The Present Bias Problem with Medication Adherence

Posted on November 29, 2017 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I recently met Matthew Loper, the founder of a startup company called Wellth. The company is using behavioral economics to improve healthcare outcomes. They’re literally paying patients cold hard cash to take their medications. Plus, they have some pretty cool technology that uses just the smart phone to track medication adherence.

I must admit that I’ve seen hundreds of medication compliance companies over the years. While the approach each took was intriguing, all of them seemed to have some major obstacle to adoption. Some were too expensive. Some would never be adopted by patients. Some would never be adopted by healthcare providers, etc.

With this in mind, I was intrigued by a few slides that Matthew Loper from Wellth showed me about the medication adherence market and why the startups in that space have had limited success to date. First, he started off with this slide which illustrated the problem:

I’m not sure I agree totally with the concept of chronic patients not doing what’s rational. Instead, I think this slide illustrates that many chronic patients make short term versus long term decisions when it comes to their care. No doubt these short term decisions are very rational decisions in their minds. However, this data illustrates the Present Bias problem we have with medication adherence.

Matthew’s next slide illustrated really well how most current medication adherence solutions don’t solve the present bias problem:

I thought this slide categorized the medication adherence companies I’ve seen really well. It also explains why most of them aren’t very effective. Then, Matthew went on to suggest that paying patients to adhere to their care plan does overcome the Present Bias challenge:

You can talk with Wellth if you want to get more details on their work and the results of their pilots. It’s still early in their journey, but the concept seems to be producing some quality results. Plus, I love their efforts to use the cash incentive long enough to create a habit which then is sustained well after the payments stop. Pretty fascinating approach.

No doubt there are a lot more complexities associated with medication adherence. For example, this approach doesn’t take into account people who are motivated by money. However, it’s surprising how even rich people want to get a good deal. It will also take some time to see how much money is required to truly motivate someone to be compliant and if that cost is less that the amount of money saved. Not to mention, how do you even quantify how much money was saved when someone is more adherent to their care plan.

These challenges aren’t unique to Wellth, but to every healthcare IT solution working on this problem. It’s also why many of them have a hard time making the case for their solution. Turns out that purchasers of these solutions have a present bias problem as well. However, as more studies are done and as we get better at tracking a patient’s health, we’ll better be able to understand the long term benefits of things like medication adherence.

What do you think of Wellth’s approach to medication adherence? Should we be paying patients when they adhere to their care plan?