Convenience is king
Everyone has a vested interest in prescription adherence; for pharma, pharmacy, providers and payers, the interest is financial.
For patients, it's personal: the return on adherence is paid in the currency of health and life, which is harder to represent
on a spreadsheet (Quantified Health acolytes notwithstanding). The science of adherence seems to have pivoted in recent years
away from a B.F. Skinner-flavored behaviorist approach to one focused more on behavioral economics, with the emphasis placed
on money as the primary mover.
It's true that out-of-pocket costs and copays do continue to prevent patients from picking up their prescriptions. In fact,
some signs point to difficulties with financial assistance programs in the health exchanges. It's an important one, but cost
is only one barrier. Innovative technological approaches using narrative storytelling and gameplay— such as CyberDoctor's
recently released PatientPartner app—are generating impressive data. PatientPartner asks patients to live with a disease vicariously
by choosing a fictional diabetic (in this case), and making health decisions for him or her through a series of prompted "scenarios,"
which resemble all too real-world situations. Bad choices lead to poor health outcomes in the story, which ostensibly helps
to model healthy living for actual patients by hammering home the risks of non-adherence.
At the Health 2.0 conference last October, CyberDoctor revealed the results of a randomized clinical trial with 100 non-adherent
diabetes patients in Pennsylvania's PinnacleHealth System. According to CyberDoctor CEO and founder Akhila Satish, using the
PatientPartner app increased medication adherence by 37%—from 58% to 95 %—or the equivalent of three additional days of drug
adherence per week. Patients who read through scenarios on the app for 12 minutes during the trial brought HbA1c levels down
by a full percentage point – from 10.7% to 9.7%, according to data presented by the company.
The adherence problem won't be solved by a single financial incentive, mobile app, data application, educational program,
or transparency initiative. Instead, stakeholder groups across the healthcare delivery system must use all of these tools
and more, to "collaborate out to the patient" and move beyond the traditional borders and segments of patient care. If organizations
can't work together to push adherence rates up—when so many incentives are aligned—what hope is there for success in fixing
other problems where incentives are woefully misaligned, like fee-for-service? Patients are ultimately responsible for their
own health, but no one wants to hang out in the pharmacy any longer than necessary. When it comes to practicing healthy behavior,
convenience is king.
Ben Comer is Pharm Exec's Senior Editor. He can be reached at firstname.lastname@example.org