Incentive Program Rewards Employees Who Take Their Medicines

If you’ve already got a smoking cessation program and a weight loss program, you might believe you’re doing all you can to encourage employees to be their healthiest. If you’re finding that employees enjoy receiving rewards and points from those programs, congratulations!

It is likely that you’re increasing the general level of health among your employee population, and perhaps you’re even contributing to a more favorable medical experience for your insurance rates.

However, there is more to do. The New York Times reported recently (June 13, 2010, Belluck) that as many as one-half of patients do not take their prescribed medication, neglect that may cost $100 billion in healthcare expenses each year.

We’re not talking here about a 10-day course of antibiotics, says Dr. Katrina Firlik, chief medical officer of HealthPrize Technologies.

Rather, people with chronic medical conditions—that may or may not make them feel ill—are the ones who cause health expenses to rise when they don’t follow doctor’s orders. Patients with asthma, diabetes, and other chronic conditions often end up in the hospital or emergency room when they neglect to take their medications as prescribed.

Firlik has seen the fallout firsthand. As a practicing neurosurgeon, she heard repeatedly from families that the patient had taken themselves off their medications. “I would operate on a patient who had hypertension-related bleeds in the brain, and the patient’s wife would tell me that he took himself off the medication a few years ago and just never put himself back on it. Over and over again I had this feeling of, if only someone had intervened earlier. It’s such a terrible feeling to know that this kind of thing could have been prevented.”

Instead of just wringing her hands on the way into the operating room, Firlik decided to do something that could reach a larger number of patients before they ended up on a gurney.

She gave up her practice and, along with two partners, launched HealthPrize (www.healthprize.com), which is essentially a points-based system to reward patients based on their medication compliance.

Add Medication Compliance

The impact of medication noncompliance is dramatic, not only for each individual patient, but also for the healthcare system at large.

Firlik cites a lengthy 2005 medical journal article by Michael Sokol. “The article looked at four different chronic diseases,” she says.

“It showed that if you have an adherence level of between 80% and 100%, medical costs were about $3,800 a year.

“For patients in the bottom quintile of adherence, between 0% and 19%, costs ran about $8,800—a difference of $5,000 per patient. The reason is hospitalization costs, infections, emergency room visits, all the downstream effects of, for example, diabetes. And these figures don’t even count workplace costs like absenteeism.

“Many employers already offer some kind of disease management or wellness program,” Firlik says.

“Somewhere on the order of 80% of employers have some kind of incentives for healthy behaviors, like weight loss, smoking cessation, filling out Health Risk Assessments.

“We’re arguing that medication compliance is equally important and should also be rewarded. And, in some situations, it is even more important than keeping the weight off and exercising.”

Compliance = Points

Their system, which took a year to create, uses points to reward participants. “Just like you would get points for airline miles or credit card usage, it gives people points for compliance,” Firlik continues.

“We get information when you refill your prescription and reward points for that.

“Equally important, we give points on a day-to-day basis for daily compliance. We have two ways of doing that, but the most popular one will probably be self-reporting. So a phone call, a text message, e-mail, or online via the HealthPrize website, we push a quick daily message: ‘Did you take your medication? Press one for yes, two for no.’”

Of course, some people won’t answer honestly, Firlik admits. But the idea behind the daily message is not necessarily the points. The daily contact is designed to keep people engaged, which Firlik believes is the most important part of the program.

“We borrowed the idea from the gaming industry and behavioral economics,” she says.

“The trick with the daily engagement is we reward people on a variable basis. Monday might be a 5-point day, or it might be a 50-point day. You don’t know until you’ve answered. So the natural inclination is to look up how many points you got when you answered the question.”

Ideas from Consumerism

Another idea HealthPrize borrowed from established consumer tactics is to capitalize on our tendency toward immediate gratification.

“Most loyalty programs end up with people redeeming their points for $20 Amazon^® gift cards or $10 iTunes^® cards. People don’t want to wait until the end of the year to rack up points for large items.

“And it doesn’t matter how wealthy someone is; people just love getting points. It’s a motivating factor.

“Some employers use tactics like offering a discount on copays or premiums if you adopt healthy behaviors for the year. They kind of hold it out as a carrot. It is certainly well-meaning, and can be effective, but we don’t think it’s as effective as giving people more frequent, smaller rewards.

“Health care is typically a little more timid in terms of using consumer tactics,” Firlik says.

“We’re taking lessons learned from consumer marketing outside of health care and trying to bring them into health care.

“We believe that if you really want to motivate people in the real world, use tactics that we know motivate them.

“We want this to not be a constant reminder that the person is a patient. We want them thinking about being a consumer, about winning.

“Some people have said to us that the reward of good health should be enough. Well sure, it should be. But doctors try to drill that into patient’s heads all the time, and sometimes it just doesn’t work.”

HIPAA Concerns

Of course, because of privacy concerns, you can’t ask employees about their health situations. But companies do have a lot of influence over their healthcare providers.

“Ask your provider what medication adherence solution they offer,” Firlik advises. “Just bring it up. This is an emerging area. People are thinking more about medication compliance. It has lagged behind weight loss, smoking cessation, and other wellness issues.

“Those are important, but really, this may be one of the costliest problems in health care, and many people just don’t realize it.

“A report last year by the New England Healthcare Institute estimated the problem at $290 billion of otherwise avoidable medical spending per year, directly as a result of poor compliance.

“Many people think a lack of medication adherence is just a problem of forgetting,” Firlik notes.

“If you survey patients and ask them why they didn’t take their medication today, a lot of people will have the knee-jerk reaction of saying they forgot. But really it is because they don’t value the medication. People rarely forget to brush their teeth, because they value not having bad breath in the morning. But they don’t take their Lipitor^® because they haven’t fully internalized the value of keeping their cholesterol down for preventing a heart attack or stroke. It’s a value issue, an education issue, and what we’re trying to do with the education piece is just nudge them a little bit.”