Adva Tzuk Onn , 2025-04-14 13:05:00
As the Boomer generation ages, the prevalence of polypharmacy — patients taking multiple medications to manage chronic conditions — is surging. Nearly 40% of older adults take five or more medications, a number that has tripled in the last two decades. While polypharmacy can be necessary, it also significantly increases the risk of adverse drug events (ADEs), with up to 30% of hospital admissions among older adults linked to medication-related complications. However, when speaking to health system leaders about how they handle polypharmacy patients, they often focus solely on mitigating problems by highlighting programs they use to drive adherence or describe certain medications.
But, in today’s healthcare ecosystem where providers are increasingly under value-based care (VBC) contracts, health systems, accountable care organizations (ACOs) and pharmacy leaders must go beyond traditional approaches to medication management, which often focus too narrowly on medication adherence and deprescribing. While ensuring that patients take their medications correctly and avoiding harmful drug interactions are important, a broader strategy is needed. Effective medication use is not just about keeping patients on track with their prescriptions — it’s about using medications as a tool for whole-person health. Without this mindset, providers risk missing critical factors that contribute to poor outcomes, including medication-induced complications, redundant treatments and overlooked underlying conditions.
Deprescribing is a necessary tool but is not the whole solution
Reflecting on conversations with more than 100 healthcare organizations last year, one common theme emerged: a strong focus on deprescribing. And it’s not without good reason. Research has suggested that as much as 60% of older Americans may be on a drug they don’t need. In a study of more than 200,000 older veterans with diabetes, researchers found that more than half were candidates for dropping a blood pressure or blood-sugar control medication.
However, while deprescribing is an essential component of medication optimization, reducing medication burden without a comprehensive review of the patient’s health can be shortsighted. In fact, research has shown that simply stopping medications without a broader clinical strategy can lead to unintended harm, particularly when done without careful monitoring.
Many providers view deprescribing as a cost-cutting measure or a response to polypharmacy concerns, but they fail to consider that stopping one medication may increase reliance on another. For example, consider a patient managing chronic lower-back pain with long-term opioid therapy. Over time, that patient also has developed insomnia and anxiety, which their physician attributes to both his underlying pain and possible medication side effects. To help with his sleep disturbances, the patient is prescribed a benzodiazepine.
After a medication review, the healthcare team decides to deprescribe the benzodiazepine due to concerns about falls, cognitive impairment and dependence. However, they fail to consider how discontinuing the benzodiazepine will impact the patient’s ability to tolerate his chronic pain. Without the benzodiazepine, the patient experiences worsening sleep and heightened anxiety, leading to increased pain perception. As a result, the opioid use escalates as the patient relies more heavily on painkillers to cope with both increased pain and worsening sleep, raising the risk for opioid-related side effects, including sedation, falls and respiratory depression.
This example illustrates why deprescribing should not be a knee-jerk reaction to polypharmacy concerns — instead, it must be part of a thoughtful, patient-centered strategy that ensures medications work together to improve overall health. But, understanding these risks ahead of time and coming up with a plan – especially at scale when providers are responsible for thousands of patients – is an incredible challenge, one that is nearly impossible at scale without a technology-assisted approach.
Medication optimization focuses on holistic health and can improve value-based care (VBC) performance
True medication optimization also means evaluating whether each medication is appropriate, effective, aligned with the patient’s broader health goals and isn’t going to be problematic over the longer term.
For example, a patient on two blood pressure medications may appear well-controlled, but their treatment could be silently contributing to renal failure. Without a holistic medication review, only focusing on adherence and/or describing in isolation may not consider this complication, creating gaps in care or even worsening health outcomes.
Scenarios like these are actually much more prevalent than you might think possible, and again, when a provider (especially those treating Medicare populations) may be responsible for thousands of patients, it’s simply impossible to manage at scale.
A comprehensive medication management strategy is particularly critical for providers operating under VBC agreements, where financial incentives are directly tied to patient outcomes and cost containment. Poor medication management contributes to preventable emergency department visits, hospital readmissions and complications — all of which drive up costs and negatively impact performance metrics in risk-based contracts.
To succeed in value-based care, providers must move beyond traditional medication adherence programs and ensure that prescribed treatments actively contribute to better health outcomes and cost efficiency. A holistic medication management strategy should include:
- Regular medication efficacy assessments — not just for interactions but for overall impact on patient health.
- Evaluating treatment goals holistically, ensuring that medications are not only managing conditions but also preventing further complications.
- Proactive identification of risks — beyond known drug interactions, including potential long-term organ damage, nutritional deficiencies, and cognitive side effects.
- Leveraging technology to synthesize vast amounts of clinical data and identify more personalized medication adjustments.
The ability to optimize medication regimens proactively — rather than reactively responding to adverse events — positions providers for stronger financial and quality performance under value-based models.
Elevating the standard of care
For too long, healthcare organizations have assumed that adherence programs and deprescribing protocols were enough to manage polypharmacy. But optimizing medications is not just about compliance — it’s about ensuring that every prescription contributes to better patient health. Providers who fail to embrace this mindset may be treating conditions on paper but missing the bigger picture of patient well-being.
By moving beyond adherence and drug interactions to a holistic, outcomes-driven approach, health systems and providers can redefine how medication is used — not as a rigid protocol but as a dynamic, patient-centered tool for achieving better health. The future of medication management lies not in reducing pill counts or enforcing adherence alone, but in using every medication decision to drive measurable, meaningful improvements in patient outcomes.
Photo: Stas_V, Getty Images
Adva Tzuk Onn, M.D., is the Chief Medical Officer of FeelBetter and a physician with over 20 years of experience in geriatric and family medicine, having led innovative models of care in major Israeli HMOs. She is a co-founder of the Society of Lifestyle Medicine, a certified Motivational Interviewing trainer, and an active member of the Israeli Society for HealthTech. Dr. Tzuk Onn earned her medical degree from Tel Aviv University School of Medicine.
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