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Keep It Simple, Stupid!

Posted on February 28, 2014 I Written By

Kyle is CoFounder and CEO of Pristine, a VC backed company based in Austin, TX that builds software for Google Glass for healthcare, life sciences, and industrial environments. Pristine has over 30 healthcare customers. Kyle blogs regularly about business, entrepreneurship, technology, and healthcare at kylesamani.com.

There are an enormous number of startups trying to solve the medication adherence problem. Broadly speaking, these startups are trying to solve the problem through three avenues:

1) Hardware, i.e. smart pill bottles

2) Semi-intelligent software driven reminders

3) Patient education

The most effective solutions are likely to incorporate all three.

The hardware space has been the most interesting simply because of the variety of solutions cropping up. AdhereTech and CleverCap have developed unique pill bottles that control and monitor dispensing via proprietary smart pill bottles. They also incorporate software for notifications. Unfortunately, all smart pill bottle makers are bounded by FDA regulations because they physically control medications through a combination of hardware and software. FDA regulations will slow time rollout of these solutions to market and create enormous new expense.

I recently learned about PillPack, a startup that just raised $4M. They compete asymmetrically in the medication adherence by not making any hardware at all!

The problem with the pill bottle is that there are dozens of pills in a single container. Measuring and controlling output and consumption is intrinsically a difficult problem. PillPack solves these problems by simply averting the issue entirely. PillPack pre-packs pills by dose. This is particularly valuable because they pre-pack multiple kinds of medications that need to be taken at the same time.

PillPack doesn’t yet have any intelligent software that monitors when medications are taken. But with granular packaging, sensing and controlling the medications becomes dramatically easier than ever before. I suspect this will the marquee feature of PillPack 2.0. Once they add the ability to detect when a pack is opened, they can begin adding intelligent software alerts and reminders to patients and their families.

PillPack has a far more lucrative distribution strategy than companies who have to produce and distribute hardware. PillPack can scale their customer base incredibly quickly through B2C marketing. B2C marketing isn’t easy; Pillpack faces a significant challenge in terms of patient and provider education, but it’s one that’s definitely addressable. If PillPack’s service is as good as I think it is, they should develop incredibly happy customers, which will lead to recurring revenues and strong referrals.

The moment I saw Pillpack, I immediately recognized it as one of those “duh” business. We’re going to look back in 10 years and wonder why this wasn’t always around. Their solution solves so many of the pain points around taking medications on time and is coupled with a lucrative business model that feeds off of recurring revenues from long term customers.

The genius of their business is that they are tackling the medication adherence problem from a unique angle: packaging and distribution. They’ve bundled that solution into a simple and elegant package (pun intended) that helps patients avoid the pain of the modern US healthcare system: going to the pharmacy, fighting with the pharmacist, and manually tracking when to take how much of each medication.

Full disclosure: I have no relationship(s) with PillPack.

The Good News About Patient Portals …

Posted on January 14, 2014 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

I recently wrote that it’s not clear whether patient portals do much to improve health care.

Now a new study suggests they help in at least one area: medication adherence.

The research involved diabetic patients who were using cholesterol-lowering statin drugs and had registered for online portal access. Among those who started using the system’s online refill function as their only method of getting the medication, “nonadherence” dropped 6 percent.

LDL or “bad” cholesterol also decreased.

The researchers concluded that “wider adoption of online refills may improve adherence.” No decline in nonadherence was seen in patients who didn’t use the online refill function.

The Kaiser Permanente study was published in the journal Medical Care.

The study included plenty of subjects — 8,705 people who used online refills and 9,055 who didn’t. But if there’s a cause-effect relationship at work in this study, you have to wonder in which direction it might run. Might the people who tend to take their medicine as prescribed be more likely to sign up for online refills in the first place?

Still, the study is an intriguing hint that patient portals might be worth at least some of the attention they’re getting. Nonadherence to medication regimens is a huge issue for health care because of both the human toll it takes and the inefficiency it fosters in the system.

Typical nonadherence rates are in the 30-60 percent range, depending on the condition, the medication and other factors, according to Medscape. It’s especially easy to slack off when symptoms disappear.

The study builds on another piece of good news for health IT. Researchers recently found that EMRs can make diabetes care better by rendering care coordination more efficient, as Katherine Rourke wrote here at EMR and HIPAA.

Portals are, of course, experiencing tremendous popularity because they help health care providers to meet Meaningful Use Stage 2 patient-engagement requirements. But, as I wrote earlier, in a review of 46 studies related to portals, researchers didn’t find evidence for much in the way of patient benefits.

Physicians have a major job ahead of them if they’re to make full use of patient portals and receive the available federal incentives. Perhaps this study, modest as its results are, suggests that their efforts will have some benefit for the patients they serve.