Navigating the Medication Adherence Whiteout

In part one of this series, we explored the blizzard season that arrives for health plans with a January enrollment surge. Now, in part two, the storm continues when a medication adherence whiteout rolls in, creating year-round visibility gaps.

Medication Visibility Remains Buried

The January blizzard of new members, benefits reverification and prior authorizations is an intense period for health plans. But incomplete medication data can create year-round visibility challenges. These challenges can get in the way of supporting members throughout their therapy journey.

Read part one

It’s Blizzard Season for Health Plans

Medication adherence is foundational to patient safety, total cost of care and quality performance. Yet many health plans lack the timely, comprehensive intelligence needed to understand how members are using their medications—and to intervene early enough to influence behavior, support care coordination and improve Star ratings.

According to a 10-year analysis of health plan performance, health plans that demonstrated high performance on Star ratings adherence measures had higher rates of achieving at least a 4-star overall summary rating. “The better a health plan performed on these adherence measures, the higher the rate of achieving high overall ratings,” per the Journal of Managed Care & Specialty Pharmacy.

Despite the known impact, medication intelligence is often still delayed, fragmented or incomplete limiting both day-to-day coordination and broader quality outcomes.

Three Key Challenges When Tracking Medication Behavior

Reliable medication information can be difficult to find. Here’s why:

1. Timeliness: Plans receive pharmacy claims, but processing timelines vary across retail, mail order and specialty pharmacies. These delays make it harder to spot emerging adherence issues early in the process when outreach is most effective.
2. Unnotified medication changes: Members switch or stop medications without informing their care team. While the behavior can’t be prevented, timely medication intelligence helps reduce the impact of outdated or incomplete information on care coordination.
3. Therapy delays and discontinuation: Members may postpone starting therapy or discontinue treatment over time. These are behavioral challenges—not data-timeliness issues—and may not be visible until claims arrive. Earlier indicators can highlight where extra support may be needed, even if some scenarios remain hard to detect.

Without comprehensive visibility into medication behavior across an entire member population, plans are managing adherence through a perpetual snowstorm of actions. This ongoing obscurity creates operational paralysis.

Teams could expend valuable hours manually shoveling through disparate data sources, attempting to piece together an incomplete picture of member medication behavior. By the time an adherence gap or therapy delay is uncovered, the critical window for early intervention has often closed.

The result?

Preventable hospitalizations, accelerating disease progression and mounting care complexity drive costs upward while potentially sending Star ratings downward.

How Medication History for Populations Clears the Path to Better Medication Adherence

Just as excavating buried data during member onboarding enables faster risk identification, clearing the medication intelligence whiteout requires continuous visibility into medication behavior across an entire member population.

Medication History for Populations provides a clear path forward by transforming fragmented and delayed claims data into comprehensive and actionable medication intelligence.

Turning a Whiteout into Clarity

Improving medication adherence requires more than weathering the storm; it calls for intelligence infrastructure to maintain clear visibility regardless of conditions. This complete picture enables plans to support members more effectively throughout their medication journey.

With access to complete, actionable medication data, blind spots disappear and the path forward is clear. What remains is the clarity needed to deliver proactive, coordinated care that improves outcomes, enhances quality measures and reduces preventable costs.