Americans pay a high price for not taking their meds. One in five patients fails to fill new prescriptions, and half of those being treated for chronic conditions stop their medications after six months, according to the National Institutes of Health. These lapses result in additional treatments and hospital stays that cost as much as $289 billion a year, according to NEHI, a Cambridge (Mass.) health policy group. On top of the expense, missed doses cost an estimated 125,000 U.S. lives a year.
Under the Affordable Care Act, some health-care providers will be reimbursed on the basis of treatment outcomes rather than the number of procedures. So a clinic has a greater incentive to make sure its diabetes patients control their blood sugar and don’t end up in the emergency room. According to the Centers for Disease Control and Prevention, 48 percent of Americans use at least one prescription drug, and 10 percent take at least five.
Illustration by Joe Magee
There are lots of reasons patients don’t follow doctors’ orders: The medicine might cost too much or have unpleasant side effects, or patients might not understand why it was prescribed. Some simply forget. “ ‘Here, take one pill for the rest of your life.’ It’s pretty daunting,” says Anne Trontell, a program director at the Agency for Healthcare Research and Quality, a federal organization that studies the health system. There’s no simple fix for noncompliance because the causes are often unique to each patient’s lifestyle, she says.
That’s why Joshua Benner started RxAnte in late 2011. His McLean (Va.) software company uses algorithms to mine patient data to help health plans, pharmacies, and drugmakers predict who’s likely to need prodding to take their prescriptions. Patients who miss regular checkups or never get their flu shots could use some cajoling. For patients who get labeled high-risk, the plan suggests intervention strategies like giving discounts or a reminder call.
RxAnte, which Benner says is being used by health plans covering 4.5 million people, is designed to identify the most cost-effective intervention. “Who needs a co-pay discount? Who needs a refill reminder? Who needs a one-on-one session with their doctor or pharmacist to talk about all their meds?” Benner asks. The kind of analysis RxAnte performs for clients only became possible in recent years, as doctors and pharmacies began using electronic records.
Doctors and clinics can contract with EClinicalWorks, a Westborough (Mass.)-based software vendor, to send patients voice and text reminders about appointments and prescription refills. An app for patients to track their health will soon detect patterns that signal trouble ahead, says Chief Executive Officer Girish Navani. Take a patient on Lasix for congestive heart failure who, in response to prompts on her phone, reports that she’s missed several doses and is gaining weight. “This person, if I wait another four days, is guaranteed to call 911,” Navani says. The software can alert doctors before she lands in the hospital.
Israeli startup MediSafe Project makes a free app that prompts users to take their medicine with reminders on their mobile phones. If patients don’t confirm that they’ve taken their pills, the software notifies a relative or caregiver. The app launched in November and was downloaded 30,000 times in three months. Founder Omri Shor developed it to ensure his diabetic father takes his insulin correctly. “If my dad forgets to take his insulin, I get a notification,” Shor says.
Vitality, based in Los Angeles, sells GlowCap, a gadget that fits over most prescription bottles and lights up and beeps when a dose is due. It also sends alerts to family members if the bottle isn’t opened. The cap retails for $80, plus $15 a month for the cost of the wireless data plan, which is provided by AT&T (T). Proteus Digital Health last year got federal approval for a tiny ingestible sensor that can be inserted into a pill that will signal when a medication has been taken.
Patients with the highest risk of missing doses need personal interventions from a clinician or pharmacist. CVS Caremark (CVS) pharmacists have reached 3.8 million patients through meetings or phone conversations since 2011. “It turns out that the pharmacist’s recommendations are much more effective than those [patients] get from nurses or from doctors,” says Troyen Brennan, CVS’s chief medical officer. “I think that trust factor goes a really long way.”