The critical role medical adherence plays in healthcare costs was not lost on pharmaceutical companies in 2016. A report estimated that an eye-watering $637bn is lost annually to nonadherence – $188-$250bn of that in the US alone. Recouping that cost by attempting to raise drug prices is not an option in the current climate but optimising adherence outcomes to accomplish the same goal achieves revenue, drug efficacy and better clinical outcomes. In this era of value-based payment models becoming mainstream, this is certainly a triple whammy of benefits for all pharma companies to aim for.
The quest to reduce the cost of nonadherence has been the driving force for digital innovation over recent years – not just within pharma but across the whole healthcare industry. All stakeholders, be they payers, providers or pharma, understand that using digital technologies to track, remind, schedule and reorder patients’ medication can help to recoup these costs in a fairly short time frame.
Tasked with building out digital service capabilities to wrap around their product, some drug companies have thought to either partner or acquire digital health start-ups in order to get to market quickly and start gathering data. Whether they choose to own the entire ecosystem or not, mHealth solutions give pharma companies direct and real-time access to their patient base, providing data-driven insight and understanding about what creates engagement and, in turn, sales of their products. For most people, ‘feeling better cared for’ by one medication over another requires an association in the mind of the patient with the drug and value-add services that directly benefit both patient and caregivers. Complementary services such as easy online on-boarding and reordering processes, coupled with accessible educational portals, are of tremendous value to patients and are demonstrating increases in adherence in many current industry initiatives.
Engagement is complex
Does the knowledge that sugar is bad for you stop you reaching for a chocolate bar every now and then? I thought not. No matter how many compelling scientific studies demonstrate beyond all doubt that we should be cutting down on our sugar intake, we wilfully ignore it and carry on regardless. Data-driven evidence alone is clearly not enough to engage us to change our behaviour. No one likes being told what to do, which is why most successful digital health solutions include behavioural science strategies in their toolbox, in order to cajole and nudge us into modifying our behaviours towards more favourable outcomes – namely healthier, more active, lives.
Fitbit-type gadgets demonstrate that user engagement drops off after six months or so when data is simply descriptive and just provides a summary of what has happened in the past. People who adhere to a fitness or medication regime must be motivated and understand what will happen in the future. Successful digital solutions must therefore aim to nudge behaviour through a variety of behavioural science techniques such as goal motivation, social reinforcement and habit formation, coupled with predictive and prescriptive analytics.
Choice drives engagement
Providing choice ensures people can draw on different tools and methods as and when they feel like it, empowering them to manage their health in a far more proactive way. Different motivational tools optimise engagement and compliance, ultimately leading to better health outcomes. By targeting members who are likely to present with type 2 diabetes and other lifestyle-induced chronic illnesses if preventative action is not put in place, these plans have generated successful results, with reimbursement for each patient provided one year from the start of the tailored programme, once certain key performance indicators have been achieved.
Recouping the billions lost annually from nonadherence to medications for the treatment of chronic conditions is therefore the top priority for pharma companies when thinking about their digital health engagement strategy. People with chronic illness are not always ill – they can be in remission for long periods of time. Autoimmune conditions such as Crohn’s disease can flare up through an imbalance of things like stress, lack of sleep or overworking – not just as a direct consequence of nonadherence to medication. Engaging through digital solutions over the long term can be achieved by remotely monitoring – think appcessories – and analysing patient-generated data alongside objective measurement to build up a digital profile of the individual.
The understanding of these digital biomarkers could lead to valuable and seamless interactions between patients and physicians, better adjustment of therapies, and one day even predictive/proactive intervention – realising the goal of precision-based medicine. In the near term, digital biomarkers have great potential to enrich clinical trials.
Building out the digital ecosystem
It is no surprise then that most pharma companies are busy building their capabilities to gather digital biomarkers as we speak. Takeda has recently adopted the platform of Koneska Health to power more patient-centric clinical trials and develop digital biomarkers using biosensors and wearables. These will be used to aid in decision-making and help establish end points to assess a patient’s functional status in an everyday setting, making Takeda’s treatment intervention more efficacious. Biogen has been playing in this space for a few years now and conducted a clinical trial with PatientsLikeMe that showed how people living with multiple sclerosis (MS) can use wearable activity tracking devices to collect and share their mobility data, which could potentially provide relevant information to their clinicians and to other MS patients. Over the course of the study, 82% of patients complied with the study and downloaded the app, with 87% syncing with the service during the study, demonstrating very high adherence.
Start gathering data quickly
Providing evidence of improved outcomes based on digital biomarkers, and being able to claim as much, will require significant clinical trials and can take a long time. However, there is benefit in getting an mHealth solution to market quickly, independent of the regulatory or marketing claims, because it will provide the opportunity to gather data (similar to a phase IV) as well as learn from real-world use of the solution. With the spotlight on pharma all too often being negative these days, there is no better time to start building brand awareness and improving patient engagement. Take the approach of launching with a minimum viable product (MVP) when it comes to an mHealth solution that does not require regulatory approval and work toward a more robust solution that can give the required claims for the longer term.
Provide opportunities for engagement
Solutions don’t have to revolve around data capture and validating digital biomarkers. Some mHealth solutions can be content rich, containing educational materials and videos, while others might focus on the social aspect – helping patients stay connected with a support group. The latter is a vital service for patients with chronic conditions who may want to use support groups for advice, reassurance and counselling when relapses occur. Simplifying and automating the on-boarding and refill process can also be a relatively quick win for pharma to implement when building the engagement strategy. The facility for a physician to provide personalised feedback to patients based on their data could also be built in – allowing remote management by the physician while also increasing patient engagement.
In conclusion
Engaging via digital health solutions is vital for improving clinical outcomes. One Drop, the digital diabetes mHealth app, has recently shown that AC1 levels are reduced by 1% in people using the app to track their insulin, glucose, activity and food. This is just one of the many daily reported examples demonstrating successful digital engagement. Currently pharma is hugely dependent on the user engaging through an app but soon there will be a way of gathering usage data directly from devices, reducing the barriers to compliance even further. When the business models are sufficiently attractive for the pharma companies to take notice, narrowband IoT (NB-IoT) will start to be designed into devices and ecosystems. This will be another great way that technology will drive down both the cost of gathering the data but also the barriers to compliance that are inherent with installing and engaging with an app continuously.