Even the advertising on RealAge is targeted. For example, ads for both Lipitor and Vytorin run on pages for patients with
high cholesterol. "A person that's motivated to go to the doctor after seeing material sponsored by Lipitor is more than likely
to talk to the doctor about that drug," Benci says. He notes that RealAge does not publish ads for switch campaigns and ensures
that consumers who say they already take a particular drug don't receive ads for competitors.
Pharma companies can license RealAge's educational content to use with their own CRM system. But to Benci, that misses the
advantages of the site. It's hard to get patients to sign up and provide personal information, he says, and companies are
regulated about what they can say on Web sites. A patient with asthma who signs up for a compliance program on a
http://brand.com/ can only receive so much information, and the company can't engage the patient about other health issues.
"The ability of a content provider like RealAge to provide content across an entire therapeutic category makes it easier to
target a broad persistency program," Wolfman says.
That's not to say that pharma companies aren't doing their best to create compliance programs. Six months ago, AstraZeneca
launched "Measures of Success," an online program for its respiratory drug Symbicort. Patients can register online and access
a trio of disease management tools, including reminder messages and patient testimonials.
One of the more interesting tools on the site is a program by HealthHonors that encourages patients to log in or telephone
each day to let AZ know they have taken their drug at the prescribed time. When patients connect, they see or hear a short
message about the importance of taking the medication. In exchange, they receive points that can be redeemed for books on
asthma and other medically beneficial merchandise.
Pharma incentive programs have been avoided in the past, but AZ feels that it's a good fit in this case. "There are always
hurdles, but we are an ethical company and it's all about making sure you have appropriate rewards that are in line with medical
practice, and that are benefiting patients in the right way and aren't seen as inducements," explains Carolyn Fitzsimons,
executive director for Symbicort.
HealthHonors declined to provide specific numbers, but said that it was achieving results similar to those seen in recent
clinical trials of the program. There, 100 percent of registered users continued using the program throughout a five-month
period, leading to a 34 percent boost in adherence.
"The ROI can be significant depending on the brand and how they go about measuring it," explains HealthHonors founder Murat
Kalayoglu. The company's approach is steeped in research on behavior modification—the technique of increasing (or decreasing)
the frequency of a behavior through the right reinforcement at the right time and frequency.
The AZ program is geared toward patients with chronic diseases such as hypertension, hypercholesteremia, COPD, and asthma—in
which drugs may not provide perceptible benefits. "For those diseases, whether or not you take your medication today makes
you feel absolutely no different today," Kalayoglu says. "The reward for taking a statin today is not felt for months or years
down the line in the form of avoiding an ER visit. This system allows you to bring that benefit from the distant future to
the here and now."
The Patient Struggle
"I think it's time to put the words compliance and adherence and persistence in the grave," says Michael Devlin, managing director of the consumer division at healthcare agency Concentric RX. "All those
words imply that the patient is the recipient of healthcare as opposed to being an active participant. It's not a semantic
debate—it's about patient commitment."