The reason is simple: poor adherence is directly linked to more emergency room visits, hospitalizations, and other costly interventions. A strong adherence strategy supports better health outcomes, can help increase hospital Star Ratings, and is reimbursable through Medicare.
This article explores how medication adherence devices and adherence programs drive improved adherence, better patient outcomes, and financial savings within value-based care. It focuses on reimbursement mechanisms, technology integration, and strategic targeting of high-risk populations in ACOs and health systems.
Payment Mechanisms for Medication Adherence Programs
Payment structures for medication adherence programs generally fall into two categories: fee-for-service (FFS) and value-based care. Both models create opportunities to incorporate medication adherence devices, such as the Tenovi Pillbox, PatchRx, and Adherium’s Hailie sensors, for more reliable patient medication management.
Fee-for-Service
Under the fee-for-service model, reimbursement for medication adherence programs is available through the remote therapeutic monitoring code set (CPT codes 98975–98981). This pathway supports RTM medication adherence devices that collect and transmit data for musculoskeletal and respiratory conditions, and it can be paired with other chronic care management services.
The 2026 Medicare Physician Fee Schedule made this pathway even more flexible. CMS now reimburses partial-month monitoring — as few as 2–15 days of data in a 30-day period — and shorter treatment management times of 10–19 minutes per month. Previously, RTM billing required at least 16 days of data collection and 20 minutes of management time, which excluded many patients for whom lighter-touch monitoring was clinically appropriate. Many state Medicaid programs, Medicare, and some commercial payers cover this reimbursement pathway for eligible conditions.
Value-Based Care
Medication adherence devices offer an even broader range of benefits in value-based care settings. VBC entities operate under capitated payment models and quality rating systems that reward cost containment and improved patient outcomes. Medication adherence programs targeting high-cost events, such as hospital readmissions and emergency room visits, provide a direct pathway to those goals.
For instance, hospitals penalized under the Hospital Readmissions Reduction Program (HRRP) can see meaningful financial relief from reduced heart failure readmissions. Even small reductions in heart failure readmission rates — 1% or more — can yield substantial payment adjustments from Medicare, benefiting both the hospital and its patient population.
Economic and Clinical Evidence for Medication Adherence
Improving medication adherence delivers both economic and clinical returns. A systematic review across 14 disease groups found that medication non-adherence costs range from $5,271 to $44,190 per person per year, depending on the condition. Patients with chronic diseases like diabetes and hypertension who adhere to their medications have significantly fewer ER visits and hospitalizations, resulting in considerable savings.
Specific studies underscore these benefits:
- In a study of chronic vascular disease patients, medication adherence reduced hospitalizations and produced a benefit-cost ratio exceeding 13:1 for hypertensive patients over age 65.
- For patients with heart failure, remote monitoring technology reduced the risk of all-cause hospitalization by 80%, demonstrating both the financial and clinical advantages of adherence-focused interventions.
Medication Adherence Populations in Value-Based Care
Research continues to show the impact of remote monitoring strategies on chronic disease outcomes. A systematic review and subgroup meta-analysis found that telemonitoring interventions incorporating medication support and mobile health significantly improved hospitalization and mortality outcomes for patients with chronic heart failure. The findings highlighted the value of smart medication adherence devices, such as remote-monitoring-enabled pillboxes, in boosting patient engagement and reducing hospitalization.
Some medication adherence devices track pillbox opening and closing events, giving care teams objective data on how often patients take their prescribed medication. Certain patient populations and value-based initiatives are especially well positioned to benefit from a medication adherence program.
Heart Failure Patients
Given high readmission rates among heart failure patients, they are ideal candidates for medication adherence programs — especially within hospitals penalized under the HRRP. Reducing heart failure readmissions even marginally can lower penalties and improve reimbursement rates across inpatient services.
Accountable Care Organizations
ACOs benefit from adherence tools that prevent unplanned admissions and improve shared savings rates. Each avoided heart failure admission can save an ACO more, on average, than the cost of implementing an adherence program. Targeted enrollment of high-risk patients — particularly those recently discharged — aligns adherence programs with ACO goals of cost reduction and improved outcomes.
High-Risk, High-Cost Populations
Populations facing significant adherence barriers, such as patients with diabetes, schizophrenia, and hypertension, also stand to benefit. Non-adherence in these groups drives higher emergency and inpatient utilization. Closing these gaps can prevent progression to more severe conditions and reduce long-term healthcare spending.
Why Medication Adherence Devices Are Essential for Value-Based Care Success
For value-based care entities, the impact of non-adherence is profound. Improving adherence reduces avoidable events — hospitalizations and emergency visits — that rank among the most costly in healthcare. Medication adherence devices such as PatchRx, the Tenovi Pillbox, and Adherium Hailie sensors identify high-risk patients and enable timely intervention that directly improves clinical outcomes. Largely automated platforms like PatchRx require minimal clinical oversight, making them efficient options for organizations with limited resources.
With the 2026 RTM billing flexibilities lowering the barrier to entry, medication adherence programs are better positioned than ever to support VBC goals: improved patient outcomes, reduced costs, and higher quality scores. As adherence technologies evolve, they give VBC entities practical tools to achieve meaningful results in both cost savings and patient care.
