Managed Care Organizations
Patients’ nonadherence to prescribed medical treatment is one of the most serious problems facing managed care organizations today. This noncompliance results in enormous costs for patients, families and doctors, and has a major financial impact on insurers. Patient noncompliance leads to 3.5 million hospital admissions each year (11% of all hospital treatment episodes, with an average cost per admission of almost $9,000), and is the single greatest cause of readmission after hospital discharge. In addition, medication noncompliance is the primary factor in 23% of all nursing home admissions. Noncompliant patients incur healthcare costs that are four times as great as compliant patients’ costs. Altogether, patients’ failure to take prescribed medication costs society over $100 billion annually, with $45 billion in direct healthcare costs each year due to noncompliance.
ScriptAssist partners with the managed care company to identify a specific class of medication or patient population that would benefit from better prescription compliance. Patients receive personal contact over the phone from experienced registered nurses. Nurses implement empirically supported psychological techniques, following a structured intervention protocol, to help patients use their medications correctly on an ongoing basis. This service is provided at no charge to either patient or physician, through the managed care organization’s sponsorship. Positive results are seen promptly, with an expected decrease in noncompliance of about 45%.
By carefully supporting initial prescription fulfillment and continuing refills, ScriptAssist generates enhanced patient and physician satisfaction, while reducing unnecessary treatment costs among enrolled patients.
Implementation of a ScriptAssist program provides many important benefits:
- Better patient compliance with prescribed medications
- Improved patient outcomes, treatment quality and overall member satisfaction as a result of the personal contact and support
- The potential for lower hospitalization, emergency room, and outpatient medical costs to the MCO
- Risk management resulting from better outcomes via improved patient compliance
- The provision of a range of useful patient data to the treating physician
- The provision of a range of utilization and outcome data to the MCO
- Enhanced relationships between the managed care organization and physicians
- Expanded public relations opportunities for the managed care organization
- The opportunity to present improved compliance in a specific disease category as a quality improvement activity for NCQA accreditation/re-accreditation
- With certain populations (e.g., patients with diabetes, patients with cardiovascular conditions, perimenopausal women), the opportunity to meet HEDIS requirements
- The opportunity to gather additional patient feedback and information
Please email us for further information!
