Rewards: the #1 service patients request from pharma
Katrina Firlik questions whether we should be rewarding patients for good health behaviour or whether this could be seen as bribery on the part of the pharmaceutical industry. Do the long-term health benefits outweigh the challenges?
Consumers in their everyday lives are well accustomed to receiving rewards for loyalty to a product or service. Whether the brand is a hotel chain, restaurant, clothing store, credit card, or airline, the concept of earning points—or miles—towards some form of a reward is compelling to a wide swath of the population.
Why are rewards so compelling to so many consumers? For one, who doesn't like getting something for free? Equally, there is a "fun factor" to the earning of points over time. It naturally appeals to our collector, competitor, and goal-setting selves. It feels good to see our points balance increase and to "level up" from silver to gold to platinum. Maybe it's silly, but it works.
Interestingly, this is true even for the wealthy, despite the fact that the rewards earned from loyalty programs—a flight, meal, gift card, magazine subscription—would pose no serious financial hardship to cover on their own. I know high-level executives who are willing to take a less convenient flight in order to gain points from their preferred airline.
I think back to a scene I encountered a few summers ago in a wealthy suburb of New York City. A local ice cream shop was celebrating "free ice cream cone" day, and the line of well-to-do denizens and their children snaked around the corner. The "fun factor" of anticipating a free ice cream cone, despite having to wait in a long line with other happy cone-seekers, was clearly worth it, even though the purchase of a scoop of gelato from a shop a couple blocks away (with no line) would not have broken the bank for anyone.
But healthcare is different, right? Patients are consumers, true, but not in exactly the same way as when they book a flight, choose a restaurant or hotel, buy a new shirt, or swipe a credit card.
Not so fast. Maybe the psychology of our consumer selves remains relatively consistent. Maybe the successful tactics used for so long in the world outside of healthcare would also work well within, especially to motivate healthier behaviors and to stick with important medical regimens.
There is a growing body of evidence demonstrating that incentives to lose weight, exercise, quit smoking, and stick with medications can work, either in conjunction with or as an alternative to more traditional tactics: simple reminders, cost reduction strategies, and education.
A fascinating report focused on pharmaceutical services was recently released by Accenture. They surveyed 2,000 people taking a medication and asked them which pharmaceutical services they want to receive versus those they actually receive.
The most highly desired service was a rewards program, at sixty-three percent of those surveyed. Further, the most significant gap between desired service vs. received service was rewards. Although sixty-three percent of patients said they would like to receive rewards from pharmaceutical companies, only ten percent reported that they actually do.
Interestingly, far fewer patients were interested in various wellness or disease management services that pharmaceutical brands are increasingly offering or at least speaking about: access to patient support forums (only 29% desire such service), nurse support via phone (26%), and lifestyle coaching (23%).
Clearly, because different patients want and need different services, the best of all possible worlds would be to offer a suite of diverse services. However, what is clearly highlighted by this survey is this: rewards cannot be ignored and should be included in this array of services.
Although the concept of leveraging reward programs to improve the patient-consumer experience (and, more importantly, to improve clinical outcomes and decrease healthcare costs) is enjoying a growing acceptance, there are a few lingering concerns that tend to crop up and are worth addressing:
- Shouldn't good health be enough of a reward? The answer is—ideally—yes, it should. Unfortunately, however, too many people are dogged by a natural human "present bias" (in the parlance of behavioral economists): the reward of good health or complication avoidance is too far in the future, too onerous to achieve day-to-day, and perhaps even too nebulous. We tend to favor immediate gratification over delayed gratification. It's the same challenge faced in saving enough for retirement. It's more of a value issue than a cost issue.
- If pharmaceutical companies—in particular—offer rewards, won't it appear that they are simply "bribing" people to take their product; and don't they have enough of an image problem in the eyes of the public already? This is a valid concern, but I would argue that the more pressing concern is the global reality of poor outcomes and increased cost as a result of medication non-adherence. The status quo of adherence interventions to date is not working well enough. We need to broaden the approach. Lives are at stake, literally. Plus, if communicated effectively, improving outcomes via reward programs should actually enhance reputation.
- Don't rewards work only short term? There is some evidence to suggest that the efficacy of rewards may wear off over time, but it's also true that rewards need to be applied intelligently. Not all rewards strategies are equally effective. Success is based not only on which rewards are offered (luxury tends to trump utility; an Amazon or Starbucks gift card tends to be more compelling than a dull discount) but also on how the rewards are offered (smaller rewards delivered more frequently tend to work better than a larger reward delivered at the end of a long year).
Finally, returning to the Accenture survey, why should we simply cave to what patients want? Shouldn't we instead—at the risk of sounding a bit paternalistic—figure out what they actually need? Interestingly, when these same 2,000 patients were asked instead to rank the top five most important services as opposed to the most desired, "product information" and "financial assistance" ranked above rewards. (The numbers were 73%, 64%, and 60%, respectively, in terms of percentage of patients ranking those services within the top five.)
The obvious answer is to offer all of the above, assuming budgets permit. I would argue, though, that if your goal is to cajole patients to improve adherence and other health behaviors long term, and you can't do everything, wants should trump needs. It's simply more fun that way.
About the author:
Katrina Firlik is chief medical officer and co-founder of HealthPrize Technologies. She is also a neurosurgeon and author of Another Day in the Frontal Lobe: A Brain Surgeon Exposes Life on the Inside.
Have your say: Can tactics used outside of healthcare work within to motivate healthier behaviour?