This week I am talking to Chris O’Brien, CEO at AdhereTech (@AdhereTech) who is working to solve medication adherence challenges with innovative simple connected technology. Chris started out life in software development and video technology but shifted into the world of DigitalHealth where he had success building healthcare information solutions
At AdhereTech they have created a simple Internet of (Medical) Things (IoMT) device that can be deployed in any environment irrespective of digital access, internet, and technology that supports patients taking medications. In the current form, this is targeted at high-cost drugs, especially in Specialty Pharmacy areas where costs can be $10,000 a month and the economics and the return on investment easier to demonstrate
The Smart Pill Bottle program provides patients with a bottle to place their medications in that tracks activity and provides reminders to those individuals locally via the bottle itself and also via a range of other channels depending on individual preferences as well as the availability of technology and connectivity.
Listen in to hear our discussion on the future of this technology and the potential applications in other areas as the costs come down and capabilities increase
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Raw Transcript
Nick van Terheyden
Today, I’m delighted to be joined by Chris O’Brien. He’s the CEO of adhere tech. Chris, thanks for joining me today.
Chris O’Brien
Thanks so much for having me. It’s a pleasure to be here.
Nick van Terheyden
So, for the benefit of the listeners, tell us a little bit about your background and how you arrived at this point, before we get into the details.
Chris O’Brien
Absolutely. You know, I was trained as a software developer, became an entrepreneur, I started and ran three different software, businesses, all video technology of all things over 15 years, I sold my last company to EULA Packard in 2010. And I just realized I didn’t want to do that with the rest of my life. And so I got in digital health thinking I would start a company, but ended up meeting some friends of mine and joining a company called everyday health in New York City. It’s operates health information websites for patients and physicians. And I ended up spending almost seven years there, as general manager of the physician side of the business. And you know, what I love about working in digital health, is that there are it’s a tremendous time, there’s so much change and opportunity. And it’s a tremendous time to be doing this. But it also for me, aligns the mission of the business with the economics of it. And I think, you know, here Tech was, is a great example of that, and never to health was a good one. And ended up actually getting to it here tech through one of the board members who’s the founder and CEO of everyday health and well, and and it’s just been great to be here because everything we do helps patients, and we literally can’t be economically, economically successful without helping patients.
Nick van Terheyden
Yeah. So you bring up an interesting point, I want to just talk a little bit about that you talk about digital health, and you know, the the essential nature of that. I hear certainly pushback on that, you know, where does it what is the value proposition, we see an awful lot of you know, digital health, that’s almost the buzzword of the certainly the year or perhaps years. But whether it’s delivering value or not some times questionable. Tell me a little bit about why you see that and what the contribution is. It’s not that I disagree with you. But I’m interested in your perspective.
Chris O’Brien
Well, I think it’s a very fair question. And the really, the question is really value for whom, right? It’s, you know, a lot of digital health solutions, even if they may be helpful to certain classes of patients are not necessarily ones that are going to fit into a payers reimbursement framework. I mean, think about it diabetes, as well solution, and you’re a commercial payer. These are patients that are relatively healthy, not going going to the emergency room or having complications, they’re going to turn off your plan, it may not make sense. No, they’re looking for 12 to 18, window payback periods, you’re not going to get that maybe if you’re, you know, Bank of America, and you have a long standing employee base, you’ll think about it differently as a payer, but the incentives are not aligned. In that case, even if the solutions work, which can be hard to measure in some cases.
Nick van Terheyden
Yeah, I think that’s exactly right. And that’s one of the challenges of the architecture of our system that, you know, we’ve created these segments that don’t align, and also have a relatively short term horizon, not always through their own making. I mean, you know, if you think about that, from an insurance perspective, great. So I’ve got this individual, and I put an investment in them, but then they jumped to a different plan A, you know, that’s true, even for the Medicaid plans, as well. So and, you know, you bring up an interesting sort of alternative perspective, you cited Bank of America, maybe we should be targeting some of this at other groups at this point. And, you know, that’s employers, as you know, more important areas of focus for some of this investment.
Chris O’Brien
Well, I think that’s right, you’ve got to find whatever the solution is, you got to find something that makes sense to the patient, first and foremost, because without patients, we have nothing. And that actually can stay with the patient for a long time. It’s got to make sense to whoever’s paying for it, which might be a payer or an employer, or in our case, it’s often pharmaceutical manufacturers or clinical trial sponsors, at least today. And it’s got to make sense to, you know, the the broader health ecosystem, at least at some level, because you’ve got to find patients, right. And in our case, pharmaceutical manufacturers don’t have patients, they have pharmacies that have patients, right. So how do we make it make sense to the pharmacies and the larger healthcare companies in which they’re a part and aligning those incentives? Whatever the solution is, is, I think it’s just really critical to getting any scale at all. And I think that’s what happens with digital health companies. They don’t get scale. They have some local data. It looks great, but it never goes anywhere.
Nick van Terheyden
Interesting. So digital health central technology, and you’ve now part of that They adhere tech, leading that particular technology. Help us understand what that is and what it is that you’re doing.
Chris O’Brien
Yeah, thank you. I’d love to do that. The let’s start with the problem of you know, the adherence understood broadly, you know, how people take their medications, when they take them? Do they take them as prescribed? Do they stay on them? Do they refill their scripts, it’s an incredibly difficult problem. And really one that that stretches across, you know, every condition, every every health, healthcare context, and really around the world, of course, you know, people in countries as they get as they grow in middle class, they first buy cell phones, medical care, and then they all of a sudden have these diabetes and other chronic condition populations, just like we do here in the United States. So, you know, the approach that the here check is taking is very different than other approaches in the marketplace. And, you know, I think it goes without saying that there have been a lot of ultimately failed approaches to attacking adherence, you know, with digital health and with other types of solutions. And, and really for, for a number of reasons, one is definitely the economic alignment. That’s just not always there. You know, again, that diabetes example, if I’m a commercial payer, I kind of want you to take your diabetes medication, but it’s not that important to me. And so it’s not worth the investment that’s needed to address it. At the same time, the other thing is that, you know, patients, especially ones with serious conditions, like cancer and MS and schizophrenia, it’s so hard for them every day, to to know what the right things to do, or to do the right things. If you think of that patient who’s been diagnosed with with cancer, say, you know, they spent 15 minutes with a doctor hopefully handed off to an ecology nurse, and then they go home, and they’ve got to manage their condition on their own, hopefully, with the helpful family member, not always. And it’s not that the providers don’t want to help they do but who needs help today? They don’t know. And that’s really the problem that we specifically are trying to solve at Intertek.
Nick van Terheyden
So before we get into the technology, I think you bring up an important point, I mean, this dates back. And as you were saying that I’m thinking of all of the therapies that medicine has come up with, you know, ranging from leeches, and mercury, and all sorts of just really quite significant impacts on you know, your personal experiences, and I’m sure adherence was a big problem going back even further, and I’ve never really thought about it, but at this point, you know, must have been, it continues to this day, even with, you know, well designed. And, you know, I’m reminded of my father, who always believed that if the medicine didn’t taste horrible, it wasn’t any good. At least that was his explanation as to why I as a child had to swallow this awful, tasty stuff. But we do we have this, you know, adherence problem, which, you know, is very significant in any therapy, if you consider, you know, based on some of the data, we’re not even sure that patients are going and filling their prescription, let alone taking it if they do fill it. And there’s all sorts of reasons why that takes place. What are the some of the solutions that have been tried, and, you know, the challenges with that to date?
Chris O’Brien
Well, I think just maybe taking it from a digital health angle, you know, you just think about a patient, maybe they’re 70, you know, they have multiple myeloma, it’s one of the conditions we work in, you know, they’re living in rural Kansas, you know, not really that near a cell tower, no internet access at home, not really sure how to use a smartphone, and all of a sudden, they get a little card at the doctor’s office and said, Hey, download this app, it’ll help you stay in touch with your physician and track your medications. Well, you know, I’m not sure they want to stay in touch with their physician and track their medications, even if they did, it reminds them every day that they have a disease that they’re trying to forget. And that’s very hard for people that it requires them to do all of this extra things. And, you know, that’s a burden that that a certain kind of patient who might be compliant already, you know, that, you know, really could maybe handle but the vast majority can’t. And so, because of that, most of the more digital health programs and that they come in all kinds of forms. So you know, financial incentives, some small amount to take your meds, or to see a doctor reminders, you know, texted to your phone, which doesn’t get to text because you don’t have even a cell phone in many cases. And you just think about these communities where the rural ones or, or more urban communities that aren’t that are economically challenged and have trust issues with the medications and medical system. You know, it’s very hard for big chunks of the population that isn’t technologically literate, to engage at all with a lot of these solutions. And so, what happens is, many patients don’t and you get only a very small percentage of patients to engage and that means even if it works for those patients, there’s no effect at a population level. So So that’s that’s been a challenge. And then, you know, the traditional one is throwing people at the problem, right? You think about, you know, and at risk Primary Care Group, for example, they have a team of probably relatively low level clinicians who literally call patients every week. Are you taking your meds? Are you taking your meds? They don’t know who’s taking their meds, who’s not. Even if they’re filling, they know it’s filling, generally, but not always. And it’s both expensive. It’s annoying to patients, and it’s ineffective.
Nick van Terheyden
Gosh, I can’t imagine the caller ID utility at that point, I’m receiving that call. I’m gonna let that one roll to voicemail. It just, it seems like a pathway to failure is my sense of it. And maybe some people have had success. For those of you just joining, I’m Dr. Nick the incrementalist today, I’m talking to Chris O’Brien, he’s the CEO of it, he attack, we were just talking about some of the challenges. And you know, you Riley bring up one of the core elements of this, which is access. And you know, when we talk about technology, but that was part of my reason for diving into that digital health, because that’s one of the areas that we see this resistance, or at least failure to deliver value, which is centered on lack of access to that technology. I mean, you talked about it from a remoteness access to a cell tower, you know, technology, even internet access. But you’re suggesting that there’s an alternative way, tell us how you can do that, and how we can start to address that aspect of it.
Chris O’Brien
Well, very specifically, at adhere Tech, we have a connected health platform that helps to monitor patients, when they’ve been diagnosed with a serious condition and are on medications today, oral solids, pills and capsules. And we do that through a series of smart devices. This is a this is a connected Philip bottle. And it is a pill bottle is just a pill bottle, it looks like a pill bottle, it acts like a pill bottle, you put your pills in it, you open it, and you and you take your meds as prescribed. But the one difference is that the pill bottle is actually an Internet of Things device, it is connected through a cell chip with our back end. Platform. And through that we’re monitoring patients in real time. So in a way, it’s solving kind of a last mile information problem. You know, the doctors know that they prescribe doc meds to patients, they send them home, who’s taking their meds, who’s not who’s taking them as prescribed, perhaps you’re supposed to take it once a day, you’re taking it twice a day or taking it every other day. You know, patients do the darndest things for reasons that make sense to them. Right? If you are having side effects, you stopped taking your meds you feel better, who’s done that no one knows for at best 30 days when you don’t fill the script or you go back to the doctor. And that’s what adhere tech is solving. We monitor those patients remotely, we can give them visual reminders, if that’s helpful, and through that we create real time information coming out of the home about who needs help, and who doesn’t today.
Nick van Terheyden
So, I mean, there’s there’s a number of elements to that, obviously, the pill bottles, so that’s unique, that’s a special device, is that something that they receive their meds in or they have to transfer them into how what’s the sort of flow of this because, you know, as you rightly point out that last mile is one of the major areas of challenge. There’s, you know, understanding or comprehension of what’s required. How is that process working?
Chris O’Brien
Well, today, here tech is largely working with large pharma manufacturers and biotechnology companies to help support their patients. So generally, the way it’s working is we’re integrated with either the specialty pharmacy or a medical practice or health system with our back end platform. And so at the time a patient is prescribed a medication or is getting a refill. They’re offered to join the smart pill bottle program is often what it’s called. And and then they then receive either the smart pill bottle from the physician or the clinician at the at the medical practice, or it will come along with their meds, typically the meds are separately packaged, and then the patient today transfers their meds from the bottle into our bottle. And then they use the same pill bottle some cases for years, and transfer the meds once a month or whenever the refills arrive. And the interesting thing about it is you don’t need to have anything at home. There’s no you don’t need to have a smartphone or even a phone at all. There’s no internet connection required. The smart bottle arrives already programmed by say your pharmacy with the right dose time it’s in your schedule. And so because of that we just get much higher opt in rates. We’re typically seeing about half of patients opt into a program which by itself is a stunning number. And of those 85% will start using the smart pill bottle and then those patients stay on in the program for in some cases many years. So our oldest program is about three years old. And we still have many patients on that medication, again, all being monitored remotely. And the great thing about it is if you take your meds as prescribed, absolutely nothing happens. Nobody bothers you, nobody calls you nobody asked me questions. But if you don’t, your pharmacist, the oncology nurse, someone else knows in real time and realistically, can then call you the next day, say and say, hey, you’ve been doing fine for a couple of months. And I see you’re stopped taking their meds what’s going on? And that’s what makes the difference that intervention in real time, people who need help get help at the time they need it.
Nick van Terheyden
So is there any component to this that actually provides a reminder? I mean, I’m, I can’t speak for other people. But I know I need constant reminders, is that included as part of the tech? I mean, I love the simplicity, I think the importance of just hey, it’s just this you need nothing else, I think is absolutely essential. But does it include some capabilities to say nudge before you get a further intervention that says, let’s check up because, you know, rightly, there could be some very valid reasons that they stop, and you sort of cited some of those earlier.
Chris O’Brien
Yeah, it does. So the smart ball itself has, has some soft lights that can be set up to go off a little bit before your scheduled dose time, there’s a time this version of it that can be set to go off after a certain number of minutes if you’ve missed your dose. And then because we’re connected in real time to the back end platform, if the program can also be set up. So there’s automated text messages to remind people to take a medication and people It’s funny, when you send someone an automated text message, they don’t always know it’s an automated text message. And so we’ll get a text back and it’ll say things like, Oh, I’m at dinner, I’ll take it when I get home. Great, you just you’re talking to our computer, but but we read them anyway. And, and then, you know, there’s automated voicemails as well, or phone calls in the case where someone doesn’t have texting, which is a surprising percentage of a lot of these populations, actually. And we think all those things help and and I think, you know, text messages, programs by themselves, you know, are better than then then nothing. You know, I think a lot of pharmacies deploy them now. But but it’s really the knowledge of what who’s having issues today who’s adherent and who’s not that makes a difference.
Nick van Terheyden
Right? So I think, you know, there’s a compelling argument here for the simplicity of this. You know, what I heard you say, as a reusable tool, so I get my device. If that’s the case, and perhaps over the course of time, my medications change, or perhaps my dosage changes, is that programmability incorporated so that I don’t have any, I don’t have to deal with it, because you talked about this as a pharmacy programs, can they still do that remotely, given that it’s a connected device?
Chris O’Brien
Well, it’s generally each specific bottle is intended for one medication, if it’s deployed by a pharmacy, it’s typically receives a secondary label with the name of that medication. And that’s important, because, you know, we’re working in, you know, a lot of specialty oral solids. And, you know, you see, you think oncology meds and some of these meds are actually quite toxic, you’re supposed to actually put gloves on before picking them up. And you wouldn’t want to switch, you know, aggregate to put your hypertensive meds into that model that just that wouldn’t be saved, especially if you’ve been transferred to another medication. So typically, if a patient is transferred to new medication, if it’s one that we are supporting, they then receive a new bottle for that for that medication.
Nick van Terheyden
So various bottles, you know, obviously, the ability to expand this, you’ve started in, I guess, intense areas, maybe high cost areas. how cost effective is this? Because, you know, the economics of this has to work. But, you know, as you think about this for other meds, you know, you’ve cited diabetes as an example. And we still have compliance issues in there. And it is important, is this something that has the potential to help solve those problems in the future?
Chris O’Brien
We think it is. You know, I think one of the the genius of the founders here is again, first of all, they made it super simple for patients. But they also figured out how to align economic incentives and at least one corner of the market. So the way that we’re going to market today is in working with specialty pharma manufacturers. You know, there are about 200 oral solids, pills and capsules on the market in the US today, at a at above $1,000 A month price point, which is where the economics for the manufacturer make a lot of sense. And it’s pretty simple for the manufacturer, we’re getting one to two additional prescription fills on average per patient per year. So you think of a medication that costs $10,000 a month, very common price point, you know, attended $20,000 in additional revenue, we’re charging you a small fraction of that, you know, literally the pharma manufacturers are seeing you know, 10x or more return on their on their spend with us. And so it makes a lot of sense for them it but of course all that would have been through it 10 years ago as well, what’s different now is that we can actually cost effectively manufacture of medical grade smart pill bottle. And at the end, we can recruit patients because the pharmacies are all themselves becoming subject to value based care arrangements, either with the larger healthcare entity or they’re apart. So they’re really motivated in a way that they, of course, have always cared about keeping their patients adherent. But that doesn’t mean they had economic incentive to do so, even 510 years ago, and now they do so it is, in fact, a very different world, from the ability of getting all of the incentives aligned. And so again, back to the manufacturers, they’re getting that one to two additional sales in the year. But even more importantly, in many of the cases we work in, they’re keeping 30% More patients on the drugs that we work with, at the end of 12 months. In some cases, we just saw a 50%, and then oncology drug. So it’s a spectacular improvement for patients. These are first line drugs. So those are patients not proceeding to chemotherapy or surgery or worse. But it’s also amazing for the pharma company, because they spent all this money developing or licensing a drug, and then have patients start taking the bad side effects too much later, they drop off. And so that’s really what drives the economics for them.
Nick van Terheyden
So you mentioned an endpoint there that, you know, is useful. So people staying on the drug and continuing to take it. One that interests me a little bit more is, you know, does that endpoint translate into better outcomes? Have you studied that as well? And where do you see this going?
Chris O’Brien
Well, I think, you know, today we’re growing within the specialty pharma manufacturer category. But what’s amazing about the world today, as there’s so many primary care groups that have gone at risk now or standing up their Medicare Advantage plans, and my mom was a pediatrician. And I remember as a kid, she would just complain so much about those terrible parents who wouldn’t give the kids the antibiotics she prescribed. And so doctors and other clinicians have always cared. But now we have groups like Oak Street and others that have validated, it’s powering ACO networks. So there’s all these are these groups now that have budget incentive product teams. And so it’s not a market that we’re working in yet. But we’re in early conversations now, with at risk health systems about supporting their patients, high risk patients on diabetes, recently discharged heart failure. And, you know, we’ve seen in academic studies that the adherence type programs can work for those populations. But we don’t yet have the claims data that would show at scale, that we can, in fact, avoid hospitalization, even though the scale of the adherence increases we’re creating indicate that that we should be able to and so that’s really the next step for us.
Nick van Terheyden
Huh, interesting. And from an endpoint standpoint, have you seen the value based translate into better outcomes as well?
Chris O’Brien
So we we have, we have hints of that, just because, in some cases, we’re seeing the patients who stay on therapy have reduced medical claims, but we don’t have as hard data now as we want to. And is it the specialty pharma manufacturer case is sometimes small population oncology, schizophrenia, cases that are not necessarily the highest cost area, to say, in urban health system of the kind we have here in New York City, you know, they want to talk about afib. And cases where they have hundreds of 1000s of patients with heart failure or potential heart failure. Right. So it we’re rejet, we’re looking to generate data now with some of our partners around these other, you know, much broadly based chronic conditions to start to show those outcomes at scale.
Nick van Terheyden
So do you think that the economics work for a broader set of therapies beyond the sort of very specialty high value
Chris O’Brien
we do, and especially because there’s so much now we’re at this point where the components that we’re buying are getting cheaper every year, and if you think out three to five years, we’re going to be able to deploy these programs at a much lower overall cost, which is going to be important as we’re working with these larger patient populations, because without using the pricing, you know, far especially pharma manufacturers willing to pay a certain amount because the drug is so expensive. If you have a large if you’re a large population of patients with diabetes, heart failure, you’re just not willing to spend that much per patient. I mean, you’d love to but the economics, it may not work for your business. So we’re driving what will drive cost down over the next three to five years, and that will let us work at at much greater scale.
Nick van Terheyden
Interesting. Well, unfortunately, as we do each and every week, we’ve run out of time, so it just remains for me to thank you for joining me on the show. Chris. Thanks for joining me.
Chris O’Brien
Thanks so much for having me. It’s been a pleasure.
