As a physician trying in earnest to prevent downstream complications of chronic conditions, I often resorted to scare tactics.
“Stick with your cholesterol medication or you’re at greater risk of heart attack.”
“Make sure to take your hypertension pills or you could end up with bleeding in the brain years down the line.”
My counsel felt right at the time, and may have done some good, but I’m now convinced that a lighter approach may have greater merit.
Medication nonadherence is one of the most serious challenges in healthcare – half of all patients with chronic diseases don’t take their medications as prescribed and nonadherence is directly associated with 125,000 deaths each year. We need to bring a multi-faceted approach to this multi-faceted problem.
Professional reminders of gloom and doom are too easy to deny when someone has an attitude of “that won’t happen to me.” For some, these warnings may even be too scary to process, or too distant in the future to resonate. Denial is easier. Plus, how often does a patient see a doctor? Perhaps too infrequently for a critical message to really take root.
What sort of alternatives can work more effectively to encourage medication adherence? Simple interventions such as reminders, co-pay cards, and lower out-of-pocket costs can play a helpful role. But these obvious tactics make a surprisingly small dent.
I believe that, in keeping with a “treat patients like people” mantra, people are more likely to engage in activities they find pleasant, or even fun. Healthcare for the most part is unpleasant, but the relatively simple act of taking a daily pill doesn’t need to be.
What if you could earn points every time you took your medication, obtained a refill, or learned something new about your condition or treatment? And what if you could exchange those points for something you actually wanted, like a gift card, a fun event, or the chance to make a donation to a cause you care about?
That is the rewarding experience that HealthPrize offers, and our approach has worked so far for dozens of pharmaceutical brands across numerous conditions. We recognize that medication nonadherence is a problem more of human psychology than of simple cost or forgetfulness. So we use human psychology to great advantage and aim to make interactions enjoyable, with a combination of immediate rewards (which chronic medications tend to lack) and gamification tactics—leaderboards, weekly drawings, goal setting.
Gamification is not new, of course. We encounter it all the time in consumer experiences to engender loyalty, enjoyment, and frequency of use — think Facebook, LinkedIn, Uber, airline miles programs, and customer cards at our favorite retailers. However, gamification is still relatively new in healthcare.
The idea of using game-like mechanics in the consumer world is now second nature, whereas its use in healthcare still raises an occasional eyebrow, even though it shouldn’t. Our successes at HealthPrize tell us that patients enjoy earning points, checking their leaderboard, and taking quizzes about their condition or treatment (for more points).
And, in contrast to their interactions with doctors, patients interact with HealthPrize multiple times per week, for an average of 38 minutes every month. That allows for the repetition of important messages, giving them time to actually sink in.
Upon hearing about HealthPrize and its gamification approach, some have asked: shouldn’t patients take their medication because it’s the right thing to do, not because they’re getting points or prizes?
To that I answer, “Yes, they should, but that’s not realistic.” Patients should also quit smoking, exercise multiple times per week, and eat healthily. If all the “rules” were always being followed, we wouldn’t need to tap into human psychology for creative solutions.
Early on in the development of our digital programs at HealthPrize, we sought feedback from participants in an effort to troubleshoot bugs and enhance the user experience. I recall receiving feedback from one woman in particular that helped to convince me that our “fun and games” approach may be more compelling than my former fear-based tactics.
This woman informed us that she needed to spend a couple days in the hospital to undergo a procedure. She had made it to the top of the HealthPrize leaderboard by taking her medication every day, refilling on time, completing every weekly quiz, and opening every “Daily Tip” (our short-form medical education and fun trivia). She was not worried too much about the procedure. What mattered more to her was slipping from her position on the leaderboard.
Katrina Firlik, MD, is co-founder and Chief Medical Officer of HealthPrize Technologies. (HealthPrize CEO Tom Kottler will be speaking on the Techonomy Health program in New York on May 16.) Prior to co-founding HealthPrize with Kottler, Firlik was a neurosurgeon in private practice in Greenwich, Connecticut, and on the clinical faculty at Yale University School of Medicine. She is also the author of Another Day in the Frontal Lobe, published by Random House.