The Poll Results Are In: 96% of Health Plans Invest in Adherence, but None Catch Risk in Real Time

How can health plans turn their medication management strategy into a real driver of patient safety and long-term value?

That question anchored the PQA webinar “Beyond the Scoreboard: Connecting Medication Adherence and Patient Outcomes,” featuring Nicki Ghazanfarpour, PharmD, BCGP, Director of Pharmacy Clinical & Quality Programs at CalOptima Health and Jimmy WuRohe, Chief Product Officer at Clarest Health.

During the session, the speakers polled the audience of health plan leaders on topics shaping the industry today: barriers to holistic care, investment priorities for pharmacy interventions, use of predictive data, and provider engagement tactics. Here are the results with recommendations drawn from the discussion.

The Poll Results at a Glance

• 36% say provider engagement is their biggest barrier to holistic medication management.

• 96% are investing in medication adherence for 2027, with 76% also prioritizing Poly-ACH and COB.

• 0% have real-time alerts to catch adverse drug events before they happen, but 67% catch some risk retroactively.

• 64% still use fax or mailed letters to reach providers.

Below, we take a closer look at each finding and the practical implications for health plans as they prepare for 2027.

#1 Provider Engagement Is the Biggest Barrier to Holistic Care

When asked about their organization’s biggest barrier in shifting medication management from a compliance activity to a holistic clinical strategy, 36% of attendees pointed to difficulty engaging care providers and prescribers.

Fragmented tools and teams came in second at 29%, followed by siloed data and limited clinical staff, tied at 18% each.

The takeaway: More than a third of plans name the same root issue: getting busy providers to engage. The rest are split across tools, data and staffing, which suggests the barriers vary depending on where a plan sits in its medication management maturity.

The recommendation: Make it easier for providers to act on plan recommendations by basing them on the clinical guidelines they follow, sending them through the systems they use every day, and tying them to financial incentives.

#2 Plans Are Pairing Adherence with Medication Safety for 2027

With CMS’s 2029 Star Ratings (2027 measurement year) on the horizon, we asked attendees which measures they are investing in, allowing them to select all that apply.

Medication adherence led at 96%, followed by polypharmacy with multiple anticholinergics and concurrent opioid/benzodiazepine use (Poly-ACH and COB) at 76%. Next came Statin Use in Persons with Diabetes (64%), Comprehensive Medication Reviews (56%), Part D CAHPS (40%) and transitions of care (36%).

The takeaway: As polypharmacy and medication safety measures carry weight in the ratings, plans are broadening their focus beyond adherence.

The recommendation: Treat these measures as one problem, not five. CMR, adherence, SUPD, Poly-ACH and COB all speak to the same underlying risks, so combining programs and vendors means members get one clear review instead of several separate outreach attempts.

#3 Most Plans Catch Medication Risk After the Fact

We know that catching risk before it becomes an adverse event is key to improving outcomes, yet none of the respondents said their organization has real-time alerts and clinical workflows in place to do so.

Over two-thirds (67%) said they catch some risk, but often retroactively, and another quarter (25%) said they’re relying mostly on claims data with a heavy lag. The remaining 8% said they’re not yet utilizing predictive analytics for medication safety.

The takeaway: Plans are still largely operating in hindsight when it comes to member risk. By the time they catch it, the adverse event may have already happened, with worse outcomes and higher costs.

The recommendation: Predictive analytics can flag medication risk before it becomes an adverse event, but only if the model behind it is sound. Look for tools that go beyond static scores, flagging risk as it emerges and turning it into care plans grounded in pharmacist- and clinician-curated recommendations.

#4 Fax Is Still the Most Common Way to Reach Providers

We asked attendees which tactics they currently use to resolve a medication gap or polypharmacy risk with providers, allowing them to select all that apply.

Automated faxes or mailed letters topped the list at 64%, ahead of peer-to-peer phone calls (56%), prior authorization (44%) and direct EHR integration (24%).

The takeaway: Plans cited engaging providers as their biggest barrier, but they’re still relying on traditional channels to reach them. Fax and mail rank highest, while direct EHR integration, which puts requests into the workflow providers already use, ranks last.

The recommendation: Don’t rely on one method. Choose a vendor that can work every channel at once, including phone, EHR messaging, electronic integrations and fax. Reaching providers wherever they respond closes gaps faster than a single-channel approach.

The Bottom Line

Across all four polls, a similar tension shows up: health plan leaders know that medication management needs to move toward proactive, coordinated, provider-aligned care, but many are still working with reactive tools and fragmented outreach to get there.

For a deeper look at how Clarest Health and CalOptima Health experts recommend closing that gap, watch the webinar recording or read the recap.