KNB Communications recently interviewed three leaders in healthcare technology – Propeller Health Co-founder and CEO David Van Sickle, RxAnte Founder and CEO Dr. Josh Benner, and RxREVU Founder and CEO Carm Huntress – to get their insights on medication adherence.
Q: A recent study by the Journal of the American Board of Family Medicine underscores the emotional and behavioral barriers faced by patients with chronic illnesses. How do we leverage technology to reduce the impact of social and economic factors such as poverty, transportation challenges, and medication costs?
DVS: We know that, in some cases, people avoid taking their daily medicines for asthma because they’re costly and they can’t afford the required co-pay or co-insurance amounts. But without those medications, people are more likely to develop symptoms, and may have to spend quite a lot of their discretionary income dealing with the costs of uncontrolled asthma, whether it’s because they’re forced to miss a day of work or school, or because they need to seek medical attention. The faster we’re able to help bring someone’s disease under control, the sooner they can avoid unnecessary costs and suffering.
We know that a lot of things in the environment, such as workplace exposures or air pollution in the community, can have a material effect on a person with chronic respiratory disease. By learning about the locations where people have symptoms, Propeller aims to help them avoid or mitigate those exposures.
For the past few years, Propeller has been part of program in Louisville to help residents better manage their asthma and to collect information about where, when and among whom asthma is happening across the metro. Aggregate data from thousands of participants has highlighted how socioeconomic context contributes to poor respiratory health. At the same time, by making these patterns visible, we’ve also opened new opportunities for municipal discussion, policy decisions, and applied public health interventions to try to address these risk factors, and to increase the respiratory health of the entire community.
JB: These are really important barriers. The cost of medications is going up. That makes them unaffordable for some patients, and those are often the patients that are also most vulnerable to the consequences of non-adherence—like low-income and older Americans for whom these medications are really important to them staying out of the hospital, keeping a job, or otherwise living independently. So, we are increasingly doing work in the Medicare, Medicaid and dual-eligible populations. We use advanced predictive analytics to identify members of those populations who are at risk, which means we predict whether they’ll be able to be adherent to the medications that have been prescribed for them.
More than that, we also predict the consequences of their expected adherence. For example, we’ll predict what their non-adherence is likely to cost over the next year or two. That score enables us to prioritize members of those populations tailor programs to the patients who are most likely to benefit. Another technology we developed, RxEffect, allows us to deliver this information in prioritized workflows to physician offices or care managers, so they always know in real time which of their patients need their attention and what problems to focus on.
Different interventions can solve for different barriers. We use telephone outreach with interactive voice response, because that’s an effective way to facilitate a refill for a patient. On the more intensive end of the spectrum, we use live pharmacist care managers to make sure that they understand the importance and the benefits of remaining adherent and to troubleshoot drug therapy problems that the patient might report. If they say, “I’m having a side effect with this med,” or, “I can’t afford this med,” the pharmacist is able to go back to the patient’s prescriber, get it changed to something that the patient might find more tolerable or more affordable, and call the patient back to offer to help get that prescription filled.
A third approach is to use so-called “digital therapeutics” or a combination of digital devices and communication tools to maintain long-term engagement with the patient. These services can be delivered through mobile phones like secure text messaging and secure chat to create an ongoing dialogue with the individual. That provides a conduit to deliver things like a video on how to use your asthma inhaler correctly, so that you and your asthmatic child can use that medicine correctly and stay out of the hospital. Or to deliver a co-pay assistance coupon or some other patient assistance tool provided by the manufacturer to overcome the cost barriers for that particular patient. This is potentially cost-effective and scalable because of the growing mobile and smartphone adoption among these populations.
CH: First and foremost, socioeconomic factors need to be brought into the equation in terms of determining what medication is right for a patient, which will ultimately lead to their adherence. Things we specifically look at are concepts around, for instance, pharmacy deserts, and the challenge for patients, because of public transportation combined with the location of specific pharmacies can lead many patients, especially low-income ones, into situations where they don’t have access to a supermarket or pharmacy within a reasonable distance, that has a pharmacy where they can get their medication.
Another issue is cost and understanding of patients’ income and what they’re ultimately going to be able to afford. Patients won’t take medications or won’t be adherent to medications they can’t afford, period. There’s really no way around that and I think that’s something that is directly tied to socioeconomic factors.
Technologies that can bring those concepts forward and identify those socioeconomic factors up-front and address them in both the exam room as well as the patient’s in a process of getting their medication filled or refilled are going to be critical, because there are a lot of programs that can support patients’ costs. Obviously identify these patients and help support them. There’s a lot of data out there that’s just not being collected and brought together cohesively and made easily accessible to patients to find and access this type of information. I think those are some critical things that really relate to the socioeconomic pieces of adherence.
About David Van Sickle
David Van Sickle is co-founder and CEO of Propeller Health – the leader in respiratory digital health. David received his PhD in medical anthropology. His dissertation research, funded by the National Science Foundation, examined the rising prevalence of asthma and allergy in India. He was then an Epidemic Intelligence Service officer at the Centers for Disease Control and Prevention in Atlanta, where he was assigned to the Air Pollution and Respiratory Health Branch. During this time, he provided epidemiological support to the National Asthma Control Program, and investigated the health effects of a variety of environmental exposures. In addition, he helped establish emergency illness and injury surveillance in coastal Mississippi after Hurricane Katrina. David was also named a Champion of Change by the White House for his work on innovation.
About Josh Benner
A leading voice on medication adherence, Dr. Benner’s award-winning research and numerous publications have shed new light on the problem of nonadherence and identified promising approaches to improving it. He is the founder and CEO of RxAnte, the leading provider of predictive analytics and targeted clinical programs for improving medication use.
Before joining RxAnte, Dr. Benner was Fellow and Managing Director at the Brookings Institution’s Center for Health Care Reform, where he focused on medical technology policy.
Prior to Brookings, Dr. Benner was principal at ValueMedics Research, an analytic and consulting services firm. Following the acquisition of ValueMedics by IMS Health in 2007, he served as senior principal in health economics and outcomes research and global lead for medication adherence at IMS. Dr. Benner received his Doctor of Pharmacy degree from Drake University and his Doctor of Science in health policy and management from the Harvard University School of Public Health.
About Carm Huntress
Carm Huntress is an entrepreneur and strategic leader with over 20 years of experience in startups focused around consumer and enterprise technology. His first web development and hosting company he started while in high school was eventually acquired in 2001. After finishing his degree in electrical engineering at Northeastern University in 2004, he went on to work for PlumVoice, an IVR and voice technology startup, where he ran their network operations. He later was asked to run product development at My Perfect Gig, a Northbridge and Commonwealth Venture start-up.
After two years as CTO at Reef Partners, where he ran the technology for a number of portfolio companies, he became CTO at Audiogon.com, the largest high end audio site in the world. He managed the transition of the core technology platform and team for growth. In 2013 he moved to Denver where he founded RxREVU.