Personalized medicine was a hot topic at the BIO conference in Philadelphia, but in a session on digital health and patient engagement, payer and provider panelists also talked about how, in order to really drive medication and treatment adherence, patient engagement also has to be personalized.
"You have to understand what are they worried about, what are their fears, what are they trying to do?" Roy Rosin, the Chief Innovation Officer at Penn Medicine said. "If we don’t engage with them that way, it doesn’t matter what technology we use."
Rosin joined Aaron Smith-McLallen, lead researcher at Independence Blue Cross in Pennsylvania and Matthew Tindall, Global Director of Consumer Solutions at IMS Health on a panel moderated by Partners Healthcare's Vice President of Connected Healthcare Dr. Joseph Kvedar. IBC and Penn have worked together on a number of interventions, including some successful text message projects and others that used connected devices or smart pill bottles, including Vitality GlowCaps.
"What do we want to know from all these studies, pilots, programs, and interventions that we’re doing?" Smith-McLallen asked. "We’re really working hard to understand and identify the people we want to engage. The pill bottles we saw, the GlowCaps, they’re really good for when people forget to take their medication. But if that’s not a barrier that you need to overcome, that’s not an intervention that works really well. So we have some other programs underway to try to understand other barriers to medication adherence across a wide range of conditions and medications."
Rosin gave one example of a situation where text messaging worked better than anything else: hypertension in new mothers.
"We had tried calling them; that didn’t work. We set up walk-in clinics; that didn’t work," he said. "But if you go to the clinic, you see them texting constantly. So we sent them home with a [non-connected] blood pressure monitor and we would text them a couple of times a day to get these results. Before this intervention we had that data for zero percent of our patients, after the texting we had it for 70 percent and we were able to not just get that data but act on it."
Smith-McLallen pointed out that by understanding the most effective intervention for each group of patients, payer groups like IBC can find the sweet spot to spend money only where it will produce results.
"The pill boxes are costly," he said. "We could send them to everybody, but everybody may not need them. So where’s that sweet spot where we get that return on investment we want? It’s easy to send 10,000 text messages, that doesn’t really cost much even if only 20 percent of them [respond], but we can’t send that many pill boxes out, that’s not a good investment. So we're trying to understand the scalability of different approaches."
Another example of tailoring the right intervention to the right group is step competitions, which many employers and insurers use to try to get people moving. Rosin pointed out that bad design assumptions can really cripple those efforts.
"The thing about 'most steps wins', which you see in wellness programs across the country, is you get not at all the effect that you want. Essentially you take active people and make them super active. And the sedentary people look up and say ‘Oh my God, I’m a million steps behind, why bother.’ But you can change those incentive designs. You can compare them to the person ahead of them. You can compare them to the 50th percentile. You can say 'If you and your team get to a target of 1,000 steps a day you’re entered into the daily lottery'. You’re able to do a lot of interesting things and dramatically change how you get sedentary people to engage in the world."
More than anything else, what makes people tick up treatment adherence is the simple feeling that someone -- particularly their doctor -- cares. Tindall at IMS credits this effect to the dramatic adherence boost he's seen from IMS' AppScript program.
"A person that goes to an app store looking for a healthcare app today, typically at 30 days 20 percent of patients still have that app, so one in five. Really bad adherence," he said. "If you look at patients who have received an electronic prescription using AppScript, it’s 56 percent app adherence. Why is that? Doctors who prescribe an app to a patient typically have patients who respond well to that. They know that the doctor has some vetting of the quality of that product, they trust the doctor, and they know they’re going to have to have follow-up visits where they'll be asked if they used the app."
Rosin's data backs that up as well, he said, pointing to a finding concerning patients with diabetes.
"Diabetics who have a high empathy doctor have 40 percent fewer complications," he said. "A lot of people looking at medication compliance say, you want to drive compliance, the first thing they need to know is the doctor cares about them. If I feel cared for, I’ll comply."