Drug adherence isn't just important for the person taking the medicine. It's also critical for the financial well-being of the healthcare system generally, with some estimates placing the cost of nonadherence as high as $300 billion annually.
While achieving 100 percent adherence is likely a farfetched notion, there is room for vast improvement. A study from the American College of Preventive Medicine found that out of every 100 prescriptions, 50 to 70 are picked up and paid for at the pharmacy, 25 to 30 are taken properly, and about 15 to 20 are refilled as prescribed. And adherence levels drop when there are long stretches in which there's little to no communication from the provider.
Pharmacy giants CVS and Walgreens have been offering their customers text messaging services for years and technology vendors such as CareSpeak Communications, Mosio and Sliverlink are bringing to market tools for hospitals, practices and payers.
Kathleen Ellmore, Vice President of Engagement Sciences at Silverlink, which is part of Welltok, said the reasons for nonadherence are varied.
"It's never one-size-fits-all. Some have side effects, some didn't know they needed a refill. A targeted message can help break down that barrier," she said. "Education is key, and personalization of the education. Sometimes you need more data -- you're just not getting enough information."
What's most likely to improve prescription adherence rates, she said, is some kind of integrated message platform, with texting and email proving to be the most effective options. Improving adherence lowers costs for the patient, the patient's employer and the health plan and government payers, such as Medicare or Medicaid, who may be at risk for the full cost of patient care.
When equipped with information on a given patient population, a provider can see who's on which medications, and whether there are multiple meds. It's possible to ascertain who needs a small nudge, who needs a bigger nudge, and who doesn't need to be bombarded with reminders -- allowing a provider to systematically target those patients most likely to improve their adherence.
Keeping these communications digital helps to mitigate any up-front costs that would be incurred, said Ellmore.
"We've replaced mail with these digital communications," she said, "so most of these communications are significantly less (money). Usually that alone helps the ROI. One of the things you can do to close the loop is offer refills right on the phone. It's automated, and you cut the human piece right out of it."
Health plan cost savings are possible in this way by making it easier to locate in-network pharmacies and network physicians, and patient cost savings through access to comparisons of drug prices and their potential out-of-pocket costs. It can also facilitate easier health plan quality reporting through direct, personalized health risk assessments and patient satisfaction surveys.
"The biggest opportunity now is really to own end-to-end consumer. You can really be intentional and really manage that experience," Ellmer said. "It's a consumer world. We're in a consumer industry, and we need to be held to the same standard."