Reducing patient burden through health policy

To be truly patient centered, the healthcare system and healthcare professionals must consider the whole patient and their socioemotional, biogeographical context and values. Currently, the healthcare system often fails to consider issues like multi-morbidity and polypharmacy which contribute to patient complexity³. Consider for example the process of prescribing and acquiring medication. When a patient has an illness, they are often prescribed medical therapy by a healthcare professional. They then either have to drive to a pharmacy to pick up the prescription or wait for it to arrive in the mail. Until recently, pharmacies considered the prescription in isolation and not as part of a larger regimen, despite the prevalence of multiple prescriptions per person.

Recently, however, many pharmacies have begun to offer medication synchronization⁴. With medication synchronization, all of a patient’s prescriptions are organized so that they can all be re-filled on the same date, rather than making patients trek to the pharmacy multiple times for multiple different prescriptions for many different illnesses, reducing waste, cost, stress, time and the burden of treatment for the patient⁵. It may also improve medication adherence and therefore indirectly, improve health outcomes⁶. This process can be difficult to practically implement due to rules and regulations by insurance companies and others. However, Florida recently passed a law making the process a little easier for Floridians. This new law allows for partial refills and the co-pays must be prorated and mandates that insurers allow individuals to synchronize their medications at an in-network pharmacy at least once a year. While ideally synchronization happens on an ongoing basis, this law gives patients the ability have synchronization covered by insurance. Unfortunately, only about two dozen other states have this law⁷.

Continued efforts to make medicine minimally disruptive need to occur to create a patient-centered healthcare system. One company is trying to do just that. Lyft, the ride sharing app, has started coordinating with care teams to drive senior patients to their doctor’s appointments. This campaign reaches a demographic in need of help with their treatment burden, making it easier for those with limited access to transportation get to appointments efficiently and with reduced wait times.¹ In turn, this campaign has saved money for insurance companies. CareMore, a company focused on senior care, has already saved over $1 million due to the decreased costs of Lyft rides compared to other forms of transportation and missed appointments due to faulty transportation times.¹ While minimally disruptive medicine is not focused on saving financial costs, it is a nice side effect of minimizing treatment burden for patients, making this a sustainable outcome that positively impacts multiple sectors of healthcare.

In order to reach the senior demographic, Lyft started a new online program called Concierge². Caregivers can access a website, instead of relying on smart phones, to call rides for their patients. One of the goals of this program is to decrease the amount of missed appointments seniors have because of their inability to find transportation, reducing stress, costs, and treatment burden².

1. Farr, Christina. Lyft is driving patients to see their doctors and saving insurers big money. CNBC News. 2017. https://www.cnbc.com/2017/08/04/lyft-is-driving-patients-to-see-their-doctors-and-saving-insurers-big-money.html
2. Lyft Blog. 2016. https://blog.lyft.com/posts/nationalmedtrans-concierge
3. Moffat K, Mercer SW. Challenges of managing people with multimorbidity in today’s healthcare systems. BMC Family Practice. 2015;16:129. doi:10.1186/s12875-015-0344-4
4. Krumme, Alexis A MS. Prevalence, Effectiveness, and Characteristics of Pharmacy-Based Medication Synchronization in Programs. The American Journal of Managed Care. 2016; 22(3):179-186.
5. Ross, Alexander. Sync and Swim: The Impact of Medication Consolidation on Adherence in Medicaid Patients. Journal of Primary Care & Community Health. 2013: 4(4):240-244. doi:https://doi.org/10.1177/2150131913486481
6. Doshi, Jalpa A. PhD. Synchronized Prescription Refills and Medication Adherence: A Retrospective Claims Analysis. The American Journal of Managed Care. 2017:23(2):98-104.
7. Andrews, Michelle. Florida law makes it easier for patients on multiple medications to sync prescription refills. MedCity News. 2017. https://medcitynews.com/2017/08/florida-law-makes-easier-patients-multiple-medications-sync-prescriptions/?utm_source=dlvr.it&utm_medium=twitter

Submitted by Paige Organick, Anjali Thota, Michael Gionfriddo, Kasey Boehmer