Welcome to The Healthcare STARcast! In this episode, host Subbu Ramalingam sits down with Kempton Presley, CEO of Adhere Health, to dive deep into one of healthcare’s most persistent and costly challenges: medication adherence. Affecting half of all Americans with chronic conditions and costing the system over $500 billion annually, medication nonadherence is more than just a public health problem, it’s a personal and global issue that directly shapes Medicare Advantage Star Ratings and the competitive landscape for health plans.
Together, Subbu Ramalingam and Kempton Presley explore why adherence remains so elusive, the complex web of stakeholders involved, and the real-world impact on patient outcomes and plan economics. They discuss the evolving regulatory environment, the importance of aligning incentives, and how emerging behavioral science and data-driven solutions are making measurable improvements. If you want to understand what’s at stake, how health plans can bend the cost curve, and what the future of medication adherence could look like, especially as AI and predictive analytics enter the mix, this conversation is for you.
Tune in for practical insights, plan success stories, and an honest look at how healthcare leaders can drive momentum and lasting change in medication adherence.
Timestamps:
00:00 Medicare, Medicaid & Adhere Leadership
04:23 "Healthcare Innovation and Human Behavior"
08:32 Medication Adherence Impacts Healthcare Ratings
12:27 Patient-Pharmacy Communication Challenges
16:28 Medication Management Impacts Over Time
17:57 Bending Industry Cost Curve
21:41 "Behavioral Science & Medication Adherence"
25:22 "Personalized Member Connection Strategies"
30:27 "Connecting and Engaging with Members"
32:45 Improving Healthcare Outcomes Together
37:05 "AI, Teamwork, and Human Connection"
41:14 "Adapting to Market Shifts"
42:01 "Future of Care and Technology"
45:20 RISE Conference & Networking Plans
Tackling Medication Adherence: Insights from the Healthcare STARcast Podcast
Medication adherence is one of healthcare’s most persistent and costly challenges. In a recent episode of the Healthcare STARcast podcast, host Subbu Ramalingam and Kempton Presley, CEO of Adhere Health, delve deep into the complexities and solutions surrounding this issue. Here are the key takeaways for health plan leaders, clinicians, and industry enthusiasts seeking to improve patient outcomes and optimize ROI.
The Scope of Medication Adherence Challenges
Medication non-adherence affects half of all Americans with chronic conditions and drains approximately 500 billion dollars annually from the healthcare system. As Subbu Ramalingam points out, this challenge is not just financial. It directly impacts patient health and contributes to 125,000 preventable deaths each year, as well as ten percent of all hospitalizations. These staggering statistics underscore the critical need for system-wide strategies.
Why Medication Adherence Matters for Plans and Patients
The conversation highlights how medication adherence acts as a vital proxy for a patient’s overall healthcare experience. Kempton Presley discusses its role in influencing Medicare Advantage star ratings, Medicaid populations, and commercial plans. Adherence measures, built by organizations like the Pharmacy Quality Alliance, ripple through quality bonus payments and determine plan competitiveness. Poor adherence not only affects individual health outcomes but also influences numerous quality and safety measures across an organization’s portfolio.
Barriers and the Ecosystem of Stakeholders
Addressing the foundation of the problem, Kempton Presley emphasizes that adherence is rarely just about remembering to take a pill. Numerous factors, including lack of transportation, food insecurity, social support, side effects, and care team coordination, all play significant roles. Beyond patients, families, doctors, pharmacists, policymakers, and pharma companies collectively impact medication adherence. The involvement of these multiple stakeholders highlights the importance of designing cohesive, patient-centered strategies.
Making the Business Case: ROI of Better Adherence
For health plan executives, medication adherence is not only about quality improvement but also about financial returns. According to Kempton Presley, Adhere Health looks at ROI through multiple lenses. Short-term ROI comes from optimizing prescription fills and reducing duplicate therapies. Near-term returns focus on avoiding costly acute events such as ER visits and hospitalizations. The long-term benefits are seen in improved chronic condition outcomes and lower overall healthcare costs. Importantly, plans must balance quarterly and annual targets with the broader benefits of healthier members.
Adhere Health’s Approach to Sustainable Improvement
A standout insight from the episode is the need to maintain momentum no matter how regulatory priorities shift. Kempton Presley explains that the company uses a blend of behavioral science, advanced analytics, and a variety of communication channels to engage both members and other care team stakeholders. Adhere Health goes further by personalizing interventions at a granular level, identifying the best communication modes for each patient, and tailoring outreach strategies based on individual psychosocial and demographic factors.
Even as star ratings weights fluctuate year to year, Kempton Presley advises plans to sustain investment and effort in adherence to long-term benefit. Plans that continually push ahead with behavioral and data-driven interventions will be best equipped for upcoming changes, such as risk adjustment in quality measures and the increased role of pharmacy-related metrics.
The Power of Data and Human-Centered Design
Technology and AI are crucial to scaling these efforts, but the human element remains irreplaceable. Kempton Presley shares how predictive analytics and longitudinal insights empower outreach teams, while continuous member education and engagement drive sustainable change. AI is an enabler rather than a replacement, streamlining administration and surfacing data-driven actions for clinicians and outreach staff.
Final Thoughts: Building Adherence Momentum
The podcast wraps with a strong call for health plans to lock in robust workflows, align incentives, and foster year-over-year momentum in quality efforts. As Subbu Ramalingam and Kempton Presley stress, the medication adherence challenge is a deeply human problem and demands a blend of precision technology, behavioral understanding, and relentless focus on long-term outcomes.
Leaders who invest in cohesive, member-centered adherence strategies now will not only improve patient lives but also drive positive financial and quality results as the healthcare landscape evolves.
Show Website - https://healthcarestarcast.com/
Subbu Ramalingam - Show Host - Linkedin - https://www.linkedin.com/in/subburamalingam/
FloWise Leadership - https://flowiseleadership.com/
ViVega Business Services - https://www.vivega.co/
ATTAC Consulting Group - https://www.attacconsulting.com/
Media Partner - TopHealth - https://tophealth.care/
“Disclaimer: Informational only. Not medical advice. Consult your doctor for guidance.”