January 16, 2017
SAN FRANCISCO — The big truck driving around downtown here last week was plastered with a photo of a pile of hundred dollar bills and an eye-catching declaration: “Pharma has a $637 billion annual revenue problem.” The advertisement, from HealthPrize Technologies, spotlighted the ﬁrm’s new estimate1 of how much the industry loses when patients don’t ﬁll, or don’t reﬁll, their prescriptions. Drug companies including Pﬁzer, Shire, and Gilead pay HealthPrize to encourage patients to take their pills by turning adherence into something of a game. Patients who document their prescriptions and engage with HealthPrize’s digital quizzes, surveys, videos, and medical tips rack up points that they can redeem for rewards. HealthPrize counts nine pharma companies as customers — but it wants more, and that’s why it paid for a truck to catch the eyes of the drug industry executives and investors in town for the J.P. Morgan Healthcare Conference.
HealthPrize’s CEO, Tom Kottler, was here for JPM, too. A serial entrepreneur who started the company in 2009, he’s informal and plain-spoken, even when he peppers his speech with concepts out of an introductory psychology textbook. STAT sat down with Kottler last week to ﬁnd out more about how he’s trying to solve the problem of medication adherence — and what he’s learning about the patients he’s trying to nudge. The conversation that follows has been lightly edited for clarity and brevity.
Why the gamiﬁcation approach?
One of the reasons why people don’t take their medication is that it’s boring. We respond really well to the mechanics of games. The challenge, the status, the achievement — all that stuff. It’s what makes us human.
You try to engage patients in lots of different ways. What do they like, and dislike?
We do leaderboards, like the screens you see in ﬁtness classes where stationary riders compete against each other. Patients, using HIPAA-compliant usernames, can see how they stack up against others in the program. We did a program in chronic obstructive pulmonary disease and we asked people at the end what their favorite thing was: And 34 percent said the leaderboard. Then we asked people what their least favorite thing was in that same program, and 42 percent said the leaderboard. But they found something else to engage with.
What types of prizes can patients pick from?
Brands can choose exactly what they want to make available out of three categories: Gift certiﬁcates, coupons, and charitable donations. A lot of times they’ll offer only health products — Swiss balls, exercise equipment, juicers, and videos and books about how to cook well — because it makes them feel good about the points they’re giving away. We did a hypertension program and we built almost everything around a diet.
What do they end up choosing?
We had one program that had 150,000 items in it — iPads, iPods, you name it, it had everything in it. Ninety-two percent of our redemptions in that program were $5, $10, and $20 Amazon, iTunes, and Starbucks gift cards. Across our programs, if gift cards are available, those three options in those three denominations are the favorite things by far.
Why do you think that is?
It’s the same reason patients don’t take their medications principally. It’s the thing behavioral economists call present bias: that we’re all wired to want things in the here and now. Taking medication to treat a chronic condition has no immediate beneﬁt for people, so we tend not to like it. We think: I’m not going to have another heart attack. My cancer’s not going to come back. That’s six months, two years, ﬁve years, 15 years from now. I can’t really deal with that. And that’s the same reason why people don’t want to save up their points to get something bigger: They cash them in early to get an inexpensive gift card.
So what works best in getting people to take their pills?
On average, we see a 52 percent lift in measures like the rate at which patients ﬁll their prescriptions and the percentage of time patients possess the drug they’re supposed to be taking over a 12-month period. It’s really not about the prizes — really it’s about engaging and getting the points and all that status stuff that we love so much. In some of our programs that had the best results, points were redeemable only for charitable donations.