A Rapid Response: From Digital Adherence Programs to COVID-19 Monitoring
In 1985, former Surgeon General C. Everett Koop stated, “Drugs don’t work in patients who don’t take them.” This observation has continuously been reinforced for decades by evidence-based research about medication nonadherence. More than thirty years later, medication nonadherence is considered one of the most critical challenges in the healthcare system, burdening every constituent in care. Healthcare costs related to nonadherence exceed $300 billion annually, yet actual adherence can only be measured on a dose-by-dose basis -- not the industry standard, commonly referred to as “primary adherence” which is often measured through the analysis of pharmacy fill and refill data. Due to the advent of technology and e-prescribing, clinicians are able to track if patients fill new prescriptions, and identify prescribed medications that were never filled. Yet medication possession does not equal adherence; it is an indirect and imprecise measurement. Many patients may pick up their medications but do not take them or take them incorrectly.
A validated solution to confirm dose-by-dose adherence and support patients throughout treatment is practiced daily by public health experts all over the country: Directly Observed Therapy (DOT), wherein a healthcare professional watches a patient take every dose of medication. The practice involves more than merely observing someone take medication — it is a system that includes case management, coordination of medication delivery, and compassionate coaching and support by healthcare professionals. While DOT is well-established as among the most effective methods to achieve high medication adherence rates and facilitate better patient outcomes, it is not without its challenges. By leveraging the power of video technology, emocha retains the benefits of DOT while also extending the reach of providers. Research validates that in underfunded and over-burdened health departments across the country, emocha’s technology has alleviated common transportation, scheduling, and resource barriers, and made DOT affordable and scalable while achieving medication adherence rates greater than 90 percent.
emocha Health uses video Directly Observed Therapy (video DOT) to empower patients to take every dose of medication, improve adherence, and combat health challenges through a combination of scalable video technology and human engagement. Our video DOT service has been clinically validated to achieve comparable adherence rates to in-person DOT, while conserving public health resources, decreasing patient stigmatization, and enabling increased flexibility for both patients and providers. The urgency of the COVID-19 pandemic has illustrated the crucial role that telehealth services play in ensuring quality and accessible care for patients: with all healthcare stakeholders demanding safe and convenient access to care, we are poised to further expand our reach.
Our video DOT service records patients taking their medication at each dose and enables them to communicate directly with their provider or care team through our mobile app’s HIPAA-compliant chat. The technology includes a patient-facing mobile application and a provider-facing web portal to monitor adherence and side effects. emocha removes the barriers associated with in-person and livestream appointments, with asynchronous technology that allows providers and patients to “meet” without appointments, each on their own schedule.The program includes an emocha-guided onboarding process and a comprehensive medication reconciliation review performed by pharmacists, with daily check-in and engagement at each dose facilitated by adherence coaches and nurses.
Our focus is on patients and disease conditions where medication adherence is particularly challenging, high-stakes, and costly. We address patients that have typically been underserved and marginalized, and where medication adherence can mean life or death. Our platform, initially developed for treatment of HIV in rural Uganda, works in low-connectivity settings which enables patients without strong Internet access to submit video check-ins. Because patients can virtually check in from any location, emocha makes high quality care accessible to those in disadvantaged, remote, and rural areas.
Research data continues to prove the value of emocha’s innovative and holistic approach to adherence. In an NIH-funded Hopkins study, emocha secured 94% average adherence, saved ~$1400/patient, and was well received by staff and patients alike, who cited increased treatment flexibility, convenience, and patient privacy. In the aftermath of Hurricane Harvey, the Center for Disease Control reported that patients using emocha achieved 97% medication adherence whereas those without emocha had to pause treatment, and the CDC likewise reported that emocha’s video DOT platform helped to end a recurring TB outbreak in Puerto Rico. A NIDA-funded study in the Journal of Addiction Medicine showed that patients were satisfied with emocha for opioid use disorder treatment, and a University of Colorado study showed that HCV patients who use drugs for treatment achieve 98% medication adherence with emocha.
Preliminary data from ongoing research with pediatric asthma patients showed 92% adoption by patients and that an emocha nurse was able to remotely handle 96% of issues such as technique errors or drug problems. A study through the University of Maryland Health Plan diabetes program recorded 1,524 virtual medication visits, 86% adherence for engaged members, and 4.6 member satisfaction on a scale of 1-5. We continue to look for new use cases and populations to demonstrate our solution’s effectiveness, and have recently begun using video DOT to measure adherence among patients receiving methadone at a clinic.
Considerable research indicates that there is a correlation between nonadherence and rehospitalizations, particularly with chronic illnesses. While there is no single solution to reduce hospital readmissions, it is indisputable that better medication adherence among all participants in the health care system can help improve patient outcomes and reduce costs for payers. emocha can improve coordination and communication in patient care, to advance towards a future in which the overall health system—and patients—reaps the greatest health, quality, and financial benefits.
In response to the COVID-19 pandemic, emocha rapidly pivoted its medication adherence model to provide a remote monitoring service for symptoms of infection. emocha has extensive public health experience and a proven track record of success in combating infectious disease, and a version of the platform has been used since 2015 to monitor public health outbreaks including Ebola. Our COVID-19 symptoms monitoring service is used by employers, hospitals, municipalities, and educational institutions to monitor employees, healthcare workers, and students; identify symptomatic and asymptomatic individuals; and enable organizations to make timely decisions regarding return-to-work protocols -- while helping to prevent exposure to the virus.
The onset of the COVID-19 pandemic has fundamentally changed healthcare and accelerated emocha’s adoption, as telehealth becomes the new normal for patients and providers. We continue to work to improve and expand our technology-enabled solution for medication adherence, with pharmacists and nurse resources coupled with the addition of financial incentives modules. In 2020, we are continuing to build out our integrations, incentives, and semi-automated communication, and work to achieve our objective of predicting non-adherence in 2021 with targeted interventions to avoid hospitalizations. emocha’s platform has been deployed for new use cases, including in adolescent transplant recipients and for remote monitoring of methadone maintenance treatment in substance abuse treatment. Regulatory modernization, accelerated by the rapid adoption of telehealth during the COVID-19 national emergency, makes this a pivotal time for the company -- while enabling us to expand our services. While we have continued to modify our product to meet clients’ needs, we retain our commitment to human engagement as the cornerstone of our service.