Lack of Medication Adherence among Patients [Interview][Transcript]

Neil_Smiley_Medication_AdherenceGuest: Neil Smiley

Presenter: Neal Howard

Guest Bio: Neil Smiley founded Loopback Analytics in 2009 to deliver an advanced Software-as-a-Service platform healthcare providers can use to prevent costly readmissions. Smiley holds a computer science degree from Dartmouth College.

Segment overview: In this health supplier segment, Neil Smiley, CEO of Loopback Analytics, talks about how hospitals, pharmacies and physicians need to standardize the way they share data because inconsistencies in data sharing leads to an inaccurate analysis on why patients aren’t adhering to medication.


Health Professional Radio –

Neal Howard: Welcome to the program. I’m your host Neal Howard here on this Health Supplier Segment on Health Professional Radio, thanks for joining us today. In this Health Supplier Segment, CEO of Loopback Analytics is returning as our guest today Mr. Neil Smiley and he is here to talk about how inconsistencies in the sharing of medical data leads to a lack of medication adherence among patients. Welcome back to the Program Neil.

Neil Smiley: Great to be here.

N: Now, what exactly do you mean by medication adherence?

S: Just the degree to which patients correctly follow the prescription instructions that have been given to them by their doctor or other healthcare provider.

N: So it’s simply just taking it as prescribed? Is this lack of adherence to taking medications as prescribed, is this something that has escalated in the past few years?

S: Well it’s been a long time problem, so it’s certainly not something new. I think what you’re saying is just as the population is getting older, that older patients typically take more complex medication regimens so as you have more prescriptions to take, then adherence is just more difficult. So it’s becoming a bigger problem for our perspective.

N: Are we talking about medications for specific types of ailments, mental health medicines? Or are we talking about all medicines across the board once you reached a certain criteria like age as you mentioned?

S: Well the biggest challenge and opportunity is these chronic maintenance medications. So these are folks that would have heart failure, or cholesterol challenges, things like that, of which they have very effective treatments, but if they’re not taken, then of course you don’t get the benefit. And then, there’s also more acute treatments and by that I mean things that are more episodic for example you have an infection, you have to take your antibiotic treatment. If you don’t continue that course, then obviously, you’re not going to get better.

N: What do you think contributes to a patient just simply not wanting to take their medication as prescribed? I mean a lot of us get on the internet and decide, ‘Hey, maybe I’ll take half of this pill rather than all of it’ or maybe I won’t take it all because of the way it makes me feel, I just won’t say anything about it’.

S: Well, that’s used to be a term medication compliance and the whole word ‘compliance’ suggests that somebody is uncooperative. And I think so much in the time, folks aren’t taking their medications not because they don’t want to or they’re trying to resist the doctor’s orders. It’s just that it’s a challenge for them and so things can break down all along the way. So maybe a prescription is written but it never makes it to the pharmacy or I guess the pharmacy and the patient fails to pick them up, they don’t have transportation or maybe there’s economic barriers. So the first part of the process is, ‘How do you just make sure the patients get their meds on a timely basis? And then they’re consistently refilled.’ And of course on the next stage to that is once you get your medications, taking them correctly, and there are sometimes the breakdown is because patients get confused. They take old meds as well that have been cancelled and bought a new ones, or they’re taking the wrong quantities, wrong time of day, all kinds of ways to which things can break down.

N: Well aren’t our physicians trained to help us? I mean, once we get to a certain age and maybe we get forgetful or maybe dementia or Alzheimer’s is an issue and maybe we just have one person at home to help us out. Aren’t our doctors, and nurses, our support group at that time and even when we’re under their care at all, why do you think that our healthcare providers, our pharmacies aren’t helping a little bit more?

S: Well I think the healthcare providers do take this very seriously. But anyone that has chronic conditions with a lot of different points of care going on, it’s not just one doctor. They may be in the other hospital, they go to emergency department and they may have a skilled nursing involved, called health agencies. So all of these different players along with the patient’s own family caregivers represent a diverse set of folks to coordinate across.

N: Well aren’t there already standardized procedures as far as data sharing is concerned patient to patient or in facility to facility?

S: So this is an area where there’s tremendous opportunity for approval. Generally, healthcare is still delivered in silos. And so just because they have your records in the hospital, but it doesn’t mean those records get to your primary care physician or vice versa. And so, that each of those different care settings generally they do work to do medication adherence but you’d be surprised, some often it’s just dump out of bag of pills and start counting and also a very high reliance on patient’s own self-reported remembrances of what they’re supposedly doing, it pulls back and also have errors involved.

N: I was talking with someone recently and I discovered that healthcare facilities, providers, the way that they perform a certain operation or the way that they do triage in ER (Emergency Room) is kind of their brand. Is that sort of playing a part in this breakdown of data sharing? Is it something that is just being overlooked or is there a deliberate reason why there exist this opportunity to standardize data sharing?

S: Well I think there’s a lot of talk about changes and reimbursement in the healthcare. And under a fee-for-service environment which is where we’ve been for the last 20 years. Each different provider is basically paid to do just their own thing. And when the patients then pass along to the next care setting, it’s the responsibility of the next guy. And what you’re saying now is more repay for value, which I think is really helping to align networks of providers to work more cooperatively, thinking across the whole continuum of care. And it’s not until some of these new incentives are emerging that there’s really good alignment in terms of data sharing. So I think we’re seeing more progress now than before.

N: Okay, so basically, what you’re saying is if everyone as far as the pharmacies, the hospitals, the clinics, I guess even the home healthcare providers with get on the same page as far as this particular patient or that particular patient – their needs, their meds, their schedule – then this adherence would be much easier to adhere to, yeah?

S: Totally. Right, so many of these providers they know what they’ve prescribed, but they lack this ability what other providers that are also involved with that patient are doing. And so this is where so many of the collisions happen and also about the patient may be getting different kinds of directions or input from different parts of that care team that aren’t talking to one another.

N: Well how is Loopback Analytics taking steps to fill this gap if they haven’t already?

S: It’s certainly worked in process. So there’s going to be a long road to really get it to where it needs to be. But one of the things that Loopback Analytics does, is that we connect providers across the care continuum. So as I mentioned before, so if the hospital, the physicians, physical nursing, facilities, home health, these represent different care settings perhaps owned by different financial organizations. Loopback can connect these different care settings together, so that we’re tracking a patient as they move from one care setting to the next and enable better care coordination.

N: Now is this a closed network or is this accessed through the internet anywhere around the world if you have access to the internet?

S: It’s a hosted solution, so that if you have the right credentials, you can get access to it, if you have an internet connection. We integrate with a lot of different electronic health record systems and others and we are doing some really fascinating emergent work for people starting to recognize that patients at high risk sometimes do cross paths between mental health authority, community based organizations, the classic healthcare system, and even locations like jail and criminal justice. So the challenge with this is it isn’t just technical or a lot of these are very complex data sharing agreements that have to be worked out. And of course, incentive of alignment is important as well, that each of these different folks either part of this care continuum need to see that their interests are protected.

N: Are the interests of the caregiver that is at home, the family member, the spouse, the adult child of the patient – is there support for them? Efforts to bring them on-board as far as this platform is concerned? Or is this something that is just for credentialed facilities, pharmacies, clinics, hospitals, and then is up to the caregiver at home to get information from the last source?

S: I think our company’s focus has been primarily on networking providers together but I think our customers, basically, these provider groups very much appreciate the incredibly important role that caregivers play. Particularly with patients that have dementia and other challenges, that the involvement of the caregivers in medication adherence is just essential.

N: I know that you said that one of the criteria is age-related and we’ve been talking about dementia, we touched on it a couple of times. Is this something that you see rolling out in elder care facilities first in order to see how things are work and how works some of the bugs that as it were? Or do you see a launch across the board wherever the need is found?

S: Well I think that patients that are most vulnerable tend to be the ones that are landing back in the emergency department, becoming re-hospitalized, high rate of readmissions, and when they get very sick then frequently they are involved with skilled nursing facilities and assisted living facilities. So a big part of our focus is wiring up the network between these acute and prosecute care of facilities that care for these very sick and fragile patients. And each of these touch points of course, our major focus is on medication adherence. One thing I didn’t mentioned is that there’s a terrific opportunity to leverage data in order to create predictive algorithms, where computers are assisting in proactively identifying patients that are high risk of medication adherence failure. And that really helps these providers that are caring for these patients to basically direct scarce resources and provide appropriate interventions to fend off problems before they occur.

N: Now where can our listeners get more information about Loopback Analytics and the steps that they’re taking to address medication adherence?

S: So listeners can go to our website, it’s and certainly medication adherence is a major focus of what we’re doing now but also into the future.

N: Neil Smiley, it’s great talking with you again today.

S: Alright, thank you Neal.

N: Thank you. You’ve been listening in the Health Professional Radio, I’m your host Neal Howard on this Health Supplier Segment. In studio with Neil Smiley, CEO of Loopback Analytics, a care transitions management platform and we’ve been talking about inconsistencies of the sharing of medical data that leads to lack of medication adherence among patients. Transcripts and audio of this program are available at and also at, you can listen it in on SoundCloud and download, and you can subscribe to this podcast on iTunes.

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