Leveraging altruism to improve compliance
Dr. Murat V. Kalayoglu explains how altruistic reinforcement programs link patient engagement with charitable contributions to drive compliance
Motivating patients to adhere to medications can be incredibly difficult, but one promising intervention under development is altruistic reinforcement programs, an innovative behavior-change strategy that taps into a powerful, innate aspect of the human psychethe desire to give.
Altruistic reinforcement programs use patient engagement and adherence levels to determine charitable donations made by a sponsoring company or brand.
Donations are made on behalf of the participating patient population.
Like its cousin, the potent loyalty/reward program, altruistic reinforcement programs couple positive reinforcement with behavioral economics.
But unlike reward programs, altruistic reinforcement activates intrinsic drivers of behavior change, things that resonate with us in a deeply personal way.
These kinds of programs help create a sense of community and personal empowerment that typical relationship management strategies may struggle to achieve.
As an example, a company with a diabetes drug on the market could integrate an altruistic reinforcement module into its existing, branded or non-branded website.
Every time a patient visits the site and confirms that he or she has taken their medication, or performed another task that helps to improve their overall health and become more knowledgeable about diabetes, they earn points.
These points are pooled with those earned by all patients in the program.
The manufacturer then simply matches the points pool with a dollar amount that they donate to diabetes-specific charities like the American Diabetes Association or the Juvenile Diabetes Research Foundation.
So, in effect, a patients engagement and adherence level helps to drive contributions to organizations that are helping to find a cure for diabetes or provide support to patients with the disease.
The case for charitable giving
Charitable giving is widespread. According to Giving USA Foundation, Americans gave over $300 billion to their favorite causes in 2009, despite the recession, with over $20 billion given specifically to health-related charitable organizations.
A widely held misperception is that corporations and foundations are the biggest sources of charitable giving; in reality, individuals and bequests contribute over 80 percent of philanthropic dollars.
Another misperception is that only wealthier people give; in fact, people earning less than $25,000 per year contribute a much greater share of their income compared with those earning greater than $100,000 per year (4.2 percent vs. 2.7 percent), a trend that has been consistent for 25 years.
One cannot over-emphasize the deeply satisfying and motivating nature of charitable giving.
Giving enables people to express support for causes they care about while connecting them to others with similar interests.
This sense of empowerment and social connection makes charitable giving extremely pleasurable.
Cutting-edge research from behavioral and neuro-economics shows that a universal reward circuitry, consisting of neural structures that respond to powerful stimuli such as chocolate, nicotine, monetary rewards, and sexual activity, also responds to charitable giving.
In fact, there is striking evidence that making charitable donations activates the reward circuitry more than receiving the same sum of money for oneself.
Functional MRI studies indicate that donating to societal causes activates two distinct types of reward systems in the brain.
The enhanced motivational aspect of charitable giving may be due to activation of both the traditional reward circuitry as well as an additional, social network-related reward circuitry.
Ample evidence also exists that charitable giving leads to improved health and well being, possibly through reduced stress-related hormones and less anxiety.
Aligning stakeholder interests
Altruistic reinforcement programs are both economically effective and culturally appropriate for pharmaceutical manufacturers.
Because no patient remuneration is required to drive adherence, the altruistic reinforcement model has few regulatory and compliance barriers compared with traditional incentive programs.
As such, CMS carve out may not be necessary, allowing a difficult-to-reach population to benefit from improved adherence.
Additional benefits for manufacturers include the potential for significant tax benefits, enhanced relationships between the sponsor and patient advocacy groups, positive PR, and new collaborative channels with employers and health plans.
Collectively, these benefits could lead to a more holistic and better aligned effort between stakeholders to improve patient adherence and health.
Cost effective adherence solutions that align all stakeholder interests are not common.
Perhaps altruistic reinforcement can achieve just that.
Dr. Murat V. Kalayoglu is chief science officer for HealthHonors, [http://www.healthhonors.com/] which provides Patient Reinforcement Programs for pharmaceutical manufacturers, pharmacies and health plans.
For more from Dr. Kalayoglu on incentivizing adherence, see Using incentives to improve patient compliance.
For more on other adherence strategies, see Why metrics matter in patient adherence and How to address deliberate non-adherence.