A spoonful of sugar helps the medicine go down," Julie Andrews sang in the Disney classic Mary Poppins. It is an immortal lyric that was meant as a lesson for children, but it contains an implicit truth about healthcare: Taking medicine is often hard, and sometimes an extra incentive makes it a little easier.
For the millions of adults who don't regularly take their medicine as prescribed by their doctors, insurers and others in the healthcare industry are trying to figure out what incentives may improve medication adherence and, in the long run, improve quality and reduce costs.
Estimates put the percentage of those who don't comply with prescription instructions somewhere between one-third and one-half of all patients. Studies have found that nearly one quarter of patients with heart disease discontinue treatment within six months, and compliance for patients taking statin drugs may be below 60% after a few months. Many of those patients end up back in the hospital with a stroke, heart attack, or other severe condition that could have been prevented.
The poor compliance not only affects quality—nonadherent patients have higher hospitalization and mortality rates, according to research—but it also makes healthcare more expensive. The overall cost of poor adherence, measured in otherwise avoidable medical spending, may account for as much as $290 billion per year, or 13% of total healthcare expenditures, according to an estimate from the New England Healthcare Institute.
Insurers have yet to find the right "spoonful of sugar" to cut some of these alarming statistics, but many are experimenting with new incentives and getting creative in their approaches. For instance, Aetna Inc. is funding several pilot projects that test how giving medications to patients for free, rewarding patients for lowering blood pressure, and even giving financial incentives for compliance can improve adherence, says Edmund Pezalla, MD, MPH, national medical director and chief clinical officer for Aetna Pharmacy Management
The latter approach has been one of the most successful so far. Funded in part by Aetna, a group of researchers from the University of Pennsylvania recently set up a daily lottery with potential financial rewards for patients who had been prescribed warfarin. Each day when patients remembered to take their medicine, they had a one-in-five chance of winning $10, or a one-in-100 chance of winning $100. When they missed their medicine, they could still see what they would have won, but didn't, that day.
The point wasn't to simply pay patients or reward those who were compliant, but to engage patients and increase their motivation, says Stephen Kimmel, MD, lead researcher on the project and associate professor of medicine and epidemiology at the University of Pennsylvania School of Medicine.