Adherence is one of the key concerns with medications. Obviously, if we can’t get the patient to take the right dose at the right time, how can we expect the promised results?
By Tom Kottler, CEO and Co-Founder, HealthPrize
The problem is that once that bottle leaves the pharmacist’s hands, we’ve left all marketing and professional influence behind. You’re depending on a busy, possibly distracted, possibly recalcitrant, possibly forgetful patient to do the right thing.
Fortunately, we’re working on that. First, let’s clarify our term here. To “gamify” means to incorporate game play elements into non-gaming applications in order to drive participation, engagement and loyalty. Its main purpose is to help people with personal growth, societal improvement or marketing engagement. Which includes getting better.
As HealthPrize’s CMO and co-founder Dr. Katrina Firlik writes, “Taking medication every day is not fun, and often comes with various unpleasantries, like transient side effects, copays, trips to the pharmacy, and daily reminders like: (1) you have a condition, (2) you are a patient, and (3) you’re getting old. Gamification in healthcare, buoyed by mobile and online technology, is just starting to take hold as a motivational strategy designed to bring a sense of ‘fun’ to otherwise mundane tasks. Medication adherence is a perfect target.”
Why wouldn’t all constituencies in healthcare—doctors, hospitals, employers, insurers, pharmaceutical companies, pharmacies, etc.— join forces to make the patient experience more pleasant, maybe even a little fun? It’s in everyone’s best interest, especially the patient’s.
How does it work? Here’s an example: you leave your ophthalmologist’s office after your eye exam, and the receptionist hands you a $10 Starbucks gift card and says, “Enjoy! Courtesy of your health plan.” You enjoy a latte on your way home. And you associate that experience with the doctor visit.
How do you feel when your credit card company’s online rewards mall lets you redeem points by choosing a gift card to Williams-Sonoma or Barnes & Noble? Cash back is boring: Williams-Sonoma is fun. The key here is luxury over utility, and the ability to choose. You may be asking “But does this work the same way in the more serious realm of pharmaceuticals?” Let me answer that question with some of our findings.
First, here’s the problem the industry is facing:
• Pharma companies lose an annual $564 billion each year as a result of non-adherence globally—$188 billion in the U.S. alone
• 25% of all new scripts are never filled
• 50% of scripts are ineffective due to failure to take the drug or to follow instructions (source: WHO)
• Non-adherence is one of the leading causes of organ rejection in transplant patients
Additionally, chronic meds offer no short-term benefits, unlike diet and exercise. So taking your meds today but not tomorrow doesn’t do much good. But we’re up against human nature (see “Take My Meds? I’d Rather..” diagram, below).
To counter these tendencies, gamification adds positivity to taking a medication: immediate gratification, gaming dynamics, social elements. The benefits, scientifically validated by behavioral economics and psychology, are numerous:
•Increasing long-term motivation and loyalty
•Making repetitive daily activities more pleasurable
•Creating meaningful and interesting brand connections
Here’s a typical reluctant patient in a typical situation: Consider:
THE REAL STORY BEHIND MEDICATION NON-ADHERENCE: A COMEDY
• 76% of patients think pharmaceutical companies have a responsibility to provide information and services to help patients manage their own health
• 64% of patients are willing to provide information on their health in order to receive free information and services
That word “services” is where the gamification “fun” comes in. The four services patients most expect or want are:
• Rewards programs: 63%
• Product information: 53%
• Financial assistance: 51%
• Measuring and tracking: 35%
You see which one is at the top?
So that’s what patients say they want. But does it work in the real world? Don’t ask me. Ask the New England Journal of Medicine, which ran a paper entitled A Randomized, Controlled Trial of Financial Incentives for Smoking Cessation. Over 800 smokers received either information or information-plus-financial-incentive to quit smoking (rising rewards for completing a program, quitting for six months, or quitting for 12 months). The incentive group had nearly three times the quitting success rate of the information-only group.
To use an example from our own files, here’s what a gamification program looks like, in which patients receive reward points for adherence (see graphic, left).
Bottom line: adherence rates increased from 46% to 64%, accompanied by increases in market share and scripts written. What’s more, 74% of patients reported that they learned “a lot” from the program, and 90% reported that what they enjoyed most was “learning more” and “getting rewards.” Probably my favorite response was “This program really helped me stay on track and made me feel good about taking my meds. Having a chronic condition isn’t fun and is sometimes depressing, and this program gave me something to look forward to and made me feel a part of a group and less isolated.”
Something else we can all look forward to: increasing adherence for more patients, using the proven psychology of gamification.
Tom Kottler, CEO and Co-Founder,
HealthPrize. HealthPrize is the fourth start-up venture that Tom has founded or been associated with as part of the initial management team. His first startup, MedAptus, a healthcare IT company in Boston, is still going strong 12 years later. Celadon Science, now Advanced BioHealing (acquired by Shire in May 2011 for $750M), develops cell-based wound care technology licensed from the cell biology department at the Harvard Medical School. VeinAid develops non-invasive technology to treat varicose veins, based on patents with Tom as a named inventor. Prior to his entrepreneurial career, Tom was on the management team of a mid-sized CRO (contract research organization) that conducted trials for pharmaceutical companies. He helped manage the growth and sale of that company to a Fortune 500 company, for one of the highest multiples ever paid for a privately held CRO. Prior to that, Tom practiced law for nine years in Chicago and Connecticut, doing litigation and corporate law. He received his undergraduate degree from Middlebury and his law degree from the George Washington University. He is on the organizing committee of the Connecticut Challenge, a non-profit that supports cancer survivor clinics across the state of Connecticut. Tom is a member of the HealthPrize Board of Directors. He can be reached at email@example.com.