The Role of Startups in Revolutionizing Medication Adherence for Value-Based Care
Introduction
Medication adherence—the extent to which patients take their medications as prescribed—is a critical component of effective healthcare management, and it is one of the most persistent and costly challenges in healthcare. Nonadherence can lead to disease progression, increased hospitalizations, and higher healthcare costs. The American Heart Association states poor medication adherence results in approximately 125,000 deaths annually in the United States. According to the World Health Organization, only 50% of people in the U.S. take their medications as prescribed, resulting in over $500 billion in annual healthcare costs. Nonadherence doesn’t just impact the individual patient—it ripples through the entire healthcare ecosystem, affecting health systems, providers, health plans, and public health departments. As the industry shifts toward value-based care models, medication adherence has emerged as a crucial metric, with the potential to improve patient outcomes while significantly reducing healthcare costs. This makes addressing adherence not only essential but also a highly effective pathway to deliver high-quality care at lower costs.
The Limitations of Conventional Adherence Programs
The most common approaches to improving adherence are “check-the-box” programs aimed at boosting compliance and performance metrics like HEDIS (Healthcare Effectiveness Data and Information Set) measures. They aim to impact the proportion of days covered (PDC) to above 80%. However, these low-frequency touchpoints often fail to create sustainable changes in patient behavior or produce long-term health benefits – focusing instead on short-term gains.
Many conventional adherence programs typically rely on periodic reminders via phone calls, texts, or automated messages and often miss the nuances and complexities of patient behavior. While these interventions can lead to temporary improvements in medication pick-up rates, they rarely translate into meaningful, long-term behavior change. Consequently, these programs may improve surface-level adherence scores, but fail to achieve significant reductions in hospitalizations, emergency room visits, or chronic disease progression.
Conventional adherence programs may increase medication pick-up rates, but they seldom achieve sustained adherence or reduce healthcare utilization. This leads to missed opportunities for preventing hospitalizations, emergency room visits, and disease progression, which would have more meaningful impacts on both patient outcomes and healthcare costs.
Addressing the Root Causes of Non-Adherence
To overcome these challenges, new models of medication adherence support are focusing on personalized, high-touch approaches. Emerging solutions aim to address adherence at its root by recognizing the complex interplay of social, behavioral, and clinical factors involved.
Some promising strategies include:
Frequent Digital Engagement: Platforms that offer daily or weekly check-ins through digital tools can provide patients with a higher level of support, making it easier for them to stay on track and receive timely assistance if they encounter issues with their medications.
Holistic Support: Comprehensive models combine digital engagement with clinical support, leveraging pharmacists, nurses, and health coaches to address issues like side effects, regimen complexity, and even social factors impacting adherence. This creates a feedback loop that allows healthcare providers to identify and resolve barriers before they impact the patient’s health.
Patient-Centered Behavioral Techniques: Techniques such as motivational interviewing and personalized goal-setting are being incorporated to help patients build intrinsic motivation and better understand the importance of adherence. Pharmacist-led medication reviews can also help simplify complex regimens, manage potential interactions, and educate patients, thus supporting lasting behavior change.
These newer approaches aim not only to improve adherence metrics but also to empower patients, foster health literacy, and support self-management skills. They recognize that sustained adherence is linked not only to reminders and incentives but also to helping patients build confidence and knowledge.
Scene Health’s Approach: A Comprehensive, High-Touch Model
Scene Health, a partner company of Quintuple Aim, takes a radically different approach to solving for the root causes of medication non-adherence, focusing on long-term behavioral change and patient empowerment through a structured, high-frequency engagement model. Their solution is based on Directly Observed Therapy (DOT), a proven methodology that has been successfully used in public health settings for conditions like tuberculosis and hepatitis C. Scene Health has adapted DOT to a virtual care setting, combining it with behavioral science techniques to address both visible and underlying, sometimes indiscernible, barriers to adherence. They offer a comprehensive adherence solution that leverages asynchronous video messaging, personalized engagement, behavioral economics, and technology to drive lasting improvements in chronic condition management, patient health, and a reduction in unnecessary healthcare utilization.
The value add of Scene Health lies in its high-touch, personalized approach to medication adherence. Through daily video check-ins, it enables early intervention, helping clinicians address adherence issues before they escalate. The platform also tackles root causes of non-adherence, such as social barriers and regimen complexity, tailoring support to each patient. Scene Health’s sustained engagement model promotes lasting behavior change and has shown measurable clinical improvements in conditions like diabetes and hypertension. By preventing disease exacerbations, it also reduces costly hospitalizations, making it a cost-effective solution for healthcare systems.
Value-Based Care and Medication Adherence
As value-based care becomes more prevalent, medication adherence has become a key component of population health and chronic disease management. High adherence rates are associated with improved clinical outcomes, particularly in conditions like diabetes, hypertension, and heart disease, where consistent medication intake is crucial to controlling symptoms and preventing complications.
For health plans and risk-bearing entities, adherence affects quality scores and impacts performance metrics that are directly tied to reimbursement. By partnering with adherence-focused startups that can deliver measurable improvements, these entities can improve outcomes, reduce emergency visits and hospitalizations, and ultimately lower total healthcare costs. Value-based contracting models, where startups share downside risk in exchange for a portion of the value they create, offer a promising path for scaling adherence programs across broader patient populations.
Conclusion
Improving medication adherence is crucial to achieving the goals of value-based care, and the growing field of adherence-focused startups brings innovative solutions to a complex problem. While conventional programs often prioritize short-term metrics, high-touch, patient-centered solutions are demonstrating the potential for lasting behavior change and better clinical outcomes. By embracing comprehensive approaches that address both the clinical and social barriers to adherence, these solutions offer meaningful benefits to patients, providers, and the healthcare system alike. As value-based models continue to expand, adherence programs with a strong foundation in behavioral science and patient engagement will play an increasingly important role in transforming care delivery and reducing the burden on the healthcare system.
Contact Quintuple Aim to learn more about value-based contracting and Scene Health for more information on how their solutions can support your patients.
Written By: Reza Alavi, MD, MHS, MBA and Shreya Jain, MBS at Quintuple Aim in partnership with Scene Health.
