Barriers to Effective Medication Adherence
Across the world today, it remains incredibly unfortunate that despite the discovery and development of tremendous drug solutions across a vast array of illnesses, poor social infrastructure often prevents these treatments from reaching their full potential, and leads to significant care disparities. Aging populations have led to increased burden of chronic diseases that require increased medication management that care systems are unable to properly motivate. Across the world, care delivery promptly ends once a patient leaves the hospital.
Medication adherence has been described as “the holy grail of primary care” for clinicians, healthcare systems, and other stakeholders, such as insurance providers. Over half of the patient population in the United States forgets to take their medication or takes the wrong dose each day. Poor medication adherence results in up to 69% of medication-related hospital admissions in the United States and accounts for 125,000 preventable deaths annually. Total potential savings from adherence and related disease management could reach $290 billion annually, 13% of total U.S. health spending. Furthermore, medication non-adherence is likely to increase as the U.S. population ages and as patients take more medications to treat chronic conditions such as diabetes and coronary artery disease. We have a health system where the highest-risk and most expensive patients are treated reactively, rather than proactively.
Non-adherence increases direct healthcare costs via progression of controllable disease with:
- Increased service utilization at physician offices, emergency rooms, urgent care centers, and treatment facilities such as nursing homes, hospice, or dialysis centers.
- Pharmaceutical costs related to therapy intensification as comorbid conditions develop.
- Diagnostic testing that could have been avoided by controlling the primary illness.
Non-adherence creates a positive feedback loop that increases healthcare costs for both individual patients and the U.S. healthcare system. It leads to poor health outcomes, which then increases health care service utilization and overall health care costs. The financial pressure is passed to patients by payers through higher copayments, or via higher costs to employers for coverage. Increased patient cost sharing beyond a given threshold negatively impacts the level of medication adherence by making drugs too expensive to afford, continuing the cycle.
Studies have shown that most deviations in adherence are due to omissions or delays in taking doses. In addition, socioeconomic factors, such as lower education level and low health literacy, have been correlated with non-adherence. Sending health literacy along with medication reminders reduces misinformation about medication effects and help patients understand the benefit of medication adherence for their short and long-term health. Notably, from talking to patients firsthand, we found that many forgot their medications simply because taking their medicine on time wasn’t the most pressing problem they were dealing with. It’s easy to slip on medications when you’re worried about finding food, getting to work, or keeping a roof over your head.
Furthermore, it is common for patients to increase their medication-taking behavior shortly before and after an appointment with a healthcare provider, a phenomena known as “white-coat adherence”. This suggests that automated reminders from a provider-based system, interspaced with information about the health literacy advice, could digitally replicate the “white-coat adherence” effect digitally in patients and improve patient outcomes. Furthermore, communities traditionally underserved in healthcare, such as low-income populations and patients in developing countries, can be most effectively reached via mobile technology. Specifically, SMS text messaging is a low-cost way to facilitate engagement and enhance the health literacy of individuals living with chronic conditions and other health challenges.
So why haven’t interventions to improve adherence worked to date? There is an interesting gap in this space stemming from substantial asymmetries in communication from users to payers and providers to builders. Hundreds of solutions have been created in recent years, but failed to gain traction either because they were too difficult to use, or too cumbersome, or too expensive to implement. The barriers to entry in this market aren’t about building products, but nuanced iterations and improvements in technologies simply from talking to patients and truly understand their challenges. Only then can interventions truly be effective in reforming care management and patient behavior.
By bringing true patient challenges and concerns to light, we’re constantly improving the Memora Health experience to help patients make something like taking medications and receiving support from their care team feel like a friendly nudge — second nature rather than a nuisance. To date, we’ve seen a 50% increase in medication adherence score in patients using Memora over four weeks, a total adherence of nearly 81%, and a readability score of 94%, which we found particularly notable given our early cohort of patients at a safety-net hospital in Atlanta. Our vision is to unbundle care management for patients, providing long-term services such as health education, disease management, and medication reminders directly to patients at home, so that each patient receives the care and support they deserve, all at a lower cost to the system at large. As scientific and technological progress in medicine marches on, we want to make sure that the infrastructure for those breakthroughs to reach and heal patients reaches every corner of the globe.
Memora Health is building the operating system for care delivery that implements intelligent, streamlined workflows and revolutionizes the patient experience outside the care setting. We offer a smart end-to-end platform that unifies fragmented health care data to enable providers, payors, and life science companies to automate care delivery operations — from patient communication to documentation to reimbursement. We uniquely use artificial intelligence to digitize existing care delivery workflows, giving clinicians infrastructure that learns from every encounter they have. Memora supports a full suite of virtual care systems from automated patient intake and scheduling to remote monitoring and care pathways to billing and documentation. Memora is backed by Andreessen Horowitz, SV Angel, Kevin Durant, Martin Ventures, and several healthcare strategic groups.
