January 12, 2011 
In the future, will we have teams who rapidly engage patients who don’t take their medications as prescribed? Will those be medical teams for patients who recently got a transplant and police teams for mentally ill patients with a history of violence?
Seem pretty farfetched?
Compliance with medication is such a hot topic today that you’re finally see the technology innovators jumping in. You have solutions like the GlowCaps system that have been around for a few years and demonstrated their impact. Now, you have technology going even further to attach itself to the pill and send data back.
The LA Times had an article that talks about some of these technologies:
- Camera pills
- A device that you wear around your neck to monitor swallowing the pill using RFID
- A device that detects when it encounters stomach acid
BUT, the kicker here is that the article estimates this will only improve adherence by 5-15%. Remembering to take the pill isn’t the only reason people don’t take their pills!!!
Just look at this on the 11 Dimensions of Non-Adherence or this on the Predictors of Non-Adherence or some of the research coming out of CVS Caremark.
You have to address health literacy. You have to address side effects. You have to address beliefs. And, many other issues.
These solutions are “cool” and will finally tell us if people take a pill, but I’m not sure that’s the silver bullet. Plus, at what cost? Get a 5-15% improvement in adherence isn’t that impressive. We’ve done that multiple times at Silverlink with a quick remind to patients about taking their medications or asking patients about their barriers and addressing them.
As with any solution, it’s about figuring out who it benefits most and getting it to them at the right time.
Enabling Healthy Decisions 
I agree that’s a really costly way to improve adherence for all but the most financially / socially expensive medications.
I guess one can apply the concept of step therapy to increasing compliance. So payer would try the most cost effective method first, then gradually try other more costly options.
But in my opinion, the only thing that will increase compliance significantly w/o incurring cost to the payer is imposing punitive measures. As these smart devices become cheaper, it would be possible for payers to accurately assess the compliance rate for wider range of drugs.
So if you are repeatedly non-compliant, payer can start to impose financial penalties. Much like how insurance companies use point system to assess your premium.
If you accrue a lot of points, then your employer would start to demand higher contribution from your paycheck. And if it gets really bad, your coverage would be dropped. Of course, there should be opportunities for the employee to reduce points by going through some kind of education programs about compliance.