Learning How to Nudge

In a recent article in the Wall Street Journal, a Ms. Ruthanne Lowe from San Jose, CA reported that three years after her participation in a Stanford University study on behavioral change, she is still exercising. The study showed that even just a gentle nudge can have a positive effect on motivation.

The issue of how to support patients with chronic illnesses is back on the healthcare front page. Studies show that even if a patient sees a doctor, gets diagnosed, and receives a care plan, whether a drug or a regimen like diet and exercise, up to 50% of those patients will elect not to follow through. The prescription won’t be filled or the healthy life choices won’t be followed. So even if 32 million new consumers in our new health care world get access to a physician, half of them likely won’t take their meds as prescribed.

That’s a big problem.

Behaviorists have theories about root causes of non-adherence (cost, side effects, doubts about efficacy, confusion, fear, lack of obvious symptoms, and more), but most health care providers just want solutions. Physicians see their patients for 15 minutes, and they need a way to extend their reach and engage the patient beyond the office visit.

For high-risk patients, health insurance companies do the math and decide that it’s cheaper to hire nurses, put them in call centers, and have them make regular reminder telephone calls to patients. It’s expensive and inefficient (it often takes multiple calls to catch the patient at home) and effective. But with 133 million people in the U.S. with at least one chronic disease who need to be on some type of medication for the rest of their lives, there needs to be a more efficient way.

Jonathan Katz, a serial technology entrepreneur, has been involved in health care start-ups since the early 1990s. In 2006, while in between companies, he was consulting in health care and he realized that little was being done to leverage technology in patient adherence.

“I asked the question, why can’t we use technology in adherence? Everybody said, ‘great idea, but it won’t work in health care.’”

But as health care costs continued to skyrocket, attention began to focus away from just treating problems to thinking about preventing problems. So Katz founded MedAdherence.

“Our goal is to get the patient engaged in their own treatment.”

MedAdherence combines information and communication technologies with behavioral change principles to reduce medical complications and costs and improve outcomes.

By offering a multidimensional set of communication options, including the Internet, email, telephone, text messaging, mobile apps, and even personal face-to-face contact, MedAdherence makes connections using patients’ preferred modes of communication. And by including the physician in the intervention and customizing the patient messaging based on the particular condition, medication and/or device being prescribed, MedAdherence is able to extend healthcare management beyond the doctor’s office or the hospital.

Katz is quick to point out that “An important part of what we do is engage the physician as well. Remember, this is a trusted partner, so we want them part of the process, too.”

In fact, MedAdherence works in the background, and the entire experience is branded as coming from the physician. The doctor customizes the care regimen for each patient. By increasing the level of interaction between the physician and the patient, MedAdherence is actually enhancing their relationship. And because MedAdherence is doing all the administrative work, they reduce the admin load on the physician’s office.

The goal of enhancing quality of life, improving clinical outcomes, and saving costs is obvious. Studies show that health insurance saves $1200 a year if a diabetes patient is able to control his or her disease. Katz is working on several clinical studies at the moment, and he is confident that once he can empirically demonstrate cost savings, many large employers, insurers, and even large medical centers will pay a company like MedAdherence to help physicians manage their patients, help keep them well, and keep them out of the hospital.

Sometimes behavioral change requires the counsel of a therapist, but sometimes it just requires a friendly nudge until new habits are formed.

Jonathan Katz is in the business of automating the nudge…