From "Think Better" to "Think Different"

We have identified "non-adherence" as the central problem we are trying to overcome. Most vendors and agencies today will first look to the pharma and healthcare industry to see what has been done, what is not being done effectively, and what can we do better. This is a great place to start, but I would then continue the hunt for innovations and creative solutions that tackle the non-adherence challenge in other industries. As an example, convenience stores (lets use Duane Reade as our example) and grocery shops try to retain customers via loyalty programs. This is great to grow deeper knowledge of your customers' needs and track purchasing habits. As a result, these institutions can deliver targeted discounts and vouchers to motivated customers likely to make a purchase.

Great. So we've identified a solution in a different industry that has done a great job in establishing loyalty (interpreted as 'adherence to the store') for their customer base. Now what? How is this applicable to medication adherence (using this particular example)? Well, lets take this initial analysis to the next level...

What are loyalty programs designed to do besides just drive adherence to the store/brand? Answer: They reward their loyal customers for positive behavior with additional value (whether it be discounts, vouchers, etc.). Could we similarly reward our most compliant patients without breaking the bank for our clients? Perhaps. Lets explore further.

Most companies would tend to direct their initial focus on the existing market of those patients that have already been prescribed a drug. While this is certainly important to address as a baseline using tried and true techniques, it may be challenging to offer such a loyalty service without some revenue loss via reward payments. But is there a way to explore the "un-market", i.e. those 'potential' customers who are considering going on a drug, or contemplating not refilling their drug? I would argue, yes. Here is my thinking. We often think of adherence limited to patients taking their medication as prescribed. But does adherence start earlier in the treatment process? In many cases, yes. Knowing that many non-adherent patients may be price sensitive, we know that doctors first recommend (in most circumstances) lifestyle changes such as "eat healthier, or exercise". But this only further compounds the cost to the patient, defeating their initial behavioral hurdle of maintaining adherence to the drug.

So could we perhaps weave medication adherence to healthy lifestyle behaviors? We know that doctors oftentimes in conjunction with prescribing medications also recommend eating healthy. Tackling both may be prohibitively expensive for the patient and oftentimes making the patient choose between one or the other (usually the medication loses out of if the disease state is asymptomatic, such as hypercholesterolemia or hypertension). In a similar fashion to loyalty programs, could we 'reward' those patients who demonstrate compliance by offering discounts and vouchers to everyday healthy lifestyle purchases (such as organic foods, or heart healthy cereals)?

Sounds reasonable, right? But how can we do this on a confined budget? This is where we need to be creative. Could we (i.e. the pharma company) perhaps partner with General Mills, Nabisco, and other well known food brands to offer these preferential discounts to those patients who demonstrate compliance? At the same time the patient fills their script in the pharmacy, along comes out a receipt with the available discounts/vouchers on food and lifestyle items that are of importance to the consumer to help keep costs down and manageable. These types of partnerships can even expand beyond just food manufacturers to include gym discounts and so. This scenario requires minimal cost for each stakeholder, and is mutually beneficial for all involved -- pharma company enhances adherence, food company drives up sales at the point of purchase, duane reade attracts and retains loyal customers motivated to purchase at the point of script refill, and the patient is ultimately healthier and richer.

Gautam Gulati, MD,MBA,MPH
Vice President/Group Director, Science & Medicine, Digitas Health