AdhereTech and the Smart Pill Bottle
AdhereTech is using digital technology to improve patient outcomes and address a major source of waste in the healthcare system.
Patients aren’t taking their medicine. According to the CDC, nonadherence (or the failure of patients to properly take prescribed medications) causes 30 to 50 percent of chronic disease treatment failures, and results in 125,000 deaths per year in the U.S. alone[1]. Nonadherence is also a major source of waste, costing the U.S. health care system between $100 billion and $300 billion annually[2].
These costs are only going to increase. As the U.S. population continues to age, the World Health Organization estimates that by 2020 about 157 million Americans will have at least one chronic condition requiring medication therapy[3]. The American College of Preventive Medicine has written that “Nonadherence leads to worse medical treatment outcomes; higher, avoidable hospitalization rates; institutionalization for the frail elderly; and increased healthcare costs.”[4] Even with all of these terrible outcomes, adherence rates for some medications are as low as 40 percent[5].
Enter AdhereTech.
Founded by Wharton MBA Josh Stein, AdhereTech uses digital technology to monitor patient adherence in real time and remind patients to take their prescribed medications[6]. The company’s patented smart pill bottle incorporates sensors and cellular technology into the plastic walls of a bottle. The sensors can accurately measure a single pill of solid medication and down to one milliliter of liquid medication[7]. If a patient misses a dose, the bottle reminds them with an on-bottle light, then a chime, and finally an automated text message or phone call, which can also be sent to the patient’s caregiver or family members[8].
So how well does AdhereTech work? “On average, AdhereTech increases adherence by over 20 percent and duration by over 25 percent.”[9]
This can make a huge difference, particularly for patients with life-threatening diseases, and for those taking expensive medications.
The below video highlights an example of AdhereTech working with Mount Sinai to provide smart pill bottles to patients taking Harvoni, a hepatitis C medication that costs $1,100 per pill[10].
http://abc7ny.com/technology/new-smart-pill-bottle-knows-when-youve-taken-your-medication/1188691/
In addition to reminding patients to take their medication, AdhereTech also collects data on nonadherence. The company can tell if patients take their medication, if they take the correct dosage, what time of day they take it, and for how long they stay on it[11]. AdhereTech’s system can detect certain patterns of nonadherence and can solicit feedback from patients via text or phone call to ask why a dose was missed[12]. Common reasons for nonadherence, such as forgetfulness, monetary issues, or dosing confusion[13], can all be recorded and tracked. The company can then, in real-time, send alerts to the patient’s caregiver. Furthermore, AdhereTech can use this data to understand the drivers of nonadherence and the solutions that work for different types of patients[14].
On top of providing this information to doctors, AdhereTech can also give detailed feedback to pharmaceutical companies on how their drugs are being used by patients, and why patients stop using them[15].
Digital technology is core to how AdhereTech delivers on its customer promise. The company’s innovative business model has been enabled by the relatively low cost of sensors and cellular components. AdhereTech’s key critical differentiator is its ability to design products with the end user in mind, which in turn is enabled by technology.
Josh Stein explains AdhereTech’s design principles in a TEDMED Talk[16]:
http://www.tedmed.com/talks/show?id=299427
When patients opt into receiving the smart pill bottle, their specialty pharmacy knows the correct dosage time, who to send reminders to, and whether to send a text or an automated phone call. AdhereTech’s pill bottle requires zero setup and the battery lasts for over 200 days on a single charge[17]. When the battery needs to be recharged it sends an automated message to the patient, who can charge it using a standard micro-USB cord. The cellular technology in the bottle allows it to connect from anywhere in the world without having to sync to Wi-Fi or Bluetooth[18]. The bottle works exactly the same as a normal pill bottle, so it requires no learning by the patient. It’s also provided to patients for free[19], with pharma companies paying AdhereTech directly.
Going forward, AdhereTech should continue to expand its software capabilities. As the company gains scale, and as input costs for sensors and cellular components continue to decline, AdhereTech should be able to move into providing smart pill bottles for lower priced and more mass-market drugs. Ultimately, the company’s competitive advantage may rest in its proprietary database and the ability to analyze its drove of patient adherence data.
AdhereTech illustrates how the IoT has created new opportunities in the smart med space, allowing for innovation and improving patient outcomes.
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[1] “Why You Need to Take Your Medications as Prescribed or Instructed.” U.S. Food & Drug Administration, 16 Feb. 2016. <http://www.fda.gov/Drugs/ResourcesForYou/SpecialFeatures/ucm485545.htm>.
[2] Viswanathan, Meera. “Interventions to Improve Adherence to Self-administered Medications for Chronic Diseases in the United States: A Systematic Review.” Annals of Internal Medicine, 04 Dec. 2012. <http://annals.org/aim/article/1357338/interventions-improve-adherence-self-administered-medications-chronic-diseases-united-states>.
[3] Small, Takara. “Meet the Companies Disrupting Your Prescriptions.” Free Enterprise. U.S. Chamber of Commerce, 28 Jan. 2016. <https://www.freeenterprise.com/meet-the-companies-disrupting-healthcare/>.
[4] “Medication Adherence Clinical Reference.” American College of Preventive Medicine, 2011. <http://www.acpm.org/?MedAdherTT_ClinRef>.
[5] Jeffries, Adrianne. “Smart Pill Bottle Measures Meds Using Touchscreen Technology.” The Verge. 08 Oct. 2012. <http://www.theverge.com/2012/10/8/3473218/smart-pill-bottle-adheretech-capacitance>.
[6] “It’s Smart to Design Simple.” TEDMED. <http://www.tedmed.com/talks/show?id=299427>.
[7] Jeffries, Adrianne. “Smart Pill Bottle Measures Meds Using Touchscreen Technology.” The Verge. 08 Oct. 2012. <http://www.theverge.com/2012/10/8/3473218/smart-pill-bottle-adheretech-capacitance>.
[8] Stein, Josh. “AdhereTech Smart Wireless Pill Bottles.” Super-Utilizer Health Innovation Challenge. Devpost, 15 July 2015. Web. <https://super-utilizers.devpost.com/submissions/38701-adheretech-smart-wireless-pill-bottles>.
[9] Stein, Josh. “Pharmaceuticals Move into Internet of Medical Things.” CIOReview. <http://pharma-life-sciences.cioreview.com/cxoinsight/pharmaceuticals-move-into-internet-of-medical-things-nid-12841-cid-36.html>.
[10] Fleischer, Tim. “New ‘smart Pill Bottle’ Knows When You’ve Taken Your Medication.” ABC7 New York. 12 Feb. 2016. <http://abc7ny.com/technology/new-smart-pill-bottle-knows-when-youve-taken-your-medication/1188691/>.
[11] Stein, Josh. “AdhereTech Smart Wireless Pill Bottles.” Super-Utilizer Health Innovation Challenge. Devpost, 15 July 2015. Web. <https://super-utilizers.devpost.com/submissions/38701-adheretech-smart-wireless-pill-bottles>.
[12] Ibid.
[13] Ibid.
[14] Ibid.
[15] Ibid.
[16] “It’s Smart to Design Simple.” TEDMED. <http://www.tedmed.com/talks/show?id=299427>.
[17] Stein, Josh. “AdhereTech Smart Wireless Pill Bottles.” Super-Utilizer Health Innovation Challenge. Devpost, 15 July 2015. Web. <https://super-utilizers.devpost.com/submissions/38701-adheretech-smart-wireless-pill-bottles>.
[18] Ibid.
[19] Fleischer, Tim. “New ‘smart Pill Bottle’ Knows When You’ve Taken Your Medication.” ABC7 New York. 12 Feb. 2016. <http://abc7ny.com/technology/new-smart-pill-bottle-knows-when-youve-taken-your-medication/1188691/>.
Ethan, thanks for this interesting article! AdhereTech seems like a potential game-changer of a product – I was astounded to read that the annual cost of nonadherence in the U.S. healthcare system can reach $300 billion. I’m curious to more fully understand the company’s claim that this technology increases adherence by over 20%. What was the baseline measurement for a patient’s adherence rate prior to using the smart pill bottle? How is AdhereTech confirming that a patient actually takes her medication after opening the pill bottle? Countries outside of the U.S. are exploring similar technologies to monitor adherence, and a concern that’s often raised is that while a smart pill bottle can track if/ when a patient removes a pill or dose, it cannot confirm that she actually swallows the medication. I’m wondering whether the AdhereTech team has faced similar questions and what sort of data its collected to support its statistics on adherence improvement.
Great article, especially as healthcare costs in the United States are soaring, and inefficiencies in treatment are surfacing all across the healthcare chain. I like the idea of making pill intake easier and more user-friendly. As I think about the future of medication intake and this technology, the first thought that comes to mind is: How can we better support very sick patients who may be overwhelmed by the amounts of medication they have to take?
Serious illnesses often require an entire treatment regime, which can be very difficult to adhere to, especially if patients are at home on their own. In that case, I think the smart pill bottles absolutely help to remind patients if they forgot to take one of their pills. However, I wonder if this technology can be further developed to also remind patients at what time of day they need to take a certain pill, and which other medications to take at the same time. This is definitely a more tricky task, and I would be curious what the current R&D is around that, and what the potential cost savings could be given that this is likely a small – yet perhaps costly- segment of the patient population.
It’s exciting to see care becoming so much more patient-centric, and the engagement of the clinician and caregiver are a key element of adherence that Adheretech seems to be getting right. That said, I was surprised to read that Adheretech has only increased adherence by 20%. By contrast, an early competitor, Vitality Glowcaps, yielded rates of adherence of up to 99% (see source). Granted, Vitality Glowcaps only notifies the patient if the bottle hasn’t been opened, and isn’t able to determine whether the medication has actually been taken. I wonder what more Adheretech can do to incite the patient who remains noncompliant even after receiving a text or an automated phonecall to take their medication. My gut says the gap is in direct follow-up from the patient’s caregiver or physician / nurse. Data is powerful and technology can transform the recovery process, but it’s crucial we don’t lose the human element of healthcare delivery. One other hazard I’ll raise is whether we should be concerned about HIPAA compliance of data collection given all of the data is being transmitted to and stored in the cloud. That aside, I can’t wait to see how the market adopts a cheaper, smaller and easier to mass manufacture Adheretech bottle – perhaps we’ll start to see the technology being used for less expensive, more chronic illness like high cholesterol or hypertension.
Source: http://www.theverge.com/2012/10/8/3473218/smart-pill-bottle-adheretech-capacitance
Ethan – Thanks for sharing! I had come across similar technologies before in the news and I wonder how Adheretech stacks up compared to its competition. In particular, it seems the barriers to entry are very low, for example the patents are likely narrow on the design allowing different minor modifications on a similar concept. One interesting differentiator in this case is their revenue model though. For high-cost medications I can see that pharmaceutical companies would get on board with paying for these bottles, or for using them during clinical trials etc. On the other hand for low-cost medications, or patients taking many medications, I wonder if the monthly patient plans offered by competitor MedMinder are more compelling [1].
[1] https://www.medminder.com
Really interesting article Ethan! One of the things I’d love to learn more about is AdhereTech’s business model. I can see benefits to insurance companies or pharmaceutical companies subsidizing the cost of the bottle, but given the cost / pricing pressure they are under, I wonder if it is a tough sell, particularly outside of very high cost therapeutics. Additionally, I wonder a little bit about the practicality (both cost and convenience) of a senior citizen having six or 10 blinking, chirping pill bottles sitting in their cabinet. While those are probably among the patients that could use this technology the most (and who likely struggle with adherence), this is a far costlier and more cumbersome solution than a “day of the week” pill holder.