHI) measurements of their health. Created by Elevance Health, the WHI can evaluate a person’s relative health over time and the physical, behavioral, and social factors that influence it.
The WHI informs the work of CPCC pharmacists, who may ask members questions like: “Has the lack of transportation kept you from medical appointments or from getting things needed for daily living?” or, “How often do you see or talk to people that you care about and feel close to?”
Transportation to a care provider has been a top barrier identified through these types of questions, along with access to food. Mental health concerns, social isolation, and medication costs also have surfaced, among other barriers.
“It’s a personal conversation, so sometimes members are more open to talking to a pharmacist one-on-one because we’re already talking about chronic disease and medications,” Ahwah said. “We can have those conversations and then offer personalized support.”
That support can include helping a member access a benefit that may already be available to them through their health plan — like transportation assistance — or providing information about resources in their community, like a food bank.
At times, pharmacists may assist a member in lowering out-of-pocket medication costs, easing a financial burden to help them stay on track with treatment. A pharmacist may reach out on behalf of the member to a care provider or refer members to Medicare Community Resource Support — a team of social workers that can connect members with community-based resources like food or utility assistance.
The needs and solutions may vary, but each conversation is rooted in the same purpose: providing support that helps members live healthier lives.
“I always tell people, ‘No matter what, if you have a need, make sure that we address it,’” Edwards said. “‘Don’t sit in silence. Let’s work through it.’”