Pharma, adherence, and digital health coaching
Andrew Tolve explores how digital health coaching is helping the healthcare industry provide cost-effective services that boost adherence
Devising a personal care plan for every patient who walks into a doctor’s office or pharmacy is time- and resource-intensive, not to mention cost-prohibitive given the expense of one-on-one sessions with doctors, nurses, and pharmacists. At the same time, the failure of one-size-fits-all adherence campaigns goes to show that personalized care and individual treatment plans can mean the difference between an adherent and non-adherent patient.
The friction between these two polls has led scientists to the new frontier of digital health coaching. (For more on personalized care, see Personalized medicine: A kick-start for innovation?)
The idea is to use Web-based technologies to simulate one-on-one coaching sessions so that all patients can benefit from a uniquely devised medication program. “Digital health coaching is the combination of strong behavioral science with innovative technology,” says Kevin Wildenhaus, a psychologist who used to be able to treat 200 people a year through outpatient counseling. Now, as the director of Science and Innovation at Wellness & Prevention, Inc., a Johnson & Johnson company, Wildenhaus helps digitally intervene with 4,500 and 6,000 patients a day and upwards of 2 million a year. “From a scalability and cost perspective, it makes all the sense in the world,” he says.
That logic has resonated around the US, as insurance companies like Avivia Health from Kaiser Permanente, hospital networks like Advocate Health Care, and employers like Ace Hardware, eBay, and Johnson & Johnson have launched digital health coaching programs. “The healthcare industry has a crisis in its ability to provide services to people who need it and in a cost-affordable way,” says Wildenhaus. “Digital health coaching is a step in the right direction.”
The digital health coaching model begins with a baseline assessment. Patients answer questions on the Web that aim to break down their major health issues that relate to lifestyle (like weight gain and smoking), chronic conditions (such as hypertension and diabetes), and behavioral health (like depression and insomnia). Medication adherence heavily factors into the latter two, and sometimes the lifestyle category, in the case of something like smoking cessation.
In Wellness & Prevention’s model, patients are asked why, if it all, they don’t take their medicines: when they don’t feel sick; when they’re trying to save money; when they don’t have pills; when they forget; and so on. Wildenhaus argues that posing these questions in the online space is actually more effective than asking them in a face-to-face consultation, as patients feel less pressure to lie without the physical presence of a health authority. Although adherence rates hover around 50 percent, roughly 90 percents of patients claim they’re adherent to their doctors, Wildenhaus says. “The anonymity of our format allows for more honesty,” he continues.
Patients still tend to inflate their adherence via digital health coaching, with 60 to 65 percent reporting adherence to their medications, but the margin of error is less dramatic.
Once the baseline assessment is complete, digital health coaching solutions collect the patient’s information, filter it through a model built on the expertise of myriad healthcare professionals—doctors to trainers to behavioral scientists, psychologists and nutritionists—and automatically generate personalized care plans and intervention programs. These plans, says Wildenhaus, are rooted in clinical guidelines but respond to each patient’s treatment past, stumbling blocks, goals, and emotional triggers.
In Wellness & Prevention’s model, patients can log onto a Web portal that sits in the cloud and that is personalized to each patient. During the baseline assessment, questions probe into each patient’s values and motivations so that the resulting program can reflect a unique sense of purpose. When patients sign in, they see their own mission statement accompanied by inspirational photos of their choosing.
“Those true intrinsic motivations are much more powerful than statements like, ‘Remember to take your medication with your meal,’” says Wildenhaus. “Those reminders are seen as intrusions, whereas if you first establish internal motivation and sense of purpose, then using more behavioral approaches will be more effective.”
To specifically address adherence, Wildenhaus believes that mobile apps for the likes of the iPhone are an important component. When patients are asked what gets in the way of taking their meds, their most common response is their routine gets disrupted (33 percent); the second highest response is that they don’t have meds with them when they’re supposed to take them (30 percent).
“Here’s the rub,” says Wildenhaus, “lots of solutions are already based on mobile refill reminders, beepers, and texts. The problem is, to really solidify a healthy habit, you have to first be motivated to take better care of your health.” Digital health coaching can help keep those motivations “top-of-mind,” says Wildenhaus, so that patients can effectively establish a new routine around their medications.
Few solutions manage to fully erase the adherence gap. But as pharma knows well, the improvement of adherence rates by even a few percentage points can mean the difference in hundreds of thousands of successful health outcomes—and millions of dollars for the bottom line.
In one clinical trial associated with a program for nicotine addiction, Wellness & Prevention saw a spike in smoking cessation rates from 43 to 55 percent when patients had an adherence support program integrated with their medication. Likewise, in a general study with Highmark Blue Cross Blue Shield, which assessed the “Care for your Health” program for people with chronic illness, results showed that patients on the program experienced a $365 drop in their actual annual healthcare costs, whereas the costs of a comparison group not using the program rose by an average of $594 annually.
While overall costs decreased in those taking the program, their annual spending at pharmacies actually increased by $84 a person, suggesting that better medication adherence usage is associated with lower overall medical costs. As pharma seeks new ways to squeeze growth and profit out of a stagnating market, such results are bound to attract some attention.
Pharma companies can roll out digital health coaching programs specifically associated with brands, says Wildenhaus, as well as look at acquisition opportunities as more digital health solutions emerge. In 2008, Johnson & Johnson acquired then HealthMedia as one of the components in establishing a whole new Wellness & Prevention platform.
“At the end of the day, technology for the sake of technology can’t be a solution,” says Wildenhaus. “But used appropriately and in keeping with what we know about the psychology of motivation, we can then use technology and behavioral science to make systems operate more efficiently and improve population health.”
For more on the future of patient adherence, see our stories from Patients’ Week 2011.
For more on patient adherence, join the sector’s other key players at Patient Adherence Europe on May 29-30 in London.
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