On March 29, 2023, we partnered with Medicaid Health Plans of America (MHPA) to host a roundtable conversation on health equity and quality measures relating to medication adherence.

The discussion furthered the idea that we must move beyond medication possession ratio (MPR) and proportion of days covered (PDC) to measure true dose-by-dose adherence. Right on the heels of the CDC endorsement of video Directly Observed Therapy (video DOT) as equivalent to in-person DOT for tuberculosis treatment, the conversation also highlighted how technology — like Scene’s program — can help us better understand and address patient challenges, utilize data to advance health equity, and “measure what matters.”

The conversation was moderated by our Co-Founder and CEO, Sebastian Seiguer, and included five experts in the field:

- Adimika Arthur, Executive Director at Health Tech 4 Medicaid
- Tracey Davis, PharmD, Pharmacy Director at AmeriHealth Caritas DC and President of the North East Region, Academy of Managed Care Pharmacy (AMCP)
- Rachel Harrington, PhD, Senior Research Scientist, Health Equity at the National Committee for Quality Assurance (NCQA)
- Arethusa Stevens Kirk, MD, VP Clinical Strategy at UnitedHealthcare Community & State
- Anikia Nelson, MD, Senior Director, Clinical Product Management at Clarify Health Solutions

Here are the top three takeaways from their engaging conversation. 

1. Current quality measures on medication adherence are a good start, but they need to evolve to look beyond the four walls of the clinical setting and understand patient behavior; let’s do better.

“Measuring just the pickup and fill from the pharmacy only gives you one-half of the perspective and certainly doesn’t give you any information about whether patients have actually taken the medication. But more importantly, for other aspects of medication adherence that we cannot observe through medication fill rates, we really need a much more comprehensive approach when looking at that from a quality perspective.” — Arethusa Stevens Kirk, MD, VP of Clinical Strategy UnitedHealthcare Community & State

“We’d be remiss if we didn’t use technology, which is lightyears ahead of healthcare, to really help us understand medication adherence. We can build very precise and actionable quality measures, but that requires clinical nuance. We have to understand how we can capture the factors that influence what’s actually happening in the patient’s experience, and that includes social drivers of health.” — Anikia Nelson, MD, Senior Director Clinical Product Management

2. We have the technology to collect actionable data to close knowledge gaps and tackle health disparities; let’s embrace it.
   

“We need to be meeting people where they are with a product that they can engage in really easily. Having technology that is safe and efficient but has a connection point that doesn’t feel burdensome is really the best way for people to engage.” — Adimika Arthur, Executive Director Health Tech 4 Medicaid 

“We have the opportunity with telehealth to get a window into the home environment. In the clinical setting, there is very little opportunity to observe therapy being given, especially in a crisis, like when patients experience an exacerbation of their illness with asthma. Getting at the root cause requires investigation — it can be social factors in the home, and it can also be related to emotional or mental health issues. To find out, we need to expand the clinic beyond the walls of the clinic itself.” — Arethusa Stevens Kirk, MD, VP of Clinical Strategy UnitedHealthcare Community & State

“Data reflects real-life information on the social, environmental, political, and structural factors at play and can help explain patient choices in a way that we’ve never been able to do before.” — Rachel Harrington, PhD, Senior Research Scientist, Health Equity, National Committee for Quality Assurance (NCQA)

3. Questions inform how we understand problems and approach solutions; let’s reframe our language to advance health equity.

“We often ask plans how to improve adherence; why don’t we ask patients? What do people need? That’s where we need to anchor our work. It’s the investment that best informs what people will actually use.” — Adimika Arthur, Executive Director Health Tech 4 Medicaid

We need to take it a step further when we do see inequities because we know they exist. We need to look at the mindset through which we’re asking the next question. Instead of asking why patients from X community are not taking their medications, we need to ask why we, as a healthcare system, are failing this group.” — Anikia Nelson, MD, Senior Director Clinical Product Management

We left the conversation inspired and validated in our advocacy to improve the quality measures for medication adherence by incorporating direct dose-by-dose adherence observation. The discussion also supported our efforts to advance health equity by building trust with patients through 1:1 interactions to identify and help solve social determinants of health-based challenges. 

A comment from Dr. Kirk encompasses the spirit of our work perfectly:

“As a pediatrician, my guiding passion is really helping the next generation be healthy, and this work with Scene is integral to that.”

Watch the full webinar recording:

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