For many Americans, taking prescription medications is part of everyday life. Nearly 75 percent of the population takes at least one prescription medication daily, and 29 percent take five or more. Despite these numbers, there is scant guidance available to help people navigate complicated drug regimens. The problem is exacerbated for individuals with multiple chronic conditions, who are often prescribed numerous drugs by various providers to be taken on different schedules — with no single entity which is coordinating of all of their medications. It is no surprise that complications arise, particularly for populations with complex health and social needs. For some, these complications are deadly. In the US, medication issues cause an estimated 119,000 deaths annually. In a recent study, it was found that 26 percent of readmissions were caused by preventable medication-related issues.

Tackling medication complexity can help address these startling statistics, especially for people in vulnerable populations who may lack adequate resources due to low health literacy, unstable housing, social isolation, or other social determinants of health. The term medication complexity encompasses several factors including the number of medications someone is taking, challenges around medication adherence, failure to accomplish treatment goals resulting from inadequate or inappropriate drug regimens, and avoidable complications or harm caused by drug interactions — all of which can put an individual at risk for medication errors. Efforts to address medication management often focus narrowly on medication adherence during brief medical appointments or hospital discharges. These approaches overlook a common cause of medication issues in patients with complex needs: they are overwhelmed by the complexity of their medication regimens outside of a medical setting, have few resources, and do not know where or how to ask for help.

Community-Based Medication Management for People with Complex Health and Social Needs

As part of its ongoing efforts to improve patient safety, the Gordon and Betty Moore Foundation recently partnered with the Center for Health Care Strategies (CHCS) to support an initiative aimed at uncovering effective community-based medication management strategies for individuals with complex needs. As a first step, CHCS conducted a literature review as well as interviews with expert stakeholders to identify promising approaches and distilled findings in a recently published report.

Drawing from CHCS’ national exploration, following are examples of opportunities to enhance medication management at the community level:

1. Strengthening the Workforce

A strategy that many providers are using to enhance community medication management services involves repurposing workforce members like pharmacy technicians, community health workers, family caregivers, and community paramedics. People in these roles are able to serve as “eyes on the ground” for pharmacists and primary care providers given their ability to observe and interact with people in their homes. This vantage point allows them to monitor firsthand how medications are being taken, look for potential risk factors in complex medication regimens, identify financial barriers that may prevent a patient from taking their medications, and find low-cost pharmaceutical programs. Providing workforce members with comprehensive training in medication management frees up pharmacists to perform higher-level tasks, such as medication reconciliation, patient counseling, and participating in interdisciplinary care teams.

A successful example of this efforts includes a community paramedicine program in which the paramedics conduct home visits for high-risk patients, including the use of videoconferencing technology to facilitate interdisciplinary care team meetings from the patient’s home.

2. Identifying Gaps in Quality Measures

Effective quality measures for medication management in community settings are key for evaluating provider performance, yet the field is in the early stages. Although there are a variety of measures for assessing medication-safety and adverse drug errors, there are few that relate specifically to the delivery of medication services in the community. A majority of medication management measures are process oriented and fail to accurately measure the impact of community-based interventions. Robust measures that can be considered to assess the impact of community management of medication interventions include intermediate outcomes (lab measures), patient-centered outcome (Hba1c levels), and resource utilization (health care costs). Adopting more rigorous measures can help assess provider performance in implementing medication management strategies in community settings and contribute to improved outcomes for people with complex needs.

3. Building Advanced Payment Models

Addressing appropriate levels of reimbursements to encourage community-based medication management is challenging. There are many barriers to implementing value-based purchasing arrangements that support community-based pharmacy services, such as constraints in fee-for-service payment models due to a lack of provider or pharmacist infrastructure to implement and manage services and difficulty collecting timely, accurate program outcome data. In developing incentives, it is important to examine current performance on measures of medication adherence, and completion of medication administration records as a starting point. Using pay-for-performance arrangements is another way to encourage models that strengthen quality measures, improve patient outcomes, and maintain provider accountability.

Moving Forward

Other areas ripe for supporting community management of medication complexity gleaned from conversations with experts across the country include having pharmacists and pharmacy technicians screen people in a pharmacy setting for unmet social needs (e.g., housing instability, lack of transportation, food insecurity) that can contribute to adverse medication outcomes, and deploying innovative health technologies to optimize care and outcomes. Taken together, these community-based medication management interventions offer the potential to enhance health outcomes, reduce costs, and improve the quality of life for people with complex health and social needs. Under the Community Management of Medication Complexity Innovation Lab, made possible by the Gordon and Betty Moore Foundation, CHCS will work with five pilot sites that are exploring and expanding innovative community-based medication management approaches. The sites, which serve a diverse range of populations and geographic settings, will offer lessons to inform similar efforts across the country. Look for future updates from CHCS for best practice findings from the sites.