Medication Adherence: Tackling a $500 BLN Healthcare Challenge with Behavioral Science & Innovation

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

Quotes, Hooks, & Timestamps:
"Kempton recently stepped into the CEO role early this year, but he's been doing a fantastic job with Adhere. He's been with adhere since 2012, bringing over a decade of deep experience and Medication adherence analytics, Value based care."
— Subbu Ramalingam [00:02:50 → 00:03:07]

"There's no other part of the healthcare continuum that has so many different connection points with people and is such a consistent reflection of their daily choices."
— Kempton Presley [00:05:33 → 00:05:43]

"Medication non adherence contributes to about over $500 billion in avoidable healthcare costs. Right."
— Subbu Ramalingam [00:06:39 → 00:06:47]

"Where do you see the biggest gaps in how as a healthcare ecosystem currently addressing the problem, where do you see the biggest gap is."
— Subbu Ramalingam [00:08:20 → 00:08:29]

"If you're taking your meds the right way, it can lead to so many good outcomes in terms of metabolic condition control, blood pressure, diabetes control, all things that are measured by that system. If you're taking them the wrong way, it can lead to all sorts of different catastrophic events."
— Kempton Presley [00:09:29 → 00:09:46]

"So too often the cost component or the impact on medication maintenance and related stuff is often thought about it down the line as the icing of the cake, right? So thankfully there are some, although it's not perfect, there are some good quality measures that actually is helping the cost."
— Subbu Ramalingam [00:18:07 → 00:18:26]

"It's so Important to have that longitudinal situation going because adherence is very much more a marathon and not a sprint."
— Kempton Presley [00:27:36 → 00:27:43]

"I think this is where the secret sauce. Right. This is where the real kind of meat of making an impact with a lower cost intervention, you know, comes in."
— Subbu Ramalingam [00:28:26 → 00:28:36]

"We like to look at it both from a, as you pointed out earlier, kind of a personalized standpoint where we understand and we surface case studies that reflect the experiences of patients and their loved ones and how we're able to navigate the healthcare system with them and through their different life events."
— Kempton Presley [00:32:46 → 00:33:03]

"Everyone in healthcare, if it's not AI is not in the banner."
— Subbu Ramalingam [00:36:03 → 00:36:07]

"It's a complex noodle of different opinions and we have to come to a common standard, to your point. So it's going to take some more time, but I think it's worth going through that because I do see, as you pointed out, the technology is there, right?"
— Subbu Ramalingam [00:40:17 → 00:40:35]

Future of Healthcare Communities: "With information changing so rapidly, we have to find ways to synthesize the best information at the right times and do that in the context subu of new communities."
— Kempton Presley [00:42:02 → 00:42:13]


“Disclaimer: Informational only. Not medical advice. Consult your doctor for guidance.”