Show Me the Money, or Maybe Not

By Nir Tobis, VP Business Development, Vaica
Olivia R. Van Wyck, contributor

MobiHealthNews recently posted an article describing an innovative way to improve patient medication adherence. The article titled “At Mount Sinai, monetary incentives drive medication adherence” detailed Mount Sinai Health System’s idea to use both technology and monetary incentives to solve the problem of medication adherence. Using Wellth’s technology, patients took a picture of their pill and they were rewarded money up to $50 for 1 month of adherence. If they missed a dose, money was subtracted from their account.

This appeared to be an easy solution. Did financial incentive provide a reasonable way to solve the billion dollar medication adherence problem?
Good question.

An article written on new research in neuroscience and self-determination theory mentions that extrinsic motivators, such as financial incentives, can undermine a patient’s intrinsic motivation, or their internal desire to perform a particular task. The article also argues that studies have shown that people actually lose intrinsic motivation to do particular tasks after they have been rewarded extrinsically for that same task.

When it comes to medication adherence, though, forget about ‘losing intrinsic motivation’, there is a question if financial incentive influences anything at all. An example: the results of a study published by JAMA Internal Medicine showed that financial rewards combined with wireless pill bottles and social support didn’t help to increase medication adherence in patients who had just suffered a heart attack.

So, what would work? I would argue that a combination of the ‘right’ digital technology support combined with Medication Therapy Management would produce the desired result. Technology exists today that can help remind the patient to take their medications and flag their pharmacist, doctor and family if they are having problems adhering. So the right kind of support not only exists but is also available in the market and can be easily accessed. That said, patients ALSO need to understand that their lives are at stake, how following instructions on how and when to take their medicine will save their lives, improve their quality of living as well as help them to avoid returns to the hospital and avert crisis situations, this is where literacy comes in. This combination has been and continues to be tested in hospitals worldwide and is achieving a 92-98 percent success rate.

I will revisit this theme with an update on the progress of these trials in future blogs. In the meantime, I’d like to know what you think. I’d like to hear about your stories about medication adherence. What works? What doesn’t? Think about it and thank you in advance for sharing in the comment box below.