Medication Adherence Improvement Across Multiple Conditions
Medication adherence is one of the most stubborn problems in Medicare Advantage, with non-adherence driving poor outcomes, higher costs, and lower Star ratings across the PDC measures for diabetes, hypertension, and high cholesterol. What’s harder to solve is the why behind each individual member’s gap. That’s precisely where most outreach falls short. It is possible to see medication adherence improvement across multiple conditions. It happens when you stop treating non-adherence as a single problem and start addressing it as an individual, multi-causal challenge.
The Scale of the Challenge
One national plan with 3.5 million eligible members worked with MedOrion to improve adherence in diabetes, hypertension, and high cholesterol. All conditions that have an outsized impact on both member health and plan ratings. The program produced meaningful year-over-year improvements in adherence,with particularly strong conversion rates among members who had previously been non-adherent.
For diabetes, 7.79% of non-adherent members became adherent during the program. The overall population adherence rate improved by 4.82% year-over-year.
For high cholesterol, 6.31% of non-adherent became adherent, with an overall population improvement of 2.78%.
For hypertension, 6.21% became adherent.
Equally important: slip rates (were adherent and became non-adherent) held low and consistent across all three conditions, ranging from 2.44% to 2.56%. Improving adherence is one challenge. Maintaining it is another. The program addressed both.
Why Signal-Based Outreach Works Differently
Traditional adherence programs tend to treat non-adherence as a uniform gap to be closed with uniform outreach. A member misses a refill; they receive a reminder. The problem is that a missed refill can mean a dozen different things, from a cost barrier, to a side effect concern, to a transportation challenge, to a belief that the medication isn’t necessary, or simply a busy week. Generic reminders don’t move members whose barrier is something the reminder never addresses.
MedOrion’s approach operates on three layers of signal that work together continuously.
Real-time clinical signals track what has and hasn’t happened within the Stars measure framework. A prescription that wasn’t filled, a refill gap that’s opening, a PDC rate trending toward non-adherence before the measurement window closes.
Situational signals surface why adherence may be breaking down for a specific member. Like whether cost sensitivity, low care engagement, or recent clinical events are creating barriers that a standard outreach cadence would miss entirely.
Behavioral signals determine how to reach each member effectively. Which channel, what message framing, and what timing will actually move this person rather than a persona model that approximates them.
The outcome of layering these signals is individualized member journeys: the right message, through the right channel, at the right moment; all chosen automatically for each member and continuously refined as outreach outcomes feed back into the model.
What This Means for Stars
For plans trying to hold or improve their ratings, adherence performance isn’t a secondary concern, it’s often the margin between a three-star and four-star rating and the revenue that difference represents. Moving 6–8% of non-adherent members to adherent, at scale, across multiple conditions simultaneously, is the kind of performance that shows up in ratings. And, helps you stay there.
