Patient Adherence: A Key to Success in the Triple Aim

With the integration of the bundled payment model and the shift toward value-based care, organizations are striving to achieve the Triple Aim – improved experience of care, increased focus on population health, and reduced cost of care.

Innovation in patient care can result in these desired quality outcomes, while at the same time managing costs. However, patient adherence can often stand in the way. While the problem may be complex, there are several strategies and technologies available to help keep patients (and their outcomes) on track.

Why Target Patient Adherence?

The majority of recovery is happening outside the clinic. Therefore, quality healthcare relies on patients’ adherence and engagement to things like following their medication schedule, understanding of red flags or successful completion of their home exercise program.

This is one of the biggest stumbling blocks for providers working on bundled payments because even if the patient is no longer under your care, if they end up experiencing a complication leading to a readmission, the hospital must incur the financial consequences. In fact, more than 40% of patients sustain significant risks by misunderstanding, forgetting, or ignoring healthcare advice!2

Value-Based Care & Patient Adherence

Research demonstrates that adherence to home exercises can help patient outcomes of pain, physical function, and self-perceived effect.3 Patients who are engaged in their care cost healthcare systems 8% less than non-engaged patients in their base year, and 21% less in future years.4

How Does Technology Improve Adherence?

If you are able to successfully leverage technology to improve adherence (and true engagement of the patient), you may be able to help your patients receive the best outcome at the lowest cost. Several studies support this strategy showing that highly activated patients consistently report more positive care experiences.5-7

Here are three primary ways technology can lead to higher rates of patient adherence:

1. Accessibility

Therapists can leverage technology to extend their care and support to the patient beyond the clinic. Providing a portal to facilitate provider-patient communication strengthens the relationship and promotes proactive outreach from patients. Research shows that patients report that maintaining the relationship with their provider via good communication increases care satisfaction and likelihood of adherence to prescribed treatment.8 

2. Messaging & Notifications

Ever need a nudge or reminder to keep you on track? So do your patients! Automated systems help to ensure patient compliance with home programs and medication management. Plus in-app and patient portal messaging systems open communication to ensure your patient has the tools they need to recover. Make sure you are thinking mobile messaging too – 95% of texts are read within three minutes of receipt.9

3. Patient Education

Patients with low health literacy may get lost and become disengaged in our complicated healthcare system. To help these patients understand their condition and rehabilitation we can use engaging, empathetic and interactive patient education. The Center for Advancing Health defines patient engagement as the “actions individuals must take to obtain the greatest benefit from the healthcare services available to them.”10 Therefore, all strategies used to reinforce and develop patient engagement should focus on improving health literacy.11

Bullseye – Lower Costs & Improved Outcomes

The role of the therapist is much larger than the in-clinic treatment. The goal of care encompasses the entire injury recovery process, from initial evaluation to well past discharge. If you can get patients to adhere to their treatment plan during therapy, you are not only improving their immediate outcome and their experience of therapy (and your organization!), you are also helping set them up on a road to recovery and better health.

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  1. Better Care. Smarter Spending. Healthier People: Improving Quality and Paying for What Works,, accessed 3/15/17.
  2. Martin LR, Williams SL, Haskard KB, DiMatteo MR. The challenge of patient adherence. Therapeutics and Clinical Risk Management. 2005;1(3):189-199.
  4. Hibbard JH, Greene J, Overton V, Patients With Lower Activation Associated With Higher Costs; Delivery Systems Should Know Their Patients’ ‘Scores’. HealthAffairs. 2013;32(2):216-222
  5. Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res. 2004;39(4 Pt 1):1005–26.
  6. Mosen DM, Schmittdiel J, Hibbard J, Sobel D, Remmers C, Bellows J. Is patient activation associated with outcomes of care for adults with chronic conditions? J Ambul Care Manage. 2007;30(1):21–9.
  7. Alexander JA, Hearld LR, Mittler JN, Harvey J. Patient-physician role relationships and patient activation among individuals with chronic illness. Health Serv Res. 2012;47(3 Pt 1):1201–23.
  8. Ha JF, Longnecker N. Doctor-Patient Communication: A Review. The Ochsner Journal. 2010;10(1):38-43.
  10. A New Definition of Patient Engagement: What is Engagement and Why is it Important?, Center for Advancing Health, 2010. Accessed 3/15/17.
  11. Coulter, A. (2012). Patient engagement-What works? Journal of Ambulatory Care Management, 35(2), 80-9. doi: 10.1097/JAC.0b013e318249e0fd.