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3 CEO Perspectives on Medication Adherence – Part 3 of 3

Posted on August 25, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

KNB Communications recently interviewed three leaders in healthcare technology – Propeller Health Co-founder and CEO David Van Sickle, RxAnte Founder and CEO Dr. Josh Benner, and RxREVU Founder and CEO Carm Huntress – to get their insights on medication adherence.

This is part 3 in a 3 part interview on medication adherence. Be sure to read part 1 and part 2 as well.

Q: How can technology be harnessed to collect patient-reported outcomes such as real-time symptoms and perceptions of medications?

DVS: Propeller sensors passively collect information about use of inhaled medications and transmit that information through a smartphone to Propeller. Then, the system tries to make sense of how the person is doing, to estimate their level of risk and impairment, and to report back its impression and suggestions through digital apps and interfaces.

We ask people to add details about their symptoms, tell us what they perceived to have triggered their episode, and to answer periodic questionnaires that provide other kinds of information, such as whether they are waking up at night. Altogether, this information teaches us a lot about how asthma is affecting that individual in their daily life and how they are responding to treatment.

With this combination of self-reported information and medication use data, Propeller is able to inform physicians about which of their patients need more attention, to help them better understand what might need adjustment to gain control of the symptoms, and to encourage collaborative efforts to improve its care and treatment.

JB: I think this concept has a lot of merit in managing adherence, because if we can get people to communicate with us about how they’re using their medicine and how their medicines are making them feel in real-time, then we can more actively detect and overcome those barriers to nonadherence before they become a decision to stop the medicine.

Phone calls and mobile apps alike can be used to collect information from patients, assess how the medication is working, and tailor the intervention program.  For example, we use our live pharmacist call center to collect patient-reported outcomes and potential reasons why patients may have trouble using their medications as prescribed.  Response rates to digital approaches are typically lower, but they are also less costly.

CH: This is a critical issue because most technologies today, especially electronic health record systems, aren’t really set up to store anything beyond basic patient clinical factors. We need a lot more technology today that can go beyond these basic factors.  We need to think about socioeconomic, patient-reported outcome measures, and other factors to really improve our understanding of medication adherence. How effective a medication is, what outcome it’s really delivering for certain types of patients, and really looking at technologies that are sophisticated decision support systems that capture all this at the point of care, similar to what we’re doing at RxREVU, with our prescription decision support platform, and capturing those key socioeconomic factors.

If we know the patient has a poor adherence, why is that happening and is it a side effect? Is it a socioeconomic factor? What are those patient-reported outcome measures we can capture and store and then longitudinally feed that data across a whole host of patients to better understand how those factors are affecting adherence?

At the patient level, we’re looking at really simple technologies today, Even text messaging is a great solution, especially for many low-income patients that may not have a smartphone, to engage with them and capture that information.

We don’t need sophisticated apps yet. We’re not there at all, in terms of capturing these types of measurements. It’s really about these simple technologies that can engage a patient with a simple question, allow them to answer that through a technology like SMS, and then obviously store that information and make it available to stakeholders to evaluate and better understand adherence issues. Those are definitely some things I think about, as we start to get better at capturing patient-reported outcomes measures that directly affect adherence.

Additional Comments

JB: There’s an exciting tidal wave of interest in the topic of medication adherence across the healthcare system. Fifteen years ago, pharmaceutical companies were the only ones investing heavily in medication adherence. But this has changed dramatically, especially over the past six to seven years.

It’s changed because of new evidence that helped us better understand the consequences of non-adherence as a population health management problem. This stimulated the development of consensus-based quality measures for medication use.

Today, health plans, providers, pharmacies and pharmacy benefit management companies are increasingly being compensated based on the quality of care they deliver—and that is an incentive to improve adherence to critical medications. RxAnte’s products and services are used by all of these stakeholders—and in the years ahead, we want to facilitate unprecedented collaboration among these parties to help patients get more from medicines.

CH: In terms of adherence, we at RxREVU really take a different point of view. Many companies are focused clearly on the patient’s experience and around adherence and how they improve that. But ultimately, all these decisions start at the point of care. We are solely focused on helping the provider at the point of care make the most informed decision that’s going to drive an appropriate prescription to the patient, that they can afford, and they can adhere to.

As we look to the future, I think this is a critical piece that we need more and more technologies at the point of care supporting clinician’s decisions, because ultimately, you as the patient aren’t making the decision; your provider is. That’s sometimes missed, and providers are a key component to the decision-making. It is really is a shared decision-making and technologies that can sit alongside those patients and providers in the exam room and support those decisions are really going to be critical in the coming years.

This was part 3 in a 3 part interview on medication adherence. Be sure to read part 1 and part 2 to read the full interview.

About David Van Sickle

David Van Sickle is co-founder and CEO of Propeller Health – the leader in respiratory digital health. David received his PhD in medical anthropology. His dissertation research, funded by the National Science Foundation, examined the rising prevalence of asthma and allergy in India. He was then an Epidemic Intelligence Service officer at the Centers for Disease Control and Prevention in Atlanta, where he was assigned to the Air Pollution and Respiratory Health Branch. During this time, he provided epidemiological support to the National Asthma Control Program, and investigated the health effects of a variety of environmental exposures. In addition, he helped establish emergency illness and injury surveillance in coastal Mississippi after Hurricane Katrina. David was also named a Champion of Change by the White House for his work on innovation.

About Josh Benner

A leading voice on medication adherence, Dr. Benner’s award-winning research and numerous publications have shed new light on the problem of nonadherence and identified promising approaches to improving it.  He is the founder and CEO of RxAnte, the leading provider of predictive analytics and targeted clinical programs for improving medication use.

Before joining RxAnte, Dr. Benner was Fellow and Managing Director at the Brookings Institution’s Center for Health Care Reform, where he focused on medical technology policy.

Prior to Brookings, Dr. Benner was principal at ValueMedics Research, an analytic and consulting services firm. Following the acquisition of ValueMedics by IMS Health in 2007, he served as senior principal in health economics and outcomes research and global lead for medication adherence at IMS. Dr. Benner received his Doctor of Pharmacy degree from Drake University and his Doctor of Science in health policy and management from the Harvard University School of Public Health.

About Carm Huntress

Carm Huntress is an entrepreneur and strategic leader with over 20 years of experience in startups focused around consumer and enterprise technology. His first web development and hosting company he started while in high school was eventually acquired in 2001.  After finishing his degree in electrical engineering at Northeastern University in 2004, he went on to work for PlumVoice, an IVR and voice technology startup, where he ran their network operations.  He later was asked to run product development at My Perfect Gig, a Northbridge and Commonwealth Venture start-up.

After two years as CTO at Reef Partners, where he ran the technology for a number of portfolio companies, he became CTO at Audiogon.com, the largest high end audio site in the world.  He managed the transition of the core technology platform and team for growth.  In 2013 he moved to Denver where he founded RxREVU.

3 CEO Perspectives on Medication Adherence – Part 2 of 3

Posted on August 24, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

KNB Communications recently interviewed three leaders in healthcare technology – Propeller Health Co-founder and CEO David Van Sickle, RxAnte Founder and CEO Dr. Josh Benner, and RxREVU Founder and CEO Carm Huntress – to get their insights on medication adherence.

This is part 2 in a 3 part interview on medication adherence. Be sure to read part 1 and part 3 as well.

Q: A recent study by the Journal of the American Board of Family Medicine underscores the emotional and behavioral barriers faced by patients with chronic illnesses. How do we leverage technology to reduce the impact of social and economic factors such as poverty, transportation challenges, and medication costs?

DVS: We know that, in some cases, people avoid taking their daily medicines for asthma because they’re costly and they can’t afford the required co-pay or co-insurance amounts. But without those medications, people are more likely to develop symptoms, and may have to spend quite a lot of their discretionary income dealing with the costs of uncontrolled asthma, whether it’s because they’re forced to miss a day of work or school, or because they need to seek medical attention. The faster we’re able to help bring someone’s disease under control, the sooner they can avoid unnecessary costs and suffering.

We know that a lot of things in the environment, such as workplace exposures or air pollution in the community, can have a material effect on a person with chronic respiratory disease. By learning about the locations where people have symptoms, Propeller aims to help them avoid or mitigate those exposures.

For the past few years, Propeller has been part of program in Louisville to help residents better manage their asthma and to collect information about where, when and among whom asthma is happening across the metro. Aggregate data from thousands of participants has highlighted how socioeconomic context contributes to poor respiratory health. At the same time, by making these patterns visible, we’ve also opened new opportunities for municipal discussion, policy decisions, and applied public health interventions to try to address these risk factors, and to increase the respiratory health of the entire community.

JB: These are really important barriers. The cost of medications is going up. That makes them unaffordable for some patients, and those are often the patients that are also most vulnerable to the consequences of non-adherence—like low-income and older Americans for whom these medications are really important to them staying out of the hospital, keeping a job, or otherwise living independently. So, we are increasingly doing work in the Medicare, Medicaid and dual-eligible populations. We use advanced predictive analytics to identify members of those populations who are at risk, which means we predict whether they’ll be able to be adherent to the medications that have been prescribed for them.

More than that, we also predict the consequences of their expected adherence. For example, we’ll predict what their non-adherence is likely to cost over the next year or two. That score enables us to prioritize members of those populations tailor programs to the patients who are most likely to benefit.  Another technology we developed, RxEffect, allows us to deliver this information in prioritized workflows to physician offices or care managers, so they always know in real time which of their patients need their attention and what problems to focus on.

Different interventions can solve for different barriers. We use telephone outreach with interactive voice response, because that’s an effective way to facilitate a refill for a patient. On the more intensive end of the spectrum, we use live pharmacist care managers to make sure that they understand the importance and the benefits of remaining adherent and to troubleshoot drug therapy problems that the patient might report.  If they say, “I’m having a side effect with this med,” or, “I can’t afford this med,” the pharmacist is able to go back to the patient’s prescriber, get it changed to something that the patient might find more tolerable or more affordable, and call the patient back to offer to help get that prescription filled.

A third approach is to use so-called “digital therapeutics” or a combination of digital devices and communication tools to maintain long-term engagement with the patient. These services can be delivered through mobile phones like secure text messaging and secure chat to create an ongoing dialogue with the individual.  That provides a conduit to deliver things like a video on how to use your asthma inhaler correctly, so that you and your asthmatic child can use that medicine correctly and stay out of the hospital. Or to deliver a co-pay assistance coupon or some other patient assistance tool provided by the manufacturer to overcome the cost barriers for that particular patient. This is potentially cost-effective and scalable because of the growing mobile and smartphone adoption among these populations.

CH: First and foremost, socioeconomic factors need to be brought into the equation in terms of determining what medication is right for a patient, which will ultimately lead to their adherence. Things we specifically look at are concepts around, for instance, pharmacy deserts, and the challenge for patients, because of public transportation combined with the location of specific pharmacies can lead many patients, especially low-income ones, into situations where they don’t have access to a supermarket or pharmacy within a reasonable distance, that has a pharmacy where they can get their medication.

Another issue is cost and understanding of patients’ income and what they’re ultimately going to be able to afford. Patients won’t take medications or won’t be adherent to medications they can’t afford, period. There’s really no way around that and I think that’s something that is directly tied to socioeconomic factors.

Technologies that can bring those concepts forward and identify those socioeconomic factors up-front and address them in both the exam room as well as the patient’s in a process of getting their medication filled or refilled are going to be critical, because there are a lot of programs that can support patients’ costs. Obviously identify these patients and help support them. There’s a lot of data out there that’s just not being collected and brought together cohesively and made easily accessible to patients to find and access this type of information. I think those are some critical things that really relate to the socioeconomic pieces of adherence.

This was part 2 in a 3 part interview on medication adherence. Be sure to read part 1 and part 3 to read the full interview.

About David Van Sickle

David Van Sickle is co-founder and CEO of Propeller Health – the leader in respiratory digital health. David received his PhD in medical anthropology. His dissertation research, funded by the National Science Foundation, examined the rising prevalence of asthma and allergy in India. He was then an Epidemic Intelligence Service officer at the Centers for Disease Control and Prevention in Atlanta, where he was assigned to the Air Pollution and Respiratory Health Branch. During this time, he provided epidemiological support to the National Asthma Control Program, and investigated the health effects of a variety of environmental exposures. In addition, he helped establish emergency illness and injury surveillance in coastal Mississippi after Hurricane Katrina. David was also named a Champion of Change by the White House for his work on innovation.

About Josh Benner

A leading voice on medication adherence, Dr. Benner’s award-winning research and numerous publications have shed new light on the problem of nonadherence and identified promising approaches to improving it.  He is the founder and CEO of RxAnte, the leading provider of predictive analytics and targeted clinical programs for improving medication use.

Before joining RxAnte, Dr. Benner was Fellow and Managing Director at the Brookings Institution’s Center for Health Care Reform, where he focused on medical technology policy.

Prior to Brookings, Dr. Benner was principal at ValueMedics Research, an analytic and consulting services firm. Following the acquisition of ValueMedics by IMS Health in 2007, he served as senior principal in health economics and outcomes research and global lead for medication adherence at IMS. Dr. Benner received his Doctor of Pharmacy degree from Drake University and his Doctor of Science in health policy and management from the Harvard University School of Public Health.

About Carm Huntress

Carm Huntress is an entrepreneur and strategic leader with over 20 years of experience in startups focused around consumer and enterprise technology. His first web development and hosting company he started while in high school was eventually acquired in 2001.  After finishing his degree in electrical engineering at Northeastern University in 2004, he went on to work for PlumVoice, an IVR and voice technology startup, where he ran their network operations.  He later was asked to run product development at My Perfect Gig, a Northbridge and Commonwealth Venture start-up.

After two years as CTO at Reef Partners, where he ran the technology for a number of portfolio companies, he became CTO at Audiogon.com, the largest high end audio site in the world.  He managed the transition of the core technology platform and team for growth.  In 2013 he moved to Denver where he founded RxREVU.

3 CEO Perspectives on Medication Adherence – Part 1 of 3

Posted on August 23, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Medication adherence has been called the least-appreciated aspect of medicine but its impact is certainly noteworthy.

A recent report, “Adherence and Health Care Cost,” characterized it as “an important public health consideration, affecting health outcomes and overall health care costs” and estimated between 20 and 50 percent of patients are non-compliant with drug therapy.

Additionally, poor medication adherence following hospitalization costs the U.S. healthcare system roughly $100 billion annually, according to a New England Journal of Medicine study.

As our healthcare system moves to value-based reimbursement, technology will help improve medication adherence rates. With this in mind, KNB Communications recently interviewed three leaders in healthcare technology – Propeller Health Co-founder and CEO David Van Sickle, RxAnte Founder and CEO Dr. Josh Benner, and RxREVU Founder and CEO Carm Huntress – to get their insights on this important topic.

This is part 1 in a 3 part interview on medication adherence. Be sure to check back and read part 2 and part 3 once they’re published.

Q: What are some solutions for addressing the top reasons for medication adherence failure:

  • Medications never getting to the patient
  • Medications not being taken correctly
  • Medications not being refilled

DVS: At Propeller, we focus on respiratory disease. We spend all of our time and attention trying to figure out ways to help people with asthma and COPD better and more effectively use the medicines that they take to prevent symptoms from occurring.

These are daily medicines that are subject to factors such as: people forgetting to take them; people not understanding them; people thinking that they’re taking them correctly but not, in fact, doing so; or people trying to negotiate or even intelligently adjust their regimens in one way or another, to benefit their life or for their own understanding of medicine.

Propeller builds devices that capture information about the day-to-day use of those medications and attempts to understand the patterns with which people are taking them or not. Then, we’re able make use of that information through digital interfaces and experiences, to try to encourage, educate, coach, and remind people about how to better manage their condition.

Across the market we’re seeing the creation of digital interfaces and experiences that are tightly coupled to medications that aim to make them more personal, more accessible, and more convenient. These start from thinking about medications from the patient’s perspective, and asking the question: How can you simplify and strengthen these regimens in ways that makes them easier for people to understand and use?

JB:  The adherence failures you identified are an all-too-common cascade of risks for anyone prescribed a medication.  If the patient never fills a new prescription, we call it “primary non-adherence.”  This happens for 20-30% of new prescriptions written.  Of those who fill a prescription, about 50% don’t take it correctly, or stop prematurely.  Effective solutions need to understand why these failures occur, and prevent them from happening.  Our perspectives on this are informed by decades of research and our direct experience managing 8 million people’s medication adherence for health plans around the country.

Some of the reasons people don’t take medications are because they’ve decided, for what they think are good reasons, not to take the medication. This is actually most of the non-adherence that we observe in our work managing population-level adherence.  People either think that the medication didn’t work for them, that they experienced a side effect or fear a side effect that someone else told them about, or they made a choice not to pay for it because of its cost. Essentially, they considered the risks, the benefit, the convenience and the cost, and made a conscious decision not to take the medication.

Other patients want to be adherent but may be forgetful, have complex regimens they don’t understand, are inadvertently taking a drug incorrectly, can’t get access to the pharmacy or the product, or they want to take it but can’t afford it. That’s a different set of barriers.

Our approach is generally to predict who is at risk of these failures, determine the likely barriers, and then deliver an appropriate intervention that can overcome the barriers.

For patients who may choose not to adhere to their therapy, the answer is education and close follow-up, to make sure that they understand why they’re taking the medicine, how to take the medicine, what to expect from the medicine, so that they know it’s working or know it’s not working.  Close monitoring of lab values or clinical signs and symptoms can show them whether the medication is having the intended effect for them, and help them put that benefit in perspective relative to any side effects they may be feeling.  The goal here is to prevent non-adherence.

We published some work several years ago showing that in patients starting a cholesterol medicine, if you get them back into the doctor’s office within the first three months for a cholesterol test – their likelihood of being adherent over the subsequent year is far higher than if they don’t return for another lab test in that time period.  This notion of demonstrating the benefit of treatment early in therapy is really important because it balances against what they might perceive to be as the expense or the inconvenience or the side effects.  And it prevents non-adherence.

For the patient who is already receptive to therapy and wants to be adherent, we use interventions that address different barriers. This is where things like reminders, pillboxes, special unit-dose packaging, financial assistance programs, and home delivery can be helpful.  We’re trying to make it possible for the patient to be adherent to the regimen.

CH: I think when it comes to the refill issue and even first-fill challenges; the thing we really looked at is cost.

Our data indicates about a third of abandonment issues are usually due to cost concerns for an individual patient. A lot of that has come down to transparency. Any technology that can help bring that transparency, not only to the patient but also to the provider at the point of care, is going to be critical in creating a successful engagement and encouraging the patient to fill that medication and continue to take it.

Sadly, in many cases, there are alternatives that are less expensive that would still be clinically effective for the patient. But the provider and the patient are just unaware of what’s covered, what it would cost, and any programs that may enable the patient to get that medication at a lower cost. And so, I think that addresses that third point. In terms of the first point, what we look at is the friction from the point of prescribing to the pharmacy, to that fulfillment.

Today, there’s a huge amount of friction that really needs to be removed from the process, leading to abandonment and poor adherence. Many times, there’s a prior authorization on a drug and there is another drug that doesn’t have a prior authorization, so the patient gets to the pharmacy, can’t get it filled, and has to go through the prior authorization process, which can take days or weeks to complete.

We think that situation leads to poor adherence and has to be solved. Technology that can not only support that process and speed it up for the patient but ultimately solve it at the point of care, dealing with the PA immediately and not burdening the provider and the patient afterwards will be critical to the success of increasing that patient’s adherence. I also think about site of fulfillment, which can make a huge difference if that pharmacy a patient’s using is in network or out-of-network. Where is it on their plan?

Many times, the patient’s unaware or their provider is unaware of that. And so, technologies that can bring that information forward and help guide that patient to the right site of fulfillment are critical. It can be an actual physical pharmacy or even mail order. Anything from a technology standpoint that can address those issues is really going to have a massive impact on adherence.

To learn more about medication adherence, check out part 2 and part 3 of this medication adherence interview.

About David Van Sickle

David Van Sickle is co-founder and CEO of Propeller Health – the leader in respiratory digital health. David received his PhD in medical anthropology. His dissertation research, funded by the National Science Foundation, examined the rising prevalence of asthma and allergy in India. He was then an Epidemic Intelligence Service officer at the Centers for Disease Control and Prevention in Atlanta, where he was assigned to the Air Pollution and Respiratory Health Branch. During this time, he provided epidemiological support to the National Asthma Control Program, and investigated the health effects of a variety of environmental exposures. In addition, he helped establish emergency illness and injury surveillance in coastal Mississippi after Hurricane Katrina. David was also named a Champion of Change by the White House for his work on innovation.

About Josh Benner

A leading voice on medication adherence, Dr. Benner’s award-winning research and numerous publications have shed new light on the problem of nonadherence and identified promising approaches to improving it.  He is the founder and CEO of RxAnte, the leading provider of predictive analytics and targeted clinical programs for improving medication use.

Before joining RxAnte, Dr. Benner was Fellow and Managing Director at the Brookings Institution’s Center for Health Care Reform, where he focused on medical technology policy.

Prior to Brookings, Dr. Benner was principal at ValueMedics Research, an analytic and consulting services firm. Following the acquisition of ValueMedics by IMS Health in 2007, he served as senior principal in health economics and outcomes research and global lead for medication adherence at IMS. Dr. Benner received his Doctor of Pharmacy degree from Drake University and his Doctor of Science in health policy and management from the Harvard University School of Public Health.

About Carm Huntress

Carm Huntress is an entrepreneur and strategic leader with over 20 years of experience in startups focused around consumer and enterprise technology. His first web development and hosting company he started while in high school was eventually acquired in 2001.  After finishing his degree in electrical engineering at Northeastern University in 2004, he went on to work for PlumVoice, an IVR and voice technology startup, where he ran their network operations.  He later was asked to run product development at My Perfect Gig, a Northbridge and Commonwealth Venture start-up.

After two years as CTO at Reef Partners, where he ran the technology for a number of portfolio companies, he became CTO at Audiogon.com, the largest high end audio site in the world.  He managed the transition of the core technology platform and team for growth.  In 2013 he moved to Denver where he founded RxREVU.

How Complicated Is It to Simplify Medication Adherence?

Posted on November 17, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Of all the things that irrationally inflate health costs, one of the top concerns is people who just don’t take their prescribed medications. Medication adherence doesn’t sound like a high-tech issue, but a lot of interesting technology is being thrown at the problem.

One pharmacist (obviously harboring an interest in increasing orders) estimated that we’d save 290 billion dollars a year if everybody took the medications prescribed for them. But don’t dismiss their claim as self-serving–the Centers for Disease Control suggests they may be right. It also says that half of all medications are discontinued too early. As the “fee for value” movement starts extending to the performance of medications, concerns that patients actually follow through on prescriptions will increase.

At the recent Connected Health Conference I talked to several companies taking on the difficult adherence problem from different angles. Medisafe aids patients in self-monitoring, Insightfil creates convenient packaging that groups pills the ways patients take them, and Dose doles out medication at prescribed times.

Medisafe is one of a wave of firms that address medication adherence, representing an advance over jotting down daily practices in a paper journal. These services share a good deal in common with other solutions in the marketplace that carry out patient monitoring, care planning, and the patient-centered medical home. In all these areas, services boast of tracking behavior, providing feedback to both patients and clinicians, promoting communication, and similar aspects of the connected health vision.

Medisafe handles patients’ nonadherence in multiple ways, including importing the patient’s medication list, along with vital signs such as blood pressure. Visualizations help both the patient and the doctor see the relationship between taking medication and the relevant vital signs. Patients can manage their doctor office visits or when they have been assigned a change in medication, and monitor the effects of such events on adherence through Medisafe. Finally, doctors will be able to compare data on patients within their practices, grouping them by condition, by medication taken, by demographics, or by behavior traits.

Other medication solutions try to reduce the burden of compliance that falls on the patient–or to look at it in another way, reduce the patient’s discretion. At something of an extreme, Proteus inserts a tiny radio device into each pill and makes the patient wear a patch that can detect the presence of the pill in the body. People have suggested one or two use cases for this intrusive system (for instance, during a drug trial, to guarantee accuracy) but in general, treating patients like criminals doesn’t encourage healthy behavior.

A lot of people, especially the elderly and those with the most severe medical conditions, need so many pills and capsules that it’s hard to remember which ones to take, and when. I’ve seen relatives loading little pillboxes every Sunday morning with the pills for the upcoming week.

Insightfil hopes to take all the manual labor, and consequent chances for error, out of this process. It ships each person a customized blister pack with a week’s worth of medications, offering up to four compartments per day to cover different times. This may seem like a simple problem, but it’s actually a major logistical feat.

First, according to founder and CEO Ted Acworth, his company had to develop a robot that could recognize different pills and accurately load them into the blister packs. Then they had to find a pharmacy with nationwide reach and room in its warehouse for the robot.

Dose solves the problem a different way, through a dispenser into which a patient or caregiver can pour bottles of pills. The dispenser, which has been configured to know the patient’s medication regimen, can automatically separate the pills and release them at the right time.

Once the pills are in the box, control can be removed from the patient. This can be important for doling out opiates or other drugs that can be dangerous or that patients have a tendency to abuse.

Dose’s dispenser is a very smart machine, supporting some of other goals of connected health I mentioned. Clinicians, caregivers, and patients can get alerts about doses taken or missed. The device has bi-directional programming capabilities with a web portal and mobile app, and clinicians can change regimens over the Internet. Biometric devices can be attached to let users map medication adherence to vital signs, or to report a user’s exercise and eating habits. The device’s forward facing camera can be used for scanning the barcode of a pill bottle, as well as for video consultations with a clinician. Along with these features, the device is integrated with an FDA Drug Database and therefore an accurate drug list, along with information about potential drug interactions is readily available.

On many levels, then, advanced technology can help patients with the apparently simple problem of opening a bottle at the right time and popping a pill in their mouths. This article has been a limited look at the problem–I haven’t dealt with over-prescription or side effects, but just the question of how to get patients to take the drugs that are understood to improve their health. We’ll see over time which of these solutions–perhaps all of them at different times–can help of hundreds of millions who regularly take prescription drugs.