How is a patient’s customer value proposition related to patient adherence?

A recent study, published in the American Journal of Cardiology, illustrates the connection between a patient’s customer value proposition and that patient’s adherence.

Researchers examined Medicare data on more than 13,000 adults who had been hospitalized for a heart attack or severe chest pain caused by caused by diseased heart arteries. More than 70% received heart bypass surgery or angioplasty. The remaining 30% received medication only — including blood pressure drugs, blood thinners and drugs to control heart rate.

What was common among all of the study patients was that they all were prescribed a statin — and, here’s where the study gets interesting:

  • 70% of the surgery patients fully adhered to their statin prescription for a year; but
  • 79% of the medication-only patients were adherent to their statin medication.

If anything, the presumption would be that the surgery patients would be more adherent than the medication-only patients. As one of the researchers, Dr. Niteesh K. Choudhry (Brigham and Women’s Hospital and Harvard Medical School) admits, “Truthfully, we were quite surprised by the finding.”

So, what accounts for the difference in adherence?

Marketers tell us that we choose to purchase products that have for us the greatest customer value proposition. As the article, “Customer Value Propositions in Business Markets”, published in the Harvard Business Review, reminds us:

Prospective customers must see convincingly the cost savings or added value they can expect from using the supplier’s offering instead of the next best alternative. [my emphasis]

So, when the study patients (both surgery and non-surgery) were prescribed the statin therapy, what cost savings or added value did they expect to get from the product?

Cost savings is clearly not a factor — after all, the prescription for a statin required the expenditure of money. (Having said that, statin drugs can cost from $11 to $200 per month, according to Consumer Reports.)

So, was there added value?

For some of the study patients there was added value; for others, there wasn’t. As Dr. Choudhry explains:

It’s not clear why surgery patients were less likely to take their statins. But one possibility is that they were less likely than medication-only patients to have ongoing problems with chest pain. Without that symptom, some might think their medications are unneeded. They might think, ‘I underwent this procedure, and now I’m fixed.'”

The “productization” of treatments has made them, unfortunately, just another commodity to be purchased. Moreover, for asymptomatic treatments (in the study, the “no chest pain, no take medication” group), the customer value proposition plummets. Perhaps some might even argue there is no customer value proposition for these patients?

Do you agree or disagree? Would love to hear your thoughts!

4 Responses to “How is a patient’s customer value proposition related to patient adherence?”
  1. ‘I underwent this procedure, and now I’m fixed.’
    I believe this statement can most clearly surmise the reason why the surgery patients were less adherent than the statin only patients.
    Also, the statin only patients may be more adherent to the medication regimen in an effort to avoid a costly and scary surgery. While those who already had a surgety may simply think ‘I already did the surgery once, and it fixed me. I can do it again.’
    I see patients quite frequently who have multiple by passes done years apart, multiple caths with stents, and yet still aren’t always compliant with their medications. Many of them do not even know the medications they take, their names, or what they are taking them for. The answer “I don’t know, my daughter handles all that” is uttered all to frequently when I perform an admission assessment.
    The key to promoting greater adherence with these patients is to promote a greater understanding of the conditions that requires the medication, the mechanism of action of the medication, the long and short term benefits of the medication, and the risks associated with noncompliance. We need to take the time to explain, in real world, easy to understand terms, why the patients need the medicine and state to them very bluntly, but with the ultimate care and concern the risks they are taking if they choose to not take the medicine.
    As healthcare providers, it is our responsibility to make sure that the patients understand their medical conditions and the reasons they are being prescribed medications.
    People are often naive and ignorant, and in order to avoid appearing uneducated or uninformed, they will not ask questions. It is our job to answer the questions without them having to ask. Take away the embarrassment for them.

  2. Chris Lovell says:


    Interesting article. Adherence to medication based on perceived value does make sense and obviously problematic for unseen dangerous condition such as high cholesterol or blood pressure where there’s a lack of instant reward for taking your medication.

    Part of any adherence program needs to sell medication compliance (Adherence = compliance + persistency) to the consumer – i.e. why it is impt. to take your meds and at what dose/daily timeline. Persistency stimulates repetition of the compliance act over the allotted time frame.

    What intrigues me is why would someone whose had their chest cracked open not follow up on their statins considering the high likelihood that high cholesterol was part of the reason they got the surgery in the first place? Is it depression (high proportion of chest surgery recipients suffer from it, confusion (definitely an under looked issue for the elderly because most anesthesia meds are highly lipophilic and elderly take much longer to get those meds out of their system) or the feeling that my issue is sorted out by the surgery.

    The article suggests that the latter might be the issue – pain goes away so therefore I’m cured but I believe that our healthcare system is to blame – cardiothorasic surgeon or intervention cardiologist does the procedure, minimum follow-up, here’s your statin prescription and be on your way.

    What follow-up is there unless the patient enrolls into a drug sponsored adherence program or get a follow-up phone call 3 months after the event from the healthplan asking if they are OK?

    I know this is turning into somewhat of a rant but we break our patients into systems and bill accordingly. Highest cost procedure takes the attention of the provider therefore that’s where we focus resources. The sooner we get to an Accountable Care Organization structure, the better IMHO.

    Chris Lovell
    MedWorks Consulting LLC

  3. Mayur R Joshi says:

    I have read the article and I believe that there are a number of reasons why there may be a discrepancy between the two groups though it is difficult to pinpoint one over another.

    Without seeing the methodology behind the results it would be difficult to communicate one way or another.

    For example, it could be as simple as Surgeons aren’t as good at communicating. Surgeon led care is traditionally less holistic than physician led care care. Communication styles between surgical and medical specialities is very different and this can be the reason between the two.

    Alternatively it could very well be that there was a different value proposition between the two groups. There may be a feeling that surgery has offered a cure so patients are more inclined to question the need for treatment.

    There’s also the issue of ongoing care. Traditionally, surgically led teams will invariably focus on the pre-op/post op care and associated complications of surgery, which is only natural. The desire to ensure that any complications are avoided means that less time is spent focusing on the medical care which is usually dealt with by a cardiologist. It would be intriguing to see the level of involvement of the cardiologists in the patients who underwent surgery.

    Unfortunately medical care has always been a complicated and multidimensional process (even more so now) that without a look at the full data I would find it hard to decide one way or another.

    There is certainly an argument for the fact that medicines have become another commodity that requires a value proposition for the customer and this would invariably impact on compliance and I personally believe that education and communication are the main tools to combat this lack of compliance and adherence to medication.

Check out what others are saying...
  1. […] statins for a year while 79% of those who didn’t have surgery stayed adherent. (thanks to Box Cutters for sharing […]

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