effective adherence

1Boston | London | Los Angeles | Philadelphia

Effective Adherence: A complex problem addressed with

comprehensive behavioral programs

• For every disease, the Standard of Care includes multiple

behavioral and self-care elements.

• People struggle to adhere to their total therapies – medicines

as well as behavior modification and lifestyle changes –

negatively impacting outcomes and health economics.

• The Human Care Systems solution is a customizable software

platform to help biopharmaceutical companies engage with and

support patients and family to learn the habits of total therapy

adherence. Increase medicine adherence

Add value and connect with patients and family

Comply with regulatory requirements

Differentiate to prescribers and remove prescribing barriers

Improve health economics

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Standard of Care and Therapy Adherence

Causes of non-adherence

Comprehensive solution for complex problem

Personalized adherence program: “Mary”

Efficacy data

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Personalized Adherence

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Question: Why don’t people adhere to their medicine

regimens and other therapies?

Answer: Each person has his or her own set of complex

and interrelated reasons.

Sources: BCG analysis; Harris Interactive 10,000 Patients Survey, 2002.

Sometimes forget to use or refill

Don’t want the side effects

The drug costs too much

Don’t think I need the drug

Can’t get prescription filled, picked up, or delivered

Don’t know how to use the drug

Other

Reasons why patients don’t fill prescriptions

or comply with drug regimens (patient views)

(Percentage of patient respondents citing each reason)

Patients Report Range of Non-Adherence Causes

Cost/co-pay

Side effects

Lack of motivation and self-confidence

Doesn’t think he/she needs drug

Underlying emotional issues

Doesn’t think drug works

Patient is suspicious of pharmaceutical companies Doesn’t understand how to use/administer drugLack of productive family involvementCan’t get prescription filled, picked up or delivered

Forgetfulness

Other

Source: Human Care Systems Physician Survey, 315 physicians, 2010. .

Reasons why patients don’t fill prescriptions

or comply with drug regimens (physician views)

(Percentage of physician respondents citing each reason)

Physicians Report Range of Non-Adherence Causes

Each Adherence Barrier has Behavioral Drivers

Doesn’t understand how to use/administer drug Information processing style, misconceptions, emotionality, self-efficacy

Lack of productive family involvement Avoidance, relationship skills / strain, stimulus control, living environment

Can’t get prescription filled, picked up or delivered Social capital, problem-solving, communication, self-efficacy

Doesn’t think drug works Defense mechanisms, interpersonal skills, learning style, social capital

Underlying emotional issues Cognitive skills, mind / body relationship, life environment

Doesn’t think he/she needs drug Defense mechanisms, cognitive-emotional skills, life environment

Lack of motivation and self-confidence Self-efficacy, social capital, mind / body relationship, cognitive skills

Forgetfulness Emotionality, defense mechanisms, cognitive dysfunction

Side effects Cognitive skills, mind / body relationship, self-efficacy, stimulus control

Cost/co-pay Cognitive skills (coping), emotionality (anger), problem-solving (prioritizing)

Behavioral DriversAdherence Barrier




Efficacy data

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Symptom Therapy

Physical Pharmacology

CognitiveHCS SolutionsBehavior Science, Cognitive-Behavior Therapy, Pedagogical Science, Relationship Coaching, Mind-Body Exercises

Emotional

Behavioral

Environmental

The Problem Defines the Solution

Comprehensive Solution:

HCS behavioral approach addresses

patient thoughts, feelings, actions,

surroundings

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Complex Problem:

Nuanced interplay of cognitive,

emotional, behavioral, environmental

factors

“The odds that an adherence strategy will be successful are

related to how well the strategy can first identify the varying

needs of individual patients, and then match services

accordingly.

An ideal adherence strategy should be patient-centered and

holistic taking into account everything from lifestyle to cultural

and belief systems.”

Source: New England Health Care Institute, Client Conference, May 20, 2008

Effective Adherence is Holistic and Patient-centered

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A Holistic and Patient-centered Solution

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A Comprehensive Behavioral System

We use behavioral

science, translated to

user-friendly software,

to help patients change

problematic patterns and

learn new, healthy

thoughts, feelings,

behaviors, and

relationships.

Behavior

Modification

Classical

Conditioning

Operant

Conditioning

Social

Conditioning

Pedagogical

Science

Integrative

Learning

Experiential

Learning

Timed

Learning

Cognitive

Dimensions of

Change

Emotional

Behavioral

Environmental

Thoughts and Feelings are Biochemistry

• Mind-body therapies have broad, dramatic impact on perception, information processing, decision making, and lifestyle change

• Powerful interventions integrate all dimensions of change –cognitive, emotional, behavioral, environmental elements

• HCS solutions use standard, scientifically proven mind-body protocols

neutral state

meditative state

Proc. Natl. Acad. Sci. USA 2004 101 (46) 16369 - 16373

Mind-body exercises change thought pathways

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Who We Are

Experts in software, healthcare, psychology, user engagement, and

technology.

Clients are biopharmaceutical, medical device and diagnostics companies;

as well as health systems, employers and payers.

Headquartered: 1 Faneuil Hall, Boston, MA.

Other locations: Philadelphia, Los Angeles and London.

Formed as spin-out from the Kerdan Group (biopharma consultancy) in 2008.

Human Care Systems




Efficacy data

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Therapy for Complete Adherence: “Mary”

1. Education exercise

“Myths and misconceptions”

2. Cognitive-behavior exercise

“Shame”, “Fear”

3. Mind-body exercise

“Self-awareness”

4. Problem-solving exercises

“Cost”, “Inconvenience”

5. Goal-Setting and tracking

“Goals and emotions”

Adherence Guided Program

I must address myths

that cause my negative

feelings. When I am

emotionally invested, I

can move forward.

Adherence Profile

My disease is physical.

My experience of my

disease is holistic.

My adherence involves all

of me.

I’m skeptical, overwhelmed,

and agitated. I’d rather not

think about this! I’m tired of

being nagged. What the heck

is a mind-body relationship?

Thoughts

Perceptions of self and

condition

Feelings

Reactions of anger, fear, shame,

guilt, anxiety

Behaviors

Compliance with providers and

treatment plan; self-care habits

Environment

Relationship and tactical

obstacles to compliance

Adherence Assessment

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Mary Engages Through Multiple, Integrated

Channels

Web & Email

Mobile & SMS

Live Phone

Automated Phone (IVR)

Mail

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Mary Picks a Virtual Guide

Virtual Guides

Guides are selected based on decades of robust socio-cultural research

including micro-expression analysis.

Guides can answer questions using a heuristics engine and database.

Social conditioning involves interactions with others, including modeling, coaching, social learning, contracting, and

interpersonal support.

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Mary Follows an Integrated, Step-by-Step Program

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Mary Completes Simple Assessments to

Personalize her Experience

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Mary Engages in Tailored, Effective Learning

Challenging, calibrated to an 85%

correct response rate

Multi-media options

configured to learning style

Flash animation is interactive

Regulated by

cognitive

dissonance as

a window for

insight

Interactive, immediate feedback

for optimal learning

Hierarchically chunked

education (3-5 items at

a time) for optimal

working memory and

information processing

Continuous

reinforcement

schedule drives

engagement

Learner-centered, driven

by user choice and profile

SEE MY LEARNING STYLE

PROFILE

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Mary Works on her Thoughts and Feelings,

in a Judgment free and Private place

Mary does Personalized ExercisesPatients require multi-dimensional assistance for internal and external environments including prohibitive thoughts and feelings

like shame, anger, fear, guilt, anxiety.

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The system

knows Mary

struggles with

shame.

Smart software predicts and

times Mary’s questions.

Just like in a

therapist’s

office, Mary

quantifies her

feelings.

These are

included in

her treatment

algorithm.

Mary’s profile tells

the software that

her fear

immobilizes her,

keeping her from

compliance.

According to her

profile, Mary will

become activated by

converting fear to

anger.

Adherence to biochemical therapies

involve mind / body learning.

Information combined with the right

emotional engagement leads to insight.

Guides are selected based on decades

of robust socio-cultural research

including micro-expression analysis.

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Mary Involves her Husband

Solution: Smart software

guides family members

into behavior contracts with

each other that are

mutually reinforcing.

Solution: Mary’s spouse

learns new relationship

skills like empathy,

support, and

communication.

Solution: The system

gives Mary an action

plan personalized to her

psychological profile.

Problem: Mary’s

spouse has strong

opinions, preventing

him from listening.

Mary ignores him and

her self care too!

Solution: The system

leads the spouse

through self-awareness

and de-stress exercises.

Problem: When her

spouse comes home

from work angry,

Mary’s adherence is

threatened.

Problem: Mary

resents her spouse

nagging, because he

doesn’t follow

doctors’ orders either.

Problem: According to her

profile, Mary’s anger is

getting in the way of going

to the pharmacy.

Social interventions involve interactions with others, including modeling, coaching, social learning, contracting, and

interpersonal support.

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Why does Mary Engage with her Program?

“My husband used to always hassle me

about my weight. Now, he used the

coach training program a bit and he‟s

actually somewhat helpful with meal

planning and our daily walks. He can

be objective now.”

“It helps bring out feelings that

I wasn‟t aware of before. It

was good in helping me

handle my feelings in some

kind of perspective.”

„”I really like that it‟s

just for me. It learns

about me and grows as

I grow.”

For the first time in my life, I

feel like I have the right plan

and support for me. Like I‟m

in control.”

“it‟s reassuring and it gave me

good steps.”




Efficacy data

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Efficacy Evidence: Medicine adherence

In a trial of medicine adherence (refills) among 50 diabetic patients (42 completed), HCS significantly improved adherence.

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Trial conducted March 1, 2009 to August 31, 2010 in United States

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Efficacy Evidence: Cardiometabolic Markers

50 patients

50 patients

(*) denotes statistical significance

(95% Cl)

Final (12 months)

SBP decrease of 11mm

Hg vs. control*

5% average BMI reduction*

.3 A1c reduction*

Trial conducted April 1, 2009 to March 31, 2010 in United States

Started Trial Completed Trial

46 patients

41 patients

12 month study of 100 diabetics measuring four cardiometabolic markers: LDL, BP, BMI, A1c.

Prescribers and other

clinicians want help

encouraging therapy

adherence.

Patient non-adherence

is a source of

frustration to clinicians.

Remove prescribing

barriers.

Particularly in complex,

multi-faceted diseases,

patients and family may

be overwhelmed.

Establishing a direct

connection to patients

and family is critical in a

world of increasing

patient self-pay due to

higher co-pays.

.

REMS and other

regulatory requirements

increasingly require

biopharmaceutical

companies to support

patients in managing

therapy, including

adherence.

The largest lever to

impact health economics

in any disease is therapy

adherence: taking

medicines, working

productively with

physicians, managing

behavioral and

emotional issues.

Multidimensional

reporting, including

usage and efficacy data,

informs sales, marketing,

regulatory, development,

and health economics

outcomes.

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Human Care Systems Value to Biopharma Clients

Engage and Support

Patient & Family

Comply with Regulatory

Requirements

Impact Health

Economics

Differentiate to

PrescribersTrack and Learn

€

effective adherence

Economy & Finance