What if We Pay Patients to Take Their Medications?

FEBRUARY 02, 2018
Medication adherence, what has been done? Counseling, apps, smart pills, directly observed therapy, smart pill bottles, and more. But what if we just paid patients to take their drugs?
 
Previous studies have investigated what would happen if you made medications free, with mixed results. Conversely, offering people money (or at least the incentive) has been another area I have seen being explored lately. One app I was aware of was Mango Health, which, after demonstrating the use of the app and tracking your adherence rates, would reward you points that transferred into gift cards. My grandmother-in-law used it and liked it, though she stopped after a while when no more rewards were to be had.
 
So, then, let's talk money. is a company who offers a platform whereby patients track their adherence via their smartphone (like most companies).1 Patients take a picture of the medication they are taking to monitor adherence, and this keeps a record. But here is the intervention: Wellth will reward patients for tracking their adherence to monetary benefits (kind of). You see, patients enter the system awarded a set amount of money. Every time they miss a dose, money is removed from the pool. So, the incentive for patients is that by taking their medications, they are guaranteed not to lose money. 
 
I've seen something familiar before in the health and wellness field focused on workout apps. These apps incentivized users by giving money to customers who went to the gym (or conversely, penalized them for missed days). One example that stands out to me is Pact (formerly GymPact), which had users basically 'bet' on their adherence to gym days. Essentially, people submitted funds to a pool, and if you missed a day you lost the money offered. At the end of the term, all those that went to the gym got the money split up by the pool. Sounds cool, except that the FTC got involved when it was found out that Pact wasn't paying users correctly. It has since shut down.2
 
Behavioral economics has always interested me. I do believe that money is an excellent incentivization. I don't mean gift cards or discounts, but cold hard cash (or at least a positive bump on my bank account). That being the case, I am always a little hesitant about the mechanics of people putting in their own money. In Wellth's case, the mechanic seems a bit more promising, and so far, limited research seems to indicate this is the case.
 
Mount Sinai Health System is currently piloting Wellth at their network, and so far the pilot has enrolled 12 patients.3 While that is not a lot, these patients will help figure out the technological limitations. The program at Sinai will offer patients up to $50 for their adherence rates being maximized. Currently, the project intends on giving more details of their small pilot at an upcoming event in Las Vegas, in March. I will be excited to see what they found out and if this is something they may roll out at a larger population.

References
  1. Wellth. . Accessed February 2, 2018.
  2. App That Paid Users to Exercise Owes Nearly $1 Million for Not Paying Users to Exercise. Gizmodo. https://gizmodo.com/app-that-paid-users-to-exercise-owes-nearly-1-million-1818632078. Published September 21, 2017. Accessed February 2, 2018.
  3. At Mount Sinai, monetary incentives drive medication adherence. MobiHealthNews. www.mobihealthnews.com/content/mount-sinai-monetary-incentives-drive-medication-adherence. Published January 23, 2018. Accessed February 2, 2018.


Timothy Aungst, PharmD
Timothy Dy Aungst, PharmD, is an assistant professor of pharmacy practice at MCPHS University. He graduated from Wilkes University Nesbitt School of Pharmacy and completed a PGY-1 Pharmacy Practice Residency at St. Luke's University Hospital, and then a Clinical Geriatric Fellowship at MCPHS University. He is passionate about the rise of technology in health care and its application to pharmacy. He has published primarily on the role of mobile technology and mHealth, and made multiple national and international presentations on those topics. He blogs at TheDigitalApothecary.com, and you can find him on Twitter @TDAungst.
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