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: How can technology be harnessed to collect patient-reported outcomes such as real-time symptoms and perceptions of medications?
DVS: Propeller sensors passively collect information about use of inhaled medications and transmit that information through a smartphone to Propeller. Then, the system tries to make sense of how the person is doing, to estimate their level of risk and impairment, and to report back its impression and suggestions through digital apps and interfaces.
We ask people to add details about their symptoms, tell us what they perceived to have triggered their episode, and to answer periodic questionnaires that provide other kinds of information, such as whether they are waking up at night. Altogether, this information teaches us a lot about how asthma is affecting that individual in their daily life and how they are responding to treatment.
With this combination of self-reported information and medication use data, Propeller is able to inform physicians about which of their patients need more attention, to help them better understand what might need adjustment to gain control of the symptoms, and to encourage collaborative efforts to improve its care and treatment.
JB: I think this concept has a lot of merit in managing adherence, because if we can get people to communicate with us about how they’re using their medicine and how their medicines are making them feel in real-time, then we can more actively detect and overcome those barriers to nonadherence before they become a decision to stop the medicine.
Phone calls and mobile apps alike can be used to collect information from patients, assess how the medication is working, and tailor the intervention program. For example, we use our live pharmacist call center to collect patient-reported outcomes and potential reasons why patients may have trouble using their medications as prescribed. Response rates to digital approaches are typically lower, but they are also less costly.
CH: This is a critical issue because most technologies today, especially electronic health record systems, aren’t really set up to store anything beyond basic patient clinical factors. We need a lot more technology today that can go beyond these basic factors. We need to think about socioeconomic, patient-reported outcome measures, and other factors to really improve our understanding of medication adherence. How effective a medication is, what outcome it’s really delivering for certain types of patients, and really looking at technologies that are sophisticated decision support systems that capture all this at the point of care, similar to what we’re doing at RxREVU, with our prescription decision support platform, and capturing those key socioeconomic factors.
If we know the patient has a poor adherence, why is that happening and is it a side effect? Is it a socioeconomic factor? What are those patient-reported outcome measures we can capture and store and then longitudinally feed that data across a whole host of patients to better understand how those factors are affecting adherence?
At the patient level, we’re looking at really simple technologies today, Even text messaging is a great solution, especially for many low-income patients that may not have a smartphone, to engage with them and capture that information.
We don’t need sophisticated apps yet. We’re not there at all, in terms of capturing these types of measurements. It’s really about these simple technologies that can engage a patient with a simple question, allow them to answer that through a technology like SMS, and then obviously store that information and make it available to stakeholders to evaluate and better understand adherence issues. Those are definitely some things I think about, as we start to get better at capturing patient-reported outcomes measures that directly affect adherence.
JB: There’s an exciting tidal wave of interest in the topic of medication adherence across the healthcare system. Fifteen years ago, pharmaceutical companies were the only ones investing heavily in medication adherence. But this has changed dramatically, especially over the past six to seven years.
It’s changed because of new evidence that helped us better understand the consequences of non-adherence as a population health management problem. This stimulated the development of consensus-based quality measures for medication use.
Today, health plans, providers, pharmacies and pharmacy benefit management companies are increasingly being compensated based on the quality of care they deliver—and that is an incentive to improve adherence to critical medications. RxAnte’s products and services are used by all of these stakeholders—and in the years ahead, we want to facilitate unprecedented collaboration among these parties to help patients get more from medicines.
CH: In terms of adherence, we at RxREVU really take a different point of view. Many companies are focused clearly on the patient’s experience and around adherence and how they improve that. But ultimately, all these decisions start at the point of care. We are solely focused on helping the provider at the point of care make the most informed decision that’s going to drive an appropriate prescription to the patient, that they can afford, and they can adhere to.
As we look to the future, I think this is a critical piece that we need more and more technologies at the point of care supporting clinician’s decisions, because ultimately, you as the patient aren’t making the decision; your provider is. That’s sometimes missed, and providers are a key component to the decision-making. It is really is a shared decision-making and technologies that can sit alongside those patients and providers in the exam room and support those decisions are really going to be critical in the coming years.
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.