Nearly 70% of Americans take at least one prescription drug—with more than half on two medications, and a fifth on five or more medicines (see Nearly 7 In 10 Americans Take Prescription Drugs, Mayo Clinic, Olmsted Medical Center Find). This is not surprising, given the statistics that nearly half of all adults in the United States have at least one chronic condition.

But this doesn’t mean that consumers are taking medications as intended. A large proportion of consumers have been found to be non-adherent when taking their medications—defined as not taking the prescribed medications at the doses and times agreed upon by the consumer and their health care professional. For example, recent studies have found that 50% of consumers with cardiovascular disease have poor adherence to their prescribed medications, and of consumers with depression prescribed selective serotonin reuptake inhibitor (SSRI) therapy, only 43% of consumers were adherent (see Adherence & Health Care Costs).

Medications are an integral part of many treatment plans and a significant part of U.S. health care costs. In 2016, the U.S. spent $329 billion on retail prescription drugs, nearly 10% of total health care spending (see Prescription Drug Spending In The U.S. Health Care System). In addition to these costs of paying for the medication, nonadherence with medication therapy adds another level of cost—about 10% of hospitalizations and 125,000 preventable deaths annually. There are also indirect costs—lost income and reduced economic productivity for consumers living with chronic conditions and for their caregivers (see Medication Adherence: Taking Pills As Ordered).

These issues were the focus of the session, Adherence & The Role For New Technologies, presented by Patricia Rohman, Senior Managed Market Liaison and Joseph Cirrincione, Senior Managed Market Liaison—both with Otsuka Pharmaceutical Development & Commercialization, along with Timothy Aungst, Associate Professor of Pharmacy Practice, Massachusetts College of Pharmacy & Health Sciences, at the recent 2020 OPEN MINDS Management Best Practices Institute. Their take is that emerging technologies can play a role in improving consumer adherence with management of their conditions. And that these new technology platforms can be incorporated in current person-centered solutions and care coordination initiatives.

The emerging technologies fall in two categories—those that track adherence and those focused on improving adherence. The tracking technologies are intended to address voluntary nonadherence, where consumers deliberately do not take medication correctly because of some misinformation. There are six types of tracking technologies:

• Event-marker signaling devices like smart pills equipped with embedded sensors or cameras, such as Abiify MyCite, that track ingestion and alert care coordinators about missed dosages (see OIG Approves Otsuka Plan To Loan Smartphones To People Taking Its Digital Medicine Antipsychotic, Abilify MyCite)
• Facial recognition devices like AiCure that use a smartphone camera and motion-sensing technology to visually confirm when medication is ingested (see AiCure Introduces Industry’s First Computer Vision Platform To Remotely Capture Digital Biomarkers In Clinical Trials).
• Breath-based devices with biosensors like NanoSmart that consumers have to blow into after taking medications so the device can detect ingestion and transmit the information to the consumer’s phone, a clinical professional, or the consumer’s electronic health record (see nGageIT Announces Digital Health Product, Checks Adherence Through Users’ Breath).
• Video chats that allow the clinical professional to directly monitor the consumer taking the medication. For example, emocha Health offers a mobile app for consumers to submit daily recorded videos at every dose so the care team can confirm adherence, correct technique, address medication challenges, and provide daily support (see emocha & LifeBridge Health Partner To Support Inhaler Adherence For Individuals With Pediatric Asthma).
• Wearable devices that detect when medicine is taken and alert users when it is not, such as MangoHealth, a free app for Apple Watch and iPhones that provides alerts and medication information and even awards healthy habit points for weekly gift card raffles (see TrialCard Announces Acquisition Of Mango Health).
• Smart packaging and pill dispensers like Pillsy that can monitor the opening of a lid or tablet strip to detect adherence. These devices come in different sizes and can be purchased in pharmacy retail stores (see Pillsy Launches First Smart Pill Bottle & Mobile App).

Adherence enhancing technologies are designed to help address involuntary nonadherence, where consumers do not take their medication correctly by accident—because they forget, get distracted, or do not understand how to take medication correctly. They include educational tools to correct misconceptions about diseases and medications. There are five types of enhancing technologies:

• Calendar-based alarms like Cadex that can alert consumers to take required medication dosages at specific times of day through audio and text reminders that include the name and strength of a medication (see CADEX® Alarm Watch Announced By e-pill® Medication Reminders).
• Wearable devices like CareZone that detect when medicine is taken and alert users when it is not —the devices provide medication reminders, track health information, and even organize refills with door delivery (see Walmart Acquires CareZone).
• Email and text notifications that can provide scheduled reminders to take medication—for example, AdhereTech is a smart pill bottle that sends customized support to a consumer’s phone, via text message or automated phone call (see US Bioservices & AdhereTech Collaborate To Improve Adherence To Therapy).
• Smartphone and tablet apps like Medisafe that helps users manage medications, reminds them when and how to take their medications, warns of potential drug interactions, and provides educational videos (Medisafe Launches New Maestro Platform For Interoperable Digital Medication Management & Consumer Engagement).
• Voice recognition systems like the robotic health care companion Mabu that can have conversations with consumers, gather data every day about the dosing and timing of medication as well as other health and wellness activities, request medication refills from the pharmacy, remind consumers to take medications, track food intake, etc. (see TransPerfect DataForce Selected By Catalia Health To Add Spanish-Language Capabilities To Its Personal Health Care Companion, Mabu).

Rates of medication adherence and these adherence-related technologies are going to be increasingly important to specialty provider organizations. As the field moves to more value-based reimbursement, specialty provider organization contracts are going to include bonuses and penalties based on total cost of care, emergency room utilization, and hospital readmission rates. Performance on those metrics are directly related to consumer medication adherence, which means that provider organization reimbursement is going to be heavily influenced by those factors.

Likely all technologies, the question for management teams is which technologies to add to their consumer engagement and care coordination initiatives. Typical technology selection rules apply (see Strategic Technology Assessments: When? Why? & How?). Our faculty offered some additional advice about the importance of including the consumer perspective in the technology selection process. “Nonadherence interventions should be tailored to the individual, and should involve providers, social workers, case managers, and others on the care team, including the family,” said Ms. Rohman. “It also is extremely important to include the consumer in the decisionmaking process. Individuals with complex care needs can’t be bystanders in their own care management, they have to be participants.” Mr. Cirrincione added that clinical professionals should also make an effort to nurture a relationship with individuals at risk for nonadherence to gain trust. Mr. Aungst noted that technology will make every complex consumer an “E-Patient” that is “empowered, engaged, and enabled to manage their health.”

And for consumer engagement, adherence, and medication management, check out these resources in the OPEN MINDS Circle Library and our online communities:

And for even more, join us on September 15 at 3 pm EDT for part 2 of the PsychU webinar, Psychiatry Perspectives On Patient Care In A Post-Pandemic World where experts will discuss innovations and technological approaches to psychiatric care and identify effective treatment methods.

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