Are patients taking their medications?
It seems like a simple question, but patients not taking drugs as prescribed continues to be a challenging, and costly, problem in healthcare.
Some 50% of Americans don’t take their medications as directed by their doctor, for any of a host of reasons. This non-adherence leads to preventable hospitalizations and preventable deaths and costs 16% or $500 billion of the entire U.S. healthcare spend every year, data from the Centers for Disease Control and Prevention (CDC) show.
Side effects, drug-to-drug interactions and related issues lead to 1.3 million emergency department visits each year, according to the CDC.
From a clinical perspective, providers and pharmacists have siloed workflows, lacking a line of sight into one another’s work. Further, physicians see patients just a few times each year and often lack the time they need to address medication adherence effectively.
Patients are also more likely to take more medications as they age. About 12.8% of the U.S. population takes five or more prescription drugs (PDF), representing tens of millions of patients who are often left to keep track of these medications on their own.
Startup Scriptology launched to bring a new approach to pharmacy services and medication management by combining an extended clinical pharmacist team with a technology platform to give patients more guidance and support to help them follow their medication plan.
"Our focus is pretty simple. We're focusing on getting patients to follow the medication plans as intended, which sounds so basic," Erin Hendrick, a pharmacist by background who co-founded Scriptology, said in an interview with Fierce Healthcare.
"But, when you take a step back, and you look at patients who are on chronic medications in the U.S., in general, people are taking their medications about 50% of the time. For medications to be therapeutically effective, we need patients to take it about 80% or more, for some medications obviously much more. But when you look around, we're just not doing that," she said. "About 50% of treatment failures across the U.S., 125,000 deaths and a fourth of all hospitalizations are thought to be due to medication non-adherence. We spend about as much money on problems associated with medications in the U.S., about $600 billion, as we spend on medications, which is about $700 billion. We're focused on trying to solve that problem in a unique and cost-effective way."
Comprehensive medication management (CMM) is not a new concept. These models are designed to connect providers, payers and patients with technology to help patients navigate their medication journeys. The overall goal is to enhance patient outcomes and decrease the total cost of care.
Existing CMM programs face several barriers including the need for more buy-in from health plans to fund CMM as part of their care management initiatives. Tied in with that, some programs struggle to show long-term cost savings and improved clinical outcomes.
Hendrick says Scriptology brings a more strategic, data-informed approach to CMM using advanced analytics and leaning on clinical expertise to address the root causes of non-adherence. The company's clinical pharmacist team was designed to enhance the current model and integrate into provider care teams.
Patients get a single point of contact to discuss their medications and a personalized approach to medication management, according to Hendrick. Providers and payers get insights they can use to drive sustained quality outcomes. The approach also can help reduce costs by keeping patients healthier, at home and out of the hospital or emergency department.
Founded in partnership with Redesign Health, a healthcare startup creator based in New York City, Scriptology secured $4 million in seed funding lined up through Redesign Health's committed pools of capital.
The startup works with providers in risk-bearing contracts, such as value-based arrangements, or as part of a provider's chronic care wraparound services, Hendrick said. The company also works with payers and employers.
"We are working with a handful of partners who range from providers in primary care to traditional chronic care management to specialty care all across the country, with cohorts in California, Florida, Texas and New York. We have a few thousand patients on our platform among those partners," she said.
Scriptology incorporates pharmacists into the care continuum, starting with high-risk patients. The process starts with an in-depth call to explore each patient’s condition, communication preferences and potential barriers to adherence. The clinical pharmacist team then builds a tailored plan that considers everything from side effects to self-reported measures and outcomes, according to the company.
The company also gathers data about patients’ medication and efficacy, then reports individual patient information back to their providers. The platform aggregates clinical, behavioral, social determinants of health, cost and outcomes data to enable personalized intervention selection, outcome propensity modeling and ongoing proof of the program’s impact.
Prior to Scriptology, Hendricks spent her career in leadership roles in the private, public and nonprofit healthcare sectors. She served as chief operating officer at Emory University Hospital Midtown and worked in the specialty pharmacy space, most recently in an executive vice president role at Shields Health Solutions.
"I've spent my entire career evangelizing the concept of pharmacists being an integral part of patient care, and really decreasing the total cost of care, and that's what we're trying to do with Scriptology," she noted.
The company's leadership team includes executives with pharmacy, medical and public health experience. Erika Horstmann, head of clinical operations, spent nine years leading various aspects of operations management for Cardinal Health. Priscilla McCloskey, head of product at Scriptology, served in the same role at HumanFirst and has held product management roles with Actium Health and HCA Healthcare. In addition, Chandler Scoco, chief of staff, also comes to Scriptology from Shields Health Solutions.
Scriptology's platform leverages data and analytics to identify the patients that are most at risk for what the company refers to as "medication misadventures" and to make pharmacists' workflows more efficient.
A key part of the company's approach is communicating and engaging individual patients and coaching them on their medication plans.
"We have a clinical pharmacy team talking to the patients and we do that remotely via video, phone, chat, or app, but we're actually engaging with patients. I think this is our differentiation. There are a ton of really cool tools that have been developed that focus on non-adherence, some are super basic and some are much more technologically advanced. But, the problem is that most patients who are non-adherent aren't self-identifying as non-adherent," Hendrick said, adding, "We try to identify those patients who are most at risk proactively, and then work with them directly over time. It's not just a one-time engagement with these patients. We create a relationship and we work with them over time, then we also partner with their provider to change the plan if we need to."
There is a lot of discussion about the high cost of medications as a barrier to patient adherence. "From the literature, it appears that that's only about 30% of the problem," Hendrick noted.
"The remaining 70% of the problem is chalked up to patient choice. And, I don't mean that people are actively making a decision that they want to be non-adherent. It's about their beliefs in the medications. 'Is this plan going to make me feel better?' Or, 'Did someone I know have a problem with this medication?' There are issues in everyone's lives that sometimes get in the way of following complicated plans. And then sometimes, there are some side effects as well. We believe that the vast majority of this is due to the patient's beliefs and acceptance of the medication plan, or problems in their lives preventing them from following the plan as intended."
Scriptology cites data that its approach is proving to be effective with the patients it currently works with: a 19% decrease in total cost of care across all disease states and 90% medication adherence in diabetes, COPD and congestive heart failure populations. Providers accept more than 90% of pharmacist recommendations and its model costs 50% less than the cost of hiring full-time pharmacists, the company says.
There are a growing number of companies going after the medication non-adherence problem.
Sempre Health launched eight years ago with a text-based solution that gives patients a financial incentive to refill medications on time. The aim is to improve medication adherence and affordability for patients while the company also builds out a two-sided network of payers and life sciences companies. Sempre Health has raised $45 million to date backed by Blue Venture Fund, UPMC Enterprises, Industry Ventures, Cencora Ventures, Echo Health Ventures and other investors.
Scene Health, formerly called emocha Health, was spun out of Johns Hopkins University about two years ago to tackle medication adherence with an asynchronous video platform.
Los Angeles-based Wellth develops app-based digital health programs that use financial incentives and behavioral economics strategies combined with a consumer-grade smartphone experience to improve adherence to patients’ care plans.
Digital health company Hello Heart launched a new app to gamify medication adherence to help individuals manage heart health.
Even Amazon is getting into the pharmacy space by leveraging its logistics and supply chain muscle. Amazon Pharmacy says it wants to make it faster and easier for patients to get their prescription medications and speed up "triage to treatment."