"We hoped that it would just be fun to participate in this activity," says Kimmel. "The ultimate goal is to help people help themselves. If it works, it becomes a habit for them."
Although it didn't eliminate noncompliance, patients did start taking their medication more often and said they were more interested in taking it on a daily basis. The researchers chose warfarin in part because patients often have trouble with it. Complications can arise from taking either too much or too little or taking it at the wrong time, so improving compliance can have a significant impact.
As Kimmel had hoped, it wasn't all about the money for patients. Initially researchers paid out an average of about $150 per patient a month, but when they dropped that down to $90 there was no change in compliance. It was the daily engagement that the patients seemed interested in.
That raises questions for insurers that might be interested in rolling out a similar program on a larger scale. One reason that the program is still in the research stage is because some of the cost details have yet to be figured out, says Pezalla. "But the question is, how low an incentive is still an incentive? That's an important thing for the researchers to help us find out. What are the appropriate levels of incentives? What are the appropriate intervals?"
Aetna is testing other strategies because such a large problem takes a variety of solutions and effort from everyone involved in healthcare. Physicians can improve compliance with better communication and patient education, pharmacists can reduce nonadherence with regular counseling, and hospitals can improve discharge processes and utilize case managers.
While an incentive program may engage some patients, Pezalla doesn't expect it to fix the medication adherence problem by itself. Instead of a single, magical spoonful of sugar, the solution instead has to be multifaceted and patient-centered. "The focus really has to be on the particular member, on their willingness to participate and their desire to be healthier," he says.