Key Health and Cost Information

Payers

The Community Preventive Services Task Force provides strong evidence that reducing patient out-of-pocket costs for medications to control blood pressure improves medication adherence and blood pressure outcomes. This is especially true when lower medication costs are combined with additional interventions aimed at improving patient–provider interaction and patient knowledge (e.g., team-based care with medication counseling, patient education).¹⁹

To improve medication adherence, payers have used administrative claims data to identify the following possible gaps in care among their members and provide the appropriate healthcare professionals with timely and actionable information regarding these potential opportunities for intervention:

• Noncompliance with blood pressure, lipid-lowering, or tobacco cessation medication regimens (e.g., discontinued with no apparent medication switch).
• Non-use of blood pressure or lipid-lowering medications among members with documented hypertension, hyperlipidemia, myocardial infarction, peripheral artery disease, or stroke.

Health benefit managers are uniquely positioned to influence the adoption of medical innovation and services, so they can improve access to and the quality of health care, including the use of networked primary care teams to promote medication adherence. The proposed 6|18 strategies for medication adherence can improve interactions between the patient and the health care system, the community pharmacist and the patient, and the community pharmacist and the health care system.²⁰

Payers have considered requiring participating healthcare professionals and practices to implement protocols for hypertension treatment, cholesterol management, and tobacco cessation.²¹ Prescribing evidence-based treatment regimens and routine screening by health professionals, including pharmacists, to reconcile medications, synchronize prescription fills, and assess the efficacy of and patient adherence to the prescribed treatment helps support effective communication among team members.²²

Payers have considered incentivizing healthcare providers and pharmacies to use e-prescribing, which has been shown to increase the percentage of prescriptions that are picked up by 10% compared with written prescriptions.²³ Moreover, use of e-prescribing has been shown to decrease costs for patients and payers by encouraging substitution of generic medications or less costly formulary options.²³ Finally, e-prescribing can be used to identify patients who do not take their prescribed medication (e.g., a blood pressure medication prescription is ordered but is never picked up). Closing the communication loop, by sending confirmation to the prescriber that the prescription was picked up, is likely necessary to maximize the effects of e-prescribing on improving adherence.

Implementing a MTM Program that aligns with Centers for Medicare & Medicaid Services guidance—which, at a minimum, targets members with multiple chronic conditions such as hypertension and includes targeted medication reviews—has been shown to increase members’ rates of reaching their blood pressure and other cardiovascular health goals.²⁴

Million Hearts® developed Medication Adherence: Action Steps for Health Benefit Managers²⁵ as a call to action that demonstrates where health benefit, employee, and pharmacy benefit managers have implemented evidence- and practice-based medication adherence strategies that improve blood pressure control, cholesterol management, and smoking cessation.

Providers

The Million Hearts® Hypertension Control Change Package for Clinicians²⁶ lists evidence- and practice-based interventions for improving hypertension control. These interventions include change concepts such as providing blood pressure checks without appointment or co-payment, flowcharts for how hypertensive patients can be tracked and managed, the systematic use of evidence-based hypertension treatment protocols, and the use of direct care staff to facilitate patient self-management.   This package also includes case studies showing how physicians have used systematic team-based approaches, along with specific tools to enhance information flow and workflow, to achieve significant improvements in their patients’ blood pressure control. The Community Preventive Task Force found strong evidence to suggest that implementing these and other interventions is most effective in improving blood pressure outcomes when delivered in a team-based care model.^27,28

The current USPSTF recommendation for blood pressure screening in adults, released in October 2015, is as follows:

• The USPSTF recommends screening for high blood pressure in adults aged 18 years or older. The USPSTF recommends obtaining measurements outside of the clinical setting for diagnostic confirmation before starting treatment.⁵⁰

While SMBP is an evidence-based intervention for both diagnosis and treatment of hypertension, having coverage of home blood pressure cuffs and monitoring to help with elevated blood pressure follow-up provides an inroad to get home blood pressure monitors into the hands of adults with or at risk for hypertension.

Blood pressure control is a priority clinical quality measure universally recognized by quality reporting programs, including the Quality Payment Program.^{51, 52}

SMBP plus clinical support is more effective than usual care in lowering blood pressure and improving control among patients with hypertension.⁵³

The Community Preventive Services Task Force found that there is strong evidence that SMBP interventions, when combined with additional support (i.e., patient counseling, education, or web-based support), are effective in improving blood pressure outcomes in patients with high blood pressure.⁵⁴

The Community Preventive Services Task Force found that there is sufficient evidence that SMBP interventions, when used alone, are effective in improving blood pressure outcomes in patients with high blood pressure.⁵⁵

• SMBP interventions are cost-effective when used with either additional support or within team-based care.⁵⁶