Payer Perspective: Adherence

Payer Perspective: Adherence 

Medication and clinical care adherence are two of the most important actions a patient can take to manage their health. Providers often have limited information on medication adherence. By working with patients on adherence, providers can help patients with the understanding of why medications should be taken as ordered, and build strategies to improve adherence. Patients with chronic conditions need regular and predictable care to ensure they are adequately managing their conditions. People with chronic conditions have care that is typically more expensive than non-chronic members, and well-managed patients often cost significantly less than chronic patients who do not adequately manage their condition. In 2010, $193.4 billion was spent on direct medical costs for heart disease and stroke. Another $157 billion was spent on cancer care, and a further $176 billion was spent on the direct medical costs of diabetes, with another $69 billion in lost productivity due to diabetes (CDC, 2016). Across the board, the cost of chronic illness is very high, but can be mitigated with proper planning and adherence.


Hours: 1.00


Certificates provided by accrediting body (1 Match)

Commission for Case Manager Certification


This program has been pre-approved by The Commission for Case Manager Certification to provide 1.00 hours of continuing education credit to CCM® board certified case managers.

Course Details

Course Code: REL-PI-0-P70
Hours: 1
Type: Online Course
Content Expiration Date: 12/31/2021
Learning Objectives:
Teach patients the importance of adherence to agreed-upon action plans
Identify different educational tools for teaching self-management to patients
Write an action plan with your patients.
Identify potential social determinants of health that could impact adherence to the action plan.

Section 1: Introduction A. About This Course B. Learning Objectives Section 2: What is Adherence? C. Meet Sam D. Influencers on Adherence E. Reasons for Noncompliance F. What can we do to Improve Adherence? G. Review H. Summary Section 3: Creating an Action Plan I. Define Action Plans J. Parts of the Action Plan K. Patient-focused Action Plans L. Examples of Action Plans M. Review N. Summary Section 4: Self-Management of the Action Plan O. Self-Management Definition P. Educating Patients on Self-Management Q. Review R. Summary Section 5: Social Determinants of Health S. Social Determinants of Health T. Review U. Summary Section 6: Conclusion V. Summary W. Course Contributor X. Resources Y. References Z. Congratulations! AA. Exam BB. BrainSparks

Staff Writer: Adam Roesner, BSN
Adam Roesner, BSN has been working with various quality measures optimization since 2013. His experience in program management in both clinical and performance measures allows a unique perspective on the challenge faced by healthcare systems today. Adam has presented trainings on HCAHPS programs for sales forces and executive leadership alike, and has managed various skin health and HCAHPS educational programs and bundles for acute, post-acute, and IDN facilities. Disclosure: Adam Roesner, BSN has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
Expert Reviewer: Lisa Hohlbein, RN, CDP
Lisa Hohlbein, RN, CDP brings over 25 years of healthcare experience and offers cutting-edge expertise in the areas of the RAI process and clinical reimbursement systems. Her experience includes performing and overseeing various reimbursement reviews for Medicaid and PPS in multi-state, skilled nursing facilities, long-term care, and sub-acute care assessment and operations. Lisa has presented workshops on a variety of topics at the facility, regional, state, national, and international (Canada) levels. She was a Master Teacher with AANAC, participated on their Expert Advisory Panel, and has presented at their annual conferences. Lisa has also been a contributor to MDS Alert, Provider Magazine, LT Living, and AANAC's LTC Leader. Lisa is also a Certified INTERACT Educator, Certified Dementia Care Practitioner, and was previously a Certified Alzheimer's Disease and Dementia Care Trainer. Disclosure: Lisa Hohlbein, RN, CDP has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
Target Audience:
The target audience for this course is: Beginner level Social Workers; Case Managers; Nurses; in the following settings: All Healthcare Settings.
Relias will be transparent in disclosing if any commercial support, sponsorship or co-providership is present prior to the learner completing the course.
Course Delivery Method and Format
Asynchronous/Online Distance Learning; please see certificate details for specifics on delivery format.
Relias has a grievance policy in place to facilitate reports of dissatisfaction. Relias will make every effort to resolve each grievance in a mutually satisfactory manner. In order to report a complaint or grievance please contact Relias.
If you require special accommodations to complete this module, please contact Relias Support by completing the web form ( or by using the chat functionality.
All courses offered by Relias, LLC are developed from a foundation of diversity, inclusiveness, and a multicultural perspective. Knowledge, values and awareness related to cultural competency are infused throughout the course content.
Reference herein to any specific commercial product, process, or service by trade name, trademark, service mark, manufacturer or otherwise does not constitute or imply any endorsement, recommendation, or favoring of, or affiliation with, Relias, LLC.
All characteristics and organizations referenced in the following training are fictional. Any resemblance to any actual organizations or persons living or dead, is purely coincidental.
To earn continuing education credit for this course you must achieve a passing score of 80% on the post-test and complete the course evaluation.
If you require special accommodations to complete this module, please contact Relias Customer Support here.