Putting consumer science to work on patient compliance

Many clues to what drives patient non-adherence can be found by taking a consumer science approach to understanding patient perspectives, says Rich Montwill, vice president market development for OptumHealth, a division of UnitedHealth Group. He told attendees at eyeforpharma's recent Patient Compliance USA event that he believes moving toward a holistic view of the consumer can improve adherence and persistency of good health behaviors.

Montwill also stresses that what he calls “big ideas” are necessary to change patient behavior and sell pharma’s customers on the safety and efficacy of its medicines in order to improve adherence and persistency. “The health care industry is finally getting it,” he says. “Fifty percent of the health status of an individual is determined by his or her behavior, so if you can understand their behavior, you’re halfway there.”

The industry must proactively identify consumer needs and develop personalized engagement campaigns for providers and consumers, Montwill says. “Understanding the needs of the consumer helps us get to the next level,” he explains. And “getting to the next level” includes helping patients get the right care, select the right physician and the right medication – even the right lifestyle.

But, Montwill cautions, that such interventions must be delivered in a way that encourage the consumer to adopt them. “We must look at incentives, messaging, and communication channels carefully,” he says. And he stresses the importance of bringing providers into the loop, allowing them to be more engaged and involved in helping reinforce the message.

Taking a proactive stance
Traditionally, healthcare has been delivered in a reactive manner, Montwill says – treating the heart attack victim, rather than taking action to prevent the heart attack in the first place. But that approach is slowly but surely changing with a greater emphasis from the healthcare community as a whole on prevention.

“The challenge is, however, that each of us is very different,” Montwill says. And that means putting greater emphasis on consumer science, he predicts. “We need to understand - from a health perspective - who our consumer is – and how they act, think and receive information,” he says.

Messages must be tailored to individual preferences, value and preferred communication channels, he suggests. And the healthcare industries must leverage best practices from other consumer-focused industries.

“We must ensure the message is appropriate to the medical protocol for the consumer’s life stage and be certain communications are focused in areas upon which the consumer is “ready” to take action,” Montwill says. “And healthcare must utilize preference and attitudinal information to determine how much information to communicate, the tone that will resonate and in which mediums. And then, we have to have that ‘big idea’ that will get them to listen to the message.”

One way that starts, he says, is with efforts like those by large employers that are implementing a “culture of wellness” – providing things to employees on a daily basis, like onsite fitness centers and healthy food choices in cafeterias and vending machines that impact the workplace community.

“Our community or church used to be our peer group, today it’s our workplace,” Montwill points out. In addition to group approaches, however, companies must supplement with a lot of individual communications, such as contests and games that get individuals involved.

Moving the dial
Such efforts are beginning to “move the dial” on compliance, he says. Research shows, he says, that consumers who make better health decisions achieve better care and cost less. In fact, treatment costs are 10% less with this group. But that’s still only scratching the surface, Montwill says.

Another study shows that consumers who want to adhere to their medication regimen but that face barriers improve their optimal use of prescriptions with assistance by nearly 10%. But Montwill questions if we have a good definition of what optimal prescription use really is. Pharma, he says, needs to define where the therapeutic value really lies.

As with consumer adoption of nearly any other product or service, pharmaceuticals experience a broad range of consumer types that mimic a basic bell curve, Montwill says. He explains there are “actives” (approximately 15% of total patient population) who are high adopters and are generally adherent to their medications, as well as “information seekers” (approximately 35% of total patient population) who want to adhere to their prescription treatment, but need a little push and for whom compliance programs are effective.

In contrast, however, there are also “skeptics” (approximately 35% of the total patient population) who are just that – skeptical – and generally less receptive than information seekers to interventions. And last, but not least, Montwill says there are “benigns” (about 15% of the total patient population) who simply have their own ideas and aren’t budging no matter how much pharma pushes. These are the 20% of consumers who never fill their initial prescription, Montwill predicts.

And despite a variety of efforts and approaches to improve patient compliance these numbers have remained pretty much the same across the past decade or more, he points out. Much of what’s been done, Montwill speculates, has “moved” the “information seekers” to be compliant (accounting for the average 50% or so of patients that adhere to most prescription regimens.

This is confirmed, Montwill points out, by the approximately 50% of patients identified by Harris Interactive in a 2005 poll as being responsive to personalized engagement techniques, including those concerned about their medication interfering with other activities (10%), those who simply forget to take their medication (25%) and those for whom cost is a concern (14%).

What’s the “big idea?”
But Montwill questions whether we’re adequately addressing the needs of the “skeptics” – who are paralyzed by what he calls “the moment of truth.” We are removing barriers, he says, for the information seekers, but not necessarily addressing the moment of stress for the skeptics – the decision to actually take the prescribed medication over and over again.

Big ideas, Montwill suggests, that could improve adherence among “information seekers” and “skeptics” might include:
• Root cause consumer science versus survey data
• Technology/data driven consumer packaging to address the “moment of stress”
• A regulatory shift in patient information to define efficacy expectations and benefits
• Provider partnerships
• Scalability is essential

“We need some ‘big ideas’ to solve this problem,” Montwill says. “Medication adherence remains a peak not yet conquered. We have to determine who our targeted consumer is and what the ‘big idea’ is that will attract their attention.”

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