InnovationRx: Getting Patients to Take Their Own Medicine, Literally

6/24/08Follow @wroush

It’s one of the paradoxes of modern medicine in the United States. At the doctor’s office and the drugstore, we say we want prescription drugs. In fact, we spend more than $200 billion on them every year. Between 1994 and 2005, a period in which the U.S. population increased by only 9 percent, the number of prescriptions patients had filled increased by a whopping 70 percent.

But when we get home, a strange intransigence sets in: large numbers of people never use the prescriptions they’ve been given, or don’t take them as directed. In a Harris Interactive poll last year, 35 percent of people said that fear of adverse reactions had kept them from taking prescriptions they’d already filled. The National Community of Pharmacists says that 24 percent of people fail to take the recommended dosage of their prescribed medicines, and that 29 percent stop taking them before they run out.

The healthcare industry’s term for this is “nonadherence,” and it’s a serious problem. The hit to the U.S. economy from health conditions that worsen when people don’t take their prescriptions correctly has been estimated at $200 billion to $300 billion a year.

Into this gap steps InnovationRx, a Newton, MA startup that thinks it can help improve medication adherence using electronic communications channels like e-mail, text messages, and live and automated phone calls. That idea, by itself, isn’t new; in fact, at least two other New England companies, Needham, MA-based Dovetail Health and New Haven, CT-based Intelecare, already offer similar outreach services. But InnovationRx isn’t just a reminder service. “What we are really setting out to do is identify the reasons for people not taking their medications”—and then craft a plan to convince them otherwise, company president Sean Teare told me last week.

“From a quick, 20-question online assessment we’re able to, first, determine who is likely to be nonadherent, and second, identify the reasons,” says Teare. “Is it cost? Fear of the side effects? Not understanding what the medication is supposed to do? Then we tailor an intervention based on that, and deliver it through the Web, or through a call center staffed by people trained in motivational interventions.”

InnovationRx LogoTeare gave me the story behind InnovationRx in anticipation of the company’s official launch later this summer. As I noted in my roundup of Boston-area “Health 2.0″ companies yesterday, there’s likely to be a string of debuts this year by local startups that, like newcomer American Well, use Web technology either to reach patients or to process patient records, or both. I already knew, because I’d been told on embargo, that InnovationRx was one of them.

Teare, a former executive at TAP Pharmaceutical Products in Illinois, says the company devised its assessment system in collaboration with Nate Rickles, a professor in the School of Pharmacy at Northeastern University’s Bouvé College of Health Sciences. Rickle’s PhD research focused on depression, where nonadherence is a major hazard—many people being treated with antidepressants stop taking the medications as soon as they begin to work. Rickles found that simply giving patients a chance to talk with pharmacists about the importance of staying on their medications could dramatically raise adherence rates.

Turning that insight into a commercial system was a challenge that attracted InnovationRx’s corporate parent, Innovation Group, a London-based conglomerate that handles claims processing and other tasks outsourced by large insurance companies. “I was hired in order to come up with a healthcare initiative that would leverage Innovation Group’s two core assets—our call centers and our claims processing software,” says Teare. “From my experience in the pharmaceutical industry, I knew that nonadherence was a big problem, but I didn’t realize how huge of a problem it is until I met Dr. Rickles at a conference last fall.” Rickles and Northeastern were looking for a company that could implement pharmacy outreach on a massive scale. “We can process highly complex, confidential transactions very quickly,” says Teare. “So we had the idea of taking those assets and applying them to direct healthcare.”

The core of InnovationRx is a website where people on prescription medications can set up secure, private accounts that help them track and understand their prescriptions. Once users have entered their prescription data, the site can provide them with automated phone, e-mail, or text-message reminders to take their medicines or get their prescriptions refilled. It also includes an online health diary, tools for investigating drug-to-drug and drug-to-food interactions, and a drug photo archive (to help identify spilled pills). Live pharmacists are available by phone for personal consultations. “We deal with every demographic, from the teenager taking meds for ADD to the elderly parent who has never really interacted with the Internet,” says Teare. “That’s why we span the spectrum, from the website to text messaging to e-mail to the call center staff.”

Of course, it’s an open question whether people who are nonadherent to begin with can be trained to heed admonitions delivered in e-mails or text messages. But for patients who do join (or perhaps are talked into joining by concerned family members), there will be at least a couple of different ways to pay. Patients can pay out-of-pocket—Teare says fees will start out at $7.99 per month, or $96 per year. The company is also talking with health plans about making access to InnovationRx one of the benefits consumers receive through their existing health plans.

And for some patients taking expensive medicines, pharmaceutical companies might be interested in sponsoring the program. “Obviously, if patients are taking their prescriptions that means more revenue” for the drug companies, says Teare. “But it’s also about better care and preventing other problems from developing. If you are a good pharmaceutical company, your job is to develop treatments that people can comply with and that don’t have a lot of side effects, and to try to keep people out of the hospital.”

Through a research grant to Rickles’s lab, says Teare, InnovationRx ultimately hopes to help scientists figure out why consumers behave so inconsistently when it comes to their prescription medications. “Obviously this is a business,” he says. “But hopefully we are advancing the science on adherence as well. Because if you miss your heartburn medication you can probably take a Tums and it will be okay—but as conditions get more chronic and serious, nonadherence raises the cost of healthcare for everyone.”

Wade Roush is a contributing editor at Xconomy. Follow @wroush

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