Effective Adherence: A complex problem addressed with comprehensive behavioral programsBoston | London | Los Angeles | Philadelphia 1
Standard of Care and Therapy Adherence • For every disease, the Standard of Care includes multiple behavioral and self-care elements. • People struggle to adhere to their total therapies – medicines as well as behavior modification and lifestyle changes – negatively impacting outcomes and health economics. • The Human Care Systems solution is a customizable software platform to help biopharmaceutical companies engage with and support patients and family to learn the habits of total therapy adherence. Increase medicine adherence Add value and connect with patients and family Comply with regulatory requirements Differentiate to prescribers and remove prescribing barriers Improve health economics 2
Personalized Adherence Causes of non-adherence Comprehensive solution for complex problem Personalized adherence program: “Mary” Efficacy data 3
Question:Why don’t people adhere to their medicineregimens and other therapies?Answer:Each person has his or her own set of complexand interrelated reasons. 4
Patients Report Range of Non-Adherence Causes Reasons why patients don’t fill prescriptions or comply with drug regimens (patient views) (Percentage of patient respondents citing each reason) Other Don’t know how to use the drug Can’t get prescription filled, picked up, or delivered Don’t think I need the drug The drug costs too much Don’t want the side effects Sometimes forget to use or refill Sources: BCG analysis; Harris Interactive 10,000 Patients Survey, 2002.
Physicians Report Range of Non-Adherence Causes Reasons why patients don’t fill prescriptions or comply with drug regimens (physician views) (Percentage of physician respondents citing each reason) Other Patient is suspicious of pharmaceutical companies Doesn’t understand how to use/administer drug Lack of productive family involvement Can’t get prescription filled, picked up or delivered Doesn’t think drug works Underlying emotional issues Doesn’t think he/she needs drug Lack of motivation and self-confidence Forgetfulness Side effects Cost/co-pay Source: Human Care Systems Physician Survey, 315 physicians, 2010. .
Each Adherence Barrier has Behavioral Drivers Adherence Barrier Behavioral Drivers Doesn’t understand how to use/administer drug Information processing style, misconceptions, emotionality, self-efficacy Lack of productive family involvement Avoidance, relationship skills / strain, stimulus control, living environment Can’t get prescription filled, picked up or delivered Social capital, problem-solving, communication, self-efficacy Doesn’t think drug works Defense mechanisms, interpersonal skills, learning style, social capital Underlying emotional issues Cognitive skills, mind / body relationship, life environment Doesn’t think he/she needs drug Defense mechanisms, cognitive-emotional skills, life environment Lack of motivation and self-confidence Self-efficacy, social capital, mind / body relationship, cognitive skills Forgetfulness Emotionality, defense mechanisms, cognitive dysfunction Side effects Cognitive skills, mind / body relationship, self-efficacy, stimulus control Cost/co-pay Cognitive skills (coping), emotionality (anger), problem-solving (prioritizing)
Personalized Adherence Causes of non-adherence Comprehensive solution for complex problem Personalized adherence program: “Mary” Efficacy data 8
Effective Adherence is Holistic and Patient-centered “The odds that an adherence strategy will be successful are related to how well the strategy can first identify the varying needs of individual patients, and then match services accordingly. An ideal adherence strategy should be patient-centered and holistic taking into account everything from lifestyle to cultural and belief systems.” Source: New England Health Care Institute, Client Conference, May 20, 2008
A Comprehensive Behavioral SystemWe use behavioral Behavior Pedagogicalscience, translated to Modification Scienceuser-friendly software,to help patients changeproblematic patterns and Cognitivelearn new, healthythoughts, feelings, Classical Integrativebehaviors, and Conditioning Learningrelationships. Emotional Operant Experiential Conditioning Learning Behavioral Social Timed Conditioning Learning Environmental Dimensions of Change 12
Thoughts and Feelings are Biochemistry Mind-body exercises change thought pathways • Mind-body therapies have broad, dramatic impact on perception, information processing, decision making, and neutral meditative state state lifestyle change • Powerful interventions integrate all dimensions of change – cognitive, emotional, behavioral, environmental elements • HCS solutions use standard, scientifically proven mind-body protocols Proc. Natl. Acad. Sci. USA 2004 101 (46) 16369 - 16373
Human Care Systems Who We Are Experts in software, healthcare, psychology, user engagement, and technology. Clients are biopharmaceutical, medical device and diagnostics companies; as well as health systems, employers and payers. Headquartered: 1 Faneuil Hall, Boston, MA. Other locations: Philadelphia, Los Angeles and London. Formed as spin-out from the Kerdan Group (biopharma consultancy) in 2008. 14
Personalized Adherence Causes of non-adherence Comprehensive solution for complex problem Personalized adherence program: “Mary” Efficacy data 15
Therapy for Complete Adherence: “Mary” Adherence Assessment Adherence Profile Adherence Guided Program I’m skeptical, overwhelmed, My disease is physical. I must address myths and agitated. I’d rather not My experience of my that cause my negative think about this! I’m tired of disease is holistic. feelings. When I am being nagged. What the heck My adherence involves all emotionally invested, I is a mind-body relationship? of me. can move forward. Thoughts 1. Education exercise Perceptions of self and “Myths and misconceptions” condition 2. Cognitive-behavior exercise Feelings “Shame”, “Fear” Reactions of anger, fear, shame, guilt, anxiety 3. Mind-body exercise Behaviors “Self-awareness” Compliance with providers and 4. Problem-solving exercises treatment plan; self-care habits “Cost”, “Inconvenience” Environment 5. Goal-Setting and tracking Relationship and tactical obstacles to compliance “Goals and emotions” 16
Mary Engages Through Multiple, IntegratedChannels Web & Email Live Phone Mobile & SMS Automated Phone (IVR) Mail 17
Mary Picks a Virtual GuideSocial conditioning involves interactions with others, including modeling, coaching, social learning, contracting, andinterpersonal support. Virtual Guides Guides are selected based on decades of robust socio-cultural research including micro-expression analysis. Guides can answer questions using a heuristics engine and database. 18
Mary Follows an Integrated, Step-by-Step Program 19
Mary Completes Simple Assessments toPersonalize her Experience 20
Mary Engages in Tailored, Effective Learning Multi-media options Challenging, calibrated to an 85% Regulated by configured to learning style correct response rate cognitive dissonance as a window for insight Hierarchically chunked education (3-5 items at a time) for optimal working memory and information processing Continuous reinforcement SEE MY LEARNING STYLE schedule drives PROFILE engagement Learner-centered, driven Flash animation is interactive Interactive, immediate feedback by user choice and profile for optimal learning 21
Mary Works on her Thoughts and Feelings,in a Judgment free and Private place 22
Mary does Personalized Exercises Patients require multi-dimensional assistance for internal and external environments including prohibitive thoughts and feelings like shame, anger, fear, guilt, anxiety. Adherence to biochemical therapies Smart software predicts and involve mind / body learning. times Mary’s questions.The systemknows Mary Mary’s profile tellsstruggles with the software thatshame. her fear immobilizes her, keeping her from compliance. Just like in a therapist’s office, Mary quantifies her According to her feelings. profile, Mary will become activated by These are converting fear to included in anger. her treatment algorithm. Guides are selected based on decades Information combined with the right of robust socio-cultural research emotional engagement leads to insight. including micro-expression analysis. 23
Mary Involves her Husband Social interventions involve interactions with others, including modeling, coaching, social learning, contracting, and interpersonal support.Problem: Mary’s Solution: Mary’s spouse Problem: According to herspouse has strong learns new relationship profile, Mary’s anger isopinions, preventing skills like empathy, getting in the way of goinghim from listening. support, and to the pharmacy.Mary ignores him and communication.her self care too! Solution: The system gives Mary an actionProblem: When her Solution: The system plan personalized to herspouse comes home leads the spouse psychological profile.from work angry, through self-awarenessMary’s adherence is and de-stress exercises.threatened.Problem: Mary Solution: Smart softwareresents her spouse guides family membersnagging, because he into behavior contracts withdoesn’t follow each other that aredoctors’ orders either. mutually reinforcing. 24
Why does Mary Engage with her Program? For the first time in my life, I „”I really like that it‟s feel like I have the right plan just for me. It learns and support for me. Like I‟m about me and grows as in control.” I grow.” “My husband used to always hassle me about my weight. Now, he used the coach training program a bit and he‟s“it‟s reassuring and it gave me actually somewhat helpful with mealgood steps.” planning and our daily walks. He can be objective now.” “It helps bring out feelings that I wasn‟t aware of before. It was good in helping me handle my feelings in some kind of perspective.” 25
Personalized Adherence Causes of non-adherence Comprehensive solution for complex problem Personalized adherence program: “Mary” Efficacy data 26
Efficacy Evidence: Medicine adherenceIn a trial of medicineadherence (refills) among50 diabetic patients (42completed), HCSsignificantly improvedadherence. Trial conducted March 1, 2009 to August 31, 2010 in United States 27
Efficacy Evidence: Cardiometabolic Markers12 month study of 100 diabetics measuring four cardiometabolic markers: LDL, BP, BMI, A1c. Started Trial Completed Trial 50 patients 46 patients Final (12 months) SBP decrease of 11mm Hg vs. control* 5% average BMI reduction* .3 A1c reduction* 50 patients 41 patients (*) denotes statistical significance (95% Cl) Trial conducted April 1, 2009 to March 31, 2010 in United States 28
Human Care Systems Value to Biopharma Clients € Differentiate to Engage and Support Comply with Regulatory Impact Health Track and Learn Prescribers Patient & Family Requirements EconomicsPrescribers and other Particularly in complex, REMS and other The largest lever to Multidimensionalclinicians want help multi-faceted diseases, regulatory requirements impact health economics reporting, includingencouraging therapy patients and family may increasingly require in any disease is therapy usage and efficacy data,adherence. be overwhelmed. biopharmaceutical adherence: taking informs sales, marketing, companies to support medicines, working regulatory, development,Patient non-adherence Establishing a direct patients in managing productively with and health economicsis a source of connection to patients therapy, including physicians, managing outcomes.frustration to clinicians. and family is critical in a adherence. behavioral and world of increasing emotional issues.Remove prescribing patient self-pay due tobarriers. higher co-pays. . 29
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