The problem of medication nonadherence is well documented. In the United States. Nearly 30% of all prescriptions are never picked up at the pharmacy, and an estimated 18 million people are unable to afford their medications.

THE PROBLEM

Studies have shown that prescriptions with copays of $50 and above are nearly four times more likely to be abandoned than those with less out of pocket costs.

Further, nearly 16% of hospital readmissions are driven by medication-related concerns, with nearly 40% of those being potentially preventable.

UPMC was looking for creative strategies to tackle problems related to both medication adherence and readmissions, while leveraging the clinical strengths of its pharmacies and streamlining operations.

"Patient-centered care revolves around easy-to-use solutions and making a connection that is easy for them," said Rebecca Taylor, PharmD, senior director of pharmacy at UPMC. "We wanted something that was simple and accessible to most of the population.

"It is estimated that more than 90% of the population has access to a phone for text messaging, so we knew using that avenue could be a potential solution," she added.

PROPOSAL

UPMC Enterprises built a technology suite and deployed it across the UPMC Health System. It's a patient management platform for pharmacy that identifies and prioritizes patients who might be at risk of nonadherence.

From there, an AI-driven virtual assistant reaches out to patients via SMS to engage them throughout their medication journey (prior to first-fill, between fills, refill support and beyond). Recently, health IT vendor Arrive Health purchased the UPMC-developed pharmacy technology.

"UPMC pharmacy experts gave their clinical insights into what would make the product successful, and engineers at UPMC Enterprises worked to bring the solution to life."

Kathryn Heffernan, UPMC Enterprises

"UPMC’s Retail Pharmacy network partnered with UPMC Enterprises, the innovation and commercialization arm of UPMC, in seeking technology-enabled services to solve some of these problems," said Kathryn Heffernan, director of product management at UPMC Enterprises.

"The teams collaborated on further understanding the problem, competitive landscape and potential value of a solution before making the decision to build out a minimum viable product of the pharmacy management platform and corresponding chatbot to pilot," she continued. "UPMC pharmacy experts gave their clinical insights into what would make the product successful, and engineers at UPMC Enterprises worked to bring the solution to life."

MEETING THE CHALLENGE

The teams started small, collaborating with select clinics and hospitals to prove out the value and ensure smooth integration with existing processes and workflow.

"Initially, the product was used to support bringing medications to inpatients at our flagship hospital, UPMC Presbyterian, and was quickly expanded to additional sites following positive reception," Heffernan recalled. "UPMC Pharmacy and UPMC Enterprises leadership then explored expansions to additional strategic use cases and populations, including employees and select clinics.

"The platform was built as a standalone entity," she continued. "It leverages patient data following enrollment in the service. With this data, the platform generates and schedules automated follow-up from the virtual assistant chatbot."

Patients receive automated SMS or robocall messages to assess adherence and satisfaction, and identify other barriers to filling prescriptions or proper use of medications. When an issue is detected based on patient responses or there is trouble reaching a patient, a member of the pharmacy support team comprised of pharmacists and pharmacy technicians intervenes to resolve the issue at hand.

RESULTS

The tech-enabled platform has proven significant value at UPMC.

"We’ve seen impacts in clinical outcomes, medication adherence, patient satisfaction and staff efficiency," Heffernan reported. "Notably, we’ve seen a two-times increase in on-time refill rates and an average of 80% of patients reporting satisfaction with the program.

"The future is bright for these technologies to interact with patients on their terms."

Rebecca Taylor, PharmD, UPMC

"We are particularly proud of the impact that this service has had on readmissions," she added. "A retrospective study of more than 30,000 patients showed that those who engaged with the chatbot and service were 32% less likely to experience a 7-day readmission and 16% less likely to experience a 30-day readmission."

ADVICE FOR OTHERS

Heffernan advises provider organizations to start with a small population or provider site to prove out the model and ensure the technology is enabling the results one wants to achieve while fitting into existing workflow.

"From there, building relationships with provider champions and continuous assessment of business value can help to inform expansion channels," she continued.

Keep it simple and accessible, Taylor advised.

"The future is bright for these technologies to interact with patients on their terms," she concluded. "I have seen success in embedding technologies with the EHR in other organizations – so I would always encourage keeping it as simple as possible for the patient and their caregivers."

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