Pascals’s Wager posits that humans all bet with their lives either that God exists, or that he does not. Based on the assumption that the stakes are infinite if God exists and that there is at least a small probability that God in fact exists. He argues that a rational person should live as though God exists and seek to believe in God. If God does not actually exist, such a person will have only finite losses whereas they stand to receive infinite gains or infinite peril if God exists.

Paul’s Wager posits that members of the healthcare triumvirate—providers, payers, and retail pharma—are betting the future of their firms either that consumerism will be the most dramatic change in healthcare in fifty years, or that it will not. Based on the assumption that the stakes are infinite if consumerism exists and that there is at least a small probability that consumerism in fact exists. I argue that a rational healthcare executive should live as though consumerism will create a dramatic change, and seek to act upon it. If consumerism does not prove to create a dramatic change, those leaders will have only finite losses whereas they stand to receive infinite gains or infinite peril if consumerism proves to be what I think it will be.

Anyway, the argument made sense to the voices in my head. There is a football adage that says when you throw a pass three things can happen, and two of them are bad.

So how does consumerism apply to retail pharmacies? When you write a prescription, five things can happen and four of them are bad.

• People fail to fill their prescription (20%)
• People fail to pick up their prescriptions (abandonment 14%)
• People fail to take their medication as prescribed (50%)
• People fail to renew their prescription (+25%)

Of those who take their medications, fifty percent do not take them as prescribed. In addition, over time, many people stop taking their medication.

These failures are so prevalent that we even have a term to describe them—nonadherence. What we don’t have is a term or a plan to correct the failures.

Clearly, some percentage of these failures cannot be fixed. Nonadherence is made up of several factors; cost, co-pays, convenience, side effects. However, user and consumerism friendly tools could make a world of difference.

Technology exists to let physicians know that what they prescribed was not filled. They could be notified that the medication was filled but not picked up, and the pharmacy already knows the medication was not picked up. And physicians and pharmacies can determine whether a medication was refilled.

Physicians and payers and pharmacies could create incentives for adherence. They could provide digital follow up reminders and track the response. They could automatically refill the prescriptions.

All of those things would work to improve the failure rate. But what if there was a personal health concierge available in patients’ homes. It could reside on a PC. It could operate from a smart app, or be tied to a wearable. Heck, it could even function with Siri-like functionality on an Amazon Echo-like device. And if you can deliver the functionality on Echo, you can deliver it through a smart watch, a smart phone, and a tablet.

• “Did you take your Toprol today?”
• “Today is the final dosage of your antibiotic.”
• “Your Niaspan runs out next week. Do you want me to refill it now?”
• “If you refill your Niaspan now, we will reduce your co-pay by fifty percent.”
• “Are you having any side effects from your statin? Please reply, ‘yes’ or ‘no.’ If yes, would you like to speak with a pharmacist?”

All of these things can be done.

They simply aren’t being done.

Every day patients are betting with their lives that they do or do not need to take their medications.  And yes, they are responsible for their choices.  But anyone who does not believe that an Easy Button would improve the process is just being naive.

Consumerism for retail pharmacies.