Adherence: The Mother Lode of Value Added Services – Or Not?

This is the third in my series of articles about Value Added Services and no discussion on the topic would be complete without a deep dive into Patient Adherence. At least from a pharmaceutical company perspective.



It should be pretty obvious why adherence is so intrinsically linked to this topic. The numbers being thrown around for non-adherence are truly staggering!

It is important to recognize though that while adherence is talked about as a win, win, win service, when one speaks with non pharma healthcare stakeholders, adherence does not often feature at the top of the list of services and solutions they need and want. Ask a physician what services they need and adherence is usually not near the top (many don’t think adherence is a problem for them and their patients), ask the same question of patients and adherence is not there, payers  too have a different set of needs they would like help with.

Pharma needs to be careful about selective hearing and translating a verbalized customer need and turning it into an adherence solution.

Yes, some of the problems these stakeholders vocalize could benefit from improved adherence, but, pharma needs to be careful about selective hearing and translating a verbalized customer need and turning it into an adherence solution. Certainly, for pharma, adherence is a very high priority issue.

Having said all of that though, I would certainly agree that adherence solutions can be a useful value-add if done differently. But, it may be that pharma should not think of it in terms of a Value Added Service, but rather a Beyond The Pill strategy. More on that later.

We have discussed in previous articles that adherence is nothing new. Pharma has worked hard to try to impact medication adherence for many years, and despite some success, it clearly has not managed to turn around the staggering lack of compliance.

Agreed, this has, up until now, been very much a support tactic to drive increased product sales and the resources allocated to it have been insignificant in the overall scheme of things. So, is it simply a matter of money, resources and focus? If pharma was to spend more money would this solve the problem?

I personally don’t think so, doing more of the same is likely not the solution the industry would hope for.

“But what about technology?”I hear you say! “Technology can provide the solution!”

We need to be realistic about the role of technology. It will not be the magic bullet that some folks hope for.

I’m not so sure of that either. The technology to support innovative adherence solutions has been around for years. Gone are the days when adherence meant reminder calls from a contact centre, direct mail, patient information, pill reminders via SMS to mobile phones, patient telephone counseling and the rest. Now we have patient apps, social media sites, communities of interest, websites, smart phones, wearable devices, and almost anything you can think of.

It is here today, it’s been here for years.

But the adherence issue persists.

We need to be realistic about the role of technology. It will not be the magic bullet that some folks hope for, but it can provide a useful set of tools that can help address the issue for many, but perhaps not all, patients and caregivers. Technology alone will not solve this issue – this is a people issue, so let’s not look at the latest social media tool as a quick fix for adherence.

What technology can do, is enable pharma to talk to patients one at a time, to offer individualized and personalized approaches to solve individual patient problems.

It is time to rethink adherence, to be clear what success looks like and address this problem differently from today and the past., so, what is going to have to change? What lessons should we have learnt over the years regarding adherence? Here are my thoughts, in no particular order:

·         This is not about the science or the drug.

·         There is no magic silver bullet.No single, simple solution will fix this problem. What works for one patient may not work for another and it will change over time. So we need a multiplicity of approaches tailored to the individual patient or caregiver.

·         Technology alone will not provide the solution.Solutions need to be crafted using all the available channels and technologies that are available, including more expensive options - people and contact centres for example.

·         How can pharma be patient focused one brand at a time?The most engaging adherence programs will likely address patients holistically and not be purely brand focused.

·         Patients do not want to be compliant, adherent or anything like that.They have their own health goals and ambitions and the healthcare industry should better understand what these are and align around how to better help patients achieve their objectives.

·         Align incentives and measures to accurately reflect what programs are trying to achieve.

·         Patient data, as it has always been, is tremendously important.The industry needs to build a deep and longitudinal understanding of customers (patients, healthcare consumers, caregivers etc), that assists in the improvement of outcomes without running foul of legal. Big data after all is about customers not products!

·         While patient behavior may seem irrational to pharma – it makes perfect sense to patients.Pharma needs to better understand and appreciate the patient’s objectives.

·         Adherence should not primarily be about education.The axiom ‘if only patients had more information’ is not helpful. They want solutions to their problems.

·         Of course, adherence needs to focus on the patient.It’s easy to say, put the patient first, but it has proven much harder for pharma to do in practice, as, for most of them, the drug always comes first.

·         There is nothing wrong with building traditional adherence programs to support an individual brand. But it is going to be increasingly difficult to convince healthcare consumers to use them once the next generation of solutions becomes available.

·         Change the name. Change the thinking. Words are important.

As I mentioned before, maybe it is better for pharma to think of adherence as a ‘Beyond the Pill’ strategy, where the value to payers, patients and physicians is more than just the pill – Pill Plus if you like...

Attached to the pill are a range of tools, services and solutions to help patients get the most benefit out of their treatment. Here the product (the pill) is integrated with an adherence program and marketed as an single package

If you want to take the idea further, then disincentives would apply to patients who do not take advantage of the additional services offered in the adherence program.

The pill is prescribed on the basis that the adherence program will be utilized. Pricing etc should also reflect this Pill Plus thinking.

Value Added Services on the other hand can focus on higher priority customer needs and broader adherence, lifestyle challenges etc and be completely separate from pill sales and, more than likely, will generate additional revenue for pharma.

These two approaches can easily cohabit together and would help to reposition pharma away from only a pill sales organization to a broader healthcare company, but one that still focuses on medications and better health outcomes.


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