Open Forum

Greetings fellow outpatient nurses,

I work in the Managed Care department of our organization. As part of a mutual effort with one of our Medicare Advantage partners (Florida Wellcare), I'm involved in a medication adherence project. The goal is to improve our quality scores for our MA patients by assisting them to keep in compliance with certain medications for diabetes, CAD, and HTN. Working solo, I've emphasized first making sure our Wellcare patients have a current prescription for the medication of concern (assuming they are actually on it), and then making efforts to reach out to those patients in danger of "falling off the back"; that is, being out of compliance by either not getting their prescriptions or by missing multiple doses. A big part of my outreach has been in using our patient portal (MyChart in Epic) for compliance-related messaging. I have found out that, unfortunately, over half of those messages go unread, though they are helpful for some. More recently I've found the time to start calling patients directly, which allows me to get in touch with people who either don't read their patient portal messages or don't have access to MyChart.

After some leadership turnover, I finally have an opportunity to improve our process. I'll be doing a presentation after the holidays that will describe my current efforts in that regard, and also advocate for some best practices for improvement. Medical assistants can pend orders to providers and also make patient outreach phone calls, so that will be part of my recommendations-to have an MA to work with. In addition, I'll do a diligent literature review beforehand to see what kind of best practices might be recommended.

Do you folks have any recommendations, either of relevant articles or best practices that you use?

Best Regards, DC

Greetings fellow outpatient nurses,

I work in the Managed Care department of our organization. As part of a mutual effort with one of our Medicare Advantage partners (Florida Wellcare), I'm involved in a medication adherence project. The goal is to improve our quality scores for our MA patients by assisting them to keep in compliance with certain medications for diabetes, CAD, and HTN. Working solo, I've emphasized first making sure our Wellcare patients have a current prescription for the medication of concern (assuming they are actually on it), and then making efforts to reach out to those patients in danger of "falling off the back"; that is, being out of compliance by either not getting their prescriptions or by missing multiple doses. A big part of my outreach has been in using our patient portal (MyChart in Epic) for compliance-related messaging. I have found out that, unfortunately, over half of those messages go unread, though they are helpful for some. More recently I've found the time to start calling patients directly, which allows me to get in touch with people who either don't read their patient portal messages or don't have access to MyChart.

After some leadership turnover, I finally have an opportunity to improve our process. I'll be doing a presentation after the holidays that will describe my current efforts in that regard, and also advocate for some best practices for improvement. Medical assistants can pend orders to providers and also make patient outreach phone calls, so that will be part of my recommendations-to have an MA to work with. In addition, I'll do a diligent literature review beforehand to see what kind of best practices might be recommended.

Do you folks have any recommendations, either of relevant articles or best practices that you use?

Best Regards, DC

Thank you for the work you are doing, David.

So much of what exists regarding the process of medication reconciliation focuses on the inpatient setting. The AMA Steps Forward content includes a module/toolkit on Medication Adherence. The video 'We Didn't Ask, They Didn't Tell' helps practice team members understand why patients may or may not take their meds as prescribed.  https://edhub.ama-assn.org/steps-forward/module/2702595.

A pharmacist colleague recently related to me one of her patient counseling encounters for a man who requested a refill on his atorvastatin too early. He explained to her that when he eats extra pizza he takes an extra dose or two for his cholesterol. So important to get to the root cause!

A relative's hypertension specialist wrote one of his Rx's to allow for two doses daily in the event he needed to titrate up based on his BP readings. His BP was well-controlled, so he remained on once daily. His Humana MA plan messaged and texted him repeatedly since he was not taking his medicine 'as prescribed'. He was labeled as non-adherent, when in fact he was not. 

This is such a complex issue!

Greetings fellow outpatient nurses,

I work in the Managed Care department of our organization. As part of a mutual effort with one of our Medicare Advantage partners (Florida Wellcare), I'm involved in a medication adherence project. The goal is to improve our quality scores for our MA patients by assisting them to keep in compliance with certain medications for diabetes, CAD, and HTN. Working solo, I've emphasized first making sure our Wellcare patients have a current prescription for the medication of concern (assuming they are actually on it), and then making efforts to reach out to those patients in danger of "falling off the back"; that is, being out of compliance by either not getting their prescriptions or by missing multiple doses. A big part of my outreach has been in using our patient portal (MyChart in Epic) for compliance-related messaging. I have found out that, unfortunately, over half of those messages go unread, though they are helpful for some. More recently I've found the time to start calling patients directly, which allows me to get in touch with people who either don't read their patient portal messages or don't have access to MyChart.

After some leadership turnover, I finally have an opportunity to improve our process. I'll be doing a presentation after the holidays that will describe my current efforts in that regard, and also advocate for some best practices for improvement. Medical assistants can pend orders to providers and also make patient outreach phone calls, so that will be part of my recommendations-to have an MA to work with. In addition, I'll do a diligent literature review beforehand to see what kind of best practices might be recommended.

Do you folks have any recommendations, either of relevant articles or best practices that you use?

Best Regards, DC