Payers Want Tools to Help with Medication Adherence

By November 9, 2015Ideas, Insights

Payers Talk: Market Research on Medication Adherence Tools & Trends

Ayogo in Conversation with Brian Cavoto of The Noise Doctors.Brian Covoto

Ayogo: Brian, you are taking a close look at innovation and specifically, mHealth technology and medication adherence tools that seem to be making a difference to payers and Pharma Benefit Managers.
Let’s define “payers” as organizations that finance or reimburse the cost of health services, like insurance, government, CMS-Medicare and Medicaid, health plan sponsors including employers or unions that may be self-insured.
BC: The Noise Doctors  recently completed a market research study for a pharmaceutical benefit management (PBM) company where we asked payer organizations some questions around what they are doing with their member populations in the realm of mHealth and adherence solutions. We did 20 in-depth telephone interviews with PBM service decision-makers. It is these payer organizations, along with health providers, PBMs, and drug manufacturers who will dictate the pace of adoption of adherence solutions.
The organizations are not as far along as we thought they would be, with only about half indicating that they are even doing something in the general realm of mHealth. They were using mobile applications related to managing benefits of one stripe or another, and only sometimes touching the prescription side.
Only a handful are currently leveraging medication adherence applications. And those that do have an application to support adherence, the focus is often around Specialty drugs, presumably given the explosion in costs for these drugs in recent years. But even those not using adherence supporting technologies are interested in using them when prompted.

Only half of payers interviewed are using apps – and most of those are for managing benefits. Only a tiny number have tackled medication adherence – mostly for expensive, specialty drugs. But payers say they want and would use something that can support adherence.

Ayogo: Can you tell us about the challenges the benefit managers are facing when implementing pharmaceutical  adherence solutions?
BC: First, the reality is that prescription drugs represent just a portion of their world, particularly self-insured employers, who rely heavily on consultants. It’s hard to get a share-of-mind of decision-makers.  On the managed care organization side there is more traction, but the attention right now seems most focused on expensive Specialty drugs, with less attention on the broader population prescribed medication for chronic illnesses.
Ayogo: Where do you see the opportunity there?
BC: Proactively targeting the right channel partners with messages that will resonate with the unique needs of each- like consultants for the self-insured, or speaking to payer organizations about outcomes-based contracting, and addressing players within pharmacy and the medical side of the managed care organizations.
Ayogo: What were they saying about mobile technology?
BC: The most commonly cited challenge relates to accessibility for older or lower income member populations who might not have smartphones. That said smartphone penetration in the US show tremendous gains for older populations, with 49% of those 65+ now owning smartphones, and that is growing on the order of 10% a year. So, some of those citing this challenge were basing their opinions on experiences from years ago. There’s an opportunity to educate stakeholders about the facts and in demonstrating the feasibility of using mobile solutions with more challenging populations.
Payers Want Tools to Help with Medication AdherenceAyogo: Yes – not only is smartphone growth extraordinary in the 65 plus age range, but the tablet has taken off. I wonder if the appeal of tablets to older adults might not be driving much of the new growth.
As a researcher what opportunities did you see for companies like Ayogo who are looking at building adherence using behavioural economics and engaging adherence strategies?
BC: You may want to communicate your empirical results and show the effectiveness of Ayogo’s approach reaching even the hard-to-engage. There’s a perception that adherence programs will only be leveraged by those who would already adhere, not those who are the problem. Related, there are some concerns that the use of financial rewards for incenting behavioural changes would just reward those who are already healthy.
Ayogo: We’re not huge fans of using financial rewards to incent behavioural changes. Not only might they reward the already healthy, as you say, but cash rewards can be counter-productive when you’re trying to get someone to tune into their more inherent motivations.  That said, cash rewards do have a place for the hardest-to-engage.
BC: So I’ll close with what I see as a product opportunity created by the move to outcomes-based approaches. Developing medication adherence solutions will require better data management and analysis than what’s there.
First, payers won’t have the resources on the analytics front on the medical side of managed care there are no prescription-focused analytics staff typically available.
Second, the prescription side of the healthcare world is still very claims-based, and most are not prepared for the deluge of new adherence-based data from wearables and sensors that is about to hit.
Third, most of the adherence solutions have focused their energy on the patient experience, with less investment in back-end integration, or in how these new data streams relate to traditional adherence metrics.
There’s a product opportunity here around the management, integration, and analysis of these new data streams. New technologies that advance our understanding of adherence as an outcome and help us interpret this deluge of data.
Ayogo: Thank you Brian – we appreciate your insights into areas ripe for mHealth innovation as it relates to pharmaceutical benefit management.
Find out how Ayogo’s Empower platform helps payers get the data they need and provide the medication adherence patients benefit from.

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