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With increasing patient adherence costs proving a heavy burden for the healthcare industry, are payments to patients the answer? Or is there another way?

By Gene Guselli on Aug 24, 2012

A recent American Journal of Medicine article covered the relative success of using monetary incentives to encourage medication adherence. But is this really the best we can do?

If we have to pay patients to take their medicine, an already expensive healthcare system will become that much more costly. Payment-to-results ratios will vary widely depending upon the type of medication (e.g., drugs with more significant side effects would likely require a larger payment).

Ultimately, widespread payment for adherence schemes could provide a perverse incentive to pharmaceutical R&D: Why should we invest more in this product to improve its side effect profile if someone is going to pay the patient to take the drug?

The evidence is fairly strong that efforts to improve patient management or physician performance that require either party to operate outside the normal workflow have short life spans. They tend to be episodic, sometimes producing decent results, but not sustainable unless they create a permanent change in the healthcare delivery process. 

Adherence solutions should become embedded in the communication patterns already in existence among healthcare professionals and patients. This requires an in-depth understanding of the current treatment management strengths and weaknesses of both physicians and patients. In a nutshell, from the physician perspective, it’s about time and technology. It’s more complicated from the patient perspective, but essentially it comes down to education and support.

Provider systems need to remotely monitor patient behavior and deliver the information to physicians in real time. Likewise, patients need to realize this type of patient-centered outreach is part of the treatment process, which becomes a natural component of care. So, a prescription given to a patient is accompanied by personalized two-way messaging options that patients come to expect from their physicians. The notion of adherence gets created from the start, and the mechanism to ensure it occurs is directly connected to the prescription: “Here’s your medicine and here’s how we’re going to make sure you stay on it."

Human nature works against adherence. Forgetfulness is not the only barrier at play … side effects, lack of confidence in the medication, improved condition, a complicated regimen, and other factors also interfere. As creatures of habit, even with pharmacy reminders and financial rewards, once someone has made the decision (consciously or not) to stop taking a given medication, it’s extremely difficult to bring him or her back into the adherence zone.

Even patients with chronic and life-threatening conditions stop taking their medication. An ongoing InfoMedics patient feedback program helps patients with HIV to identify their personal barriers to adherence, and provides them with support and education about the importance of committing to their antiviral treatment. In a sample of more than 1,000 patients in the program over a seven-month period, participants filled more than twice as many prescriptions than a control group of patients not enrolled in the program.

We’ve found that successful adherence programs need to include:

• Early patient contact. Once the patient leaves the physician’s office, the clock is ticking. Clearly, preventing adherence issues is much more manageable than trying to fix non-adherent patients after the fact. Effective programs reach out to patients quickly.
• Frequent patient contact. Every day is a new opportunity for a patient to fall off treatment. One-time, one-way information transfer is not enough. Effective programs are interactive, mobile, and remain in contact with the patient over the duration of the treatment regimen.
• Automated feedback to the physician. Programs that give physicians insight into patient understanding — especially on an individual patient basis — allow the physician to conveniently monitor treatment effectiveness and adherence. Anautomated feedback loop lets them know, without additional burden on their time-crunched day, if their recommendations are working.

Lack of adherence hurts all of us … as patients, as pharmaceutical professionals, and as citizens who in the end shoulder the burden of mounting healthcare costs.Paying patients to stick to their treatment plans is not a long-term solution. Integrating feedback and efficient patient-physician communication into the care management workflow is the best adherence tactic money can buy.