Making Medicines Work For All: How Clinicians Are Using Pharmaco-Clinical Intelligence to Personalize Medication Management
Medicines are intended to help us live longer and healthier, and to feel better. Sometimes, despite the best intentions, that doesn’t happen. Medicines can be taken in a way that makes them less effective. They can have unpleasant or dangerous side effects, as well as put a patient at risk of adverse events when mixed with other drugs or supplements.
Complicating matters, different people taking the same drug can have markedly different responses to the same dose. While many people will get the intended effects, some may get little to no benefit, and others may get unwanted side effects. No two patients are the same — body size, genetic mutations, and underlying disease influence how well medicines work.
As physicians, patients, and caregivers, this presents us with a complex challenge. How can we make sure the medicines we’re prescribing, taking, or administering to our loved ones are safe, appropriate, and effective?
Solving this challenge is FeelBetter’s raison d’etre. The company has set the goal of tackling the common and particularly complicated challenges associated with suboptimal medication management among patients with co-morbidities who take multiple drugs.
A Personal Mission
Like so many caregivers, the company’s co-founders Liat Primor and Yoram Hordan found themselves struggling with the daunting responsibilities of managing their loved ones’ medications. A mutual friend introduced Primor and Hordan, and they decided to combine their different skill sets to address the problem of suboptimal medications.
An engineer by training, Primor, FeelBetter’s CEO, is a 13-year Teva veteran who most recently served as Global Vice President of the company’s Global Generic Medicines portfolio. Hordan, also an engineer, was a Vice President at Amdocs, a COO at VATBox, and a Senior Vice President at Comverse before co-founding FeelBetter, where he is now CTO and COO.
“Caregivers, many of whom have other responsibilities inside or outside the home, typically lack training, resources, and support in their role as medication managers,” Primor explains. “However, they are not alone. In the current practice environment, doctors face mounting demands on their time as well as other limitations, which make personalizing medication management for each patient a tremendous challenge.”
From entering notes into EHRs to dealing with insurance issues to working with staff on practice management, there’s a wide range of administrative tasks outside of face-to-face patient visits and follow-up calls that a doctor must manage during a given workday, and the list is only growing. A recent study published in the Journal of General Internal Medicine found that to provide guideline-recommended care, a primary care physician would require nearly 26.7 hours per day [1].
“There are literally not enough hours in the day, and this has become a major problem when it comes to care delivery in nearly every context,” Hordan adds. “And whatever is felt in urban areas is amplified in rural communities in terms of time and resource constraints, not just for physicians but for all medical staff.”
Complicating matters, across the US and around the world, there is a huge primary care physician shortage, increasing the demands on providers who are practicing and already have long patient rosters, and even longer waiting lists. This bandwidth challenge is further complicated by pressures on physicians to increase their responsibilities, abide by new guidelines, and continue to maintain high patient satisfaction scores, all while the cost of care skyrockets as the population ages.
For already overwhelmed physicians, the capacity to comprehensively and proactively guide and personalize medication management is an ongoing struggle and, ultimately, the party that suffers the most is the patient.
“This is a particularly pressing problem when it comes to treating patients over the age of 65, who are likely to have multiple chronic conditions, each contributing, along with normal aging, to their overall health status,” Primor notes. “A patient comes in for treatment and reports taking several medications — typically prescribed by different specialists — that might include a drug for high blood pressure or heart disease, an antidepressant, and something for diabetes. That individual may also take frequent doses of over-the-counter pills to relieve pain, an upset stomach, or allergies, as well as a host of daily vitamins and supplements.”
In such a complex, fragile population, with multiple, complex issues in play at any given time, medication management can be detective work for physicians, requiring them to carefully untangle the overlapping issues of each patient. It’s also daunting for patients and their caregivers to stay on top of the medicines prescribed and why they are needed, as well as managing possible side effects.
Technology’s Role in Simplifying Medication Management
A growing public health concern, the simultaneous use of multiple medications paves the way for poor health outcomes, increased use of health services, and rising care costs. In the US alone, suboptimal medication management also leads to more than 275,000 deaths annually at a cost of $528 billion [2].
A 2019 report from the Centers for Disease Control and Prevention indicated that one-third of older Americans in their 60s and 70s take five or more prescription drugs, most commonly to manage cholesterol, high blood pressure, and diabetes [3]. Research shows that medication-related issues result in 10–30% of elderly hospitalizations and of those 50–80% are preventable [4, 5, 6].
Beyond non-adherence, there are other major challenges when it comes to medication management. Patients experience adverse reactions. Sometimes medication doses are too high or too low, sometimes different or additional drugs may be needed, and sometimes the prescribed medication is the wrong one. There are also cases when therapy is unnecessary, such as prescribing cholesterol medications to a 90-year-old patient with advanced disease who will receive little to no therapeutic benefit from taking them.
“The time has come to rethink medication management,” Hordan says. “It requires a more personalized, comprehensive approach that goes beyond a single illness, diagnosis, or point in time, and focuses on the individual patient’s care journey. And technology will play a critical role in enabling this approach.”
FeelBetter’s interdisciplinary team of clinicians, pharmacologists, and technologists developed a SaaS solution that can be used to ensure the medicines people take are safe, effective, and appropriate, aiding providers in monitoring their patients progress and more proactively delivering the right follow-up care. It’s also designed to help providers more effectively and efficiently allocate resources to better serve patients, and minimize preventable, costly use of healthcare services.
“Our goal is to enable providers to make more informed decisions that reduce the risk of harm, support patient safety, and improve quality of care,” Primor explains.
Changing the Polypharmacy Paradigm with Pharmaco-Clinical Intelligence
To meet this goal, FeelBetter has defined a new category of technology. It combines novel pharmacology and clinical capabilities, changing the polypharmacy paradigm on both an individual and population health level.
Powered by AI, FeelBetter’s SaaS solution synthesizes and analyzes pharmacology data from multiple sources, including government and commercial databases. The solution is also proactively updated with the latest clinical guidelines for different chronic conditions and treatments as they are released. FeelBetter leverages this information for patient-specific analyses, in addition to longitudinal healthcare data from electronic health records, laboratory results, pharmacy purchases, medical claims, physician visits, and care events. Additionally, FeelBetter leverages social determinants of health data to enhance the precision of the analyses and recommendations provided by its solution.
“The unique value of our system lies in its ability to combine pharmacology and clinical data, which closes a critical information gap,” Primor says. “We look at individual medication side effects, drug interactions and contraindications, inappropriate dosing and poor adherence and, at the same time, also factor in information on comorbidities and abnormal lab results, as well as the patient’s longer-term medical history.”
Enabling a comprehensive approach, FeelBetter’s Pharmaco-Clinical Intelligence pinpoints patients at high risk of deterioration and preventable hospitalization due to suboptimal medication management, and proactively suggests immediate and actionable interventions to reduce these risks.
Bringing the Power of Precision to Population Health
“When it comes to medication management, like all areas of medicine, there is no ‘one-size-fits-all’ approach,” Hordan notes. “There’s a critical need to go further — beyond uncovering and closing gaps in care among people with a unifying characteristic, whether a specific disease, geographic area, or site of care — to focusing on improving health outcomes for individual patients. Today, armed with the right tools, we can accurately distinguish between patients with conditions that are well managed, those in need of additional support, and those who are at risk of deterioration, taking into account each individual patient’s medical history and specific health risks.”
A shift to precision population health will enable the medical community to personalize medication management and target healthcare resources where they are most needed and will be most effective. With solutions such as FeelBetter, physicians can leverage actionable insights to proactively manage patients individually throughout their care journeys, reduce safety risks and costs, and deliver on the promise of value-based care. The result is a win-win — better outcomes for both patients and health organizations.
References:
[1] Porter, J., Boyd, C., Skandari, M. R., & Laiteerapong, N. (2023). Revisiting the Time Needed to Provide Adult Primary Care. Journal of general internal medicine, 38(1), 147–155. https://doi.org/10.1007/s11606-022-07707-x
[2] Zullig, L. L., Blalock, D. V., Dougherty, S., Henderson, R., Ha, C. C., Oakes, M. M., & Bosworth, H. B. (2018). The new landscape of medication adherence improvement: where population health science meets precision medicine. Patient preference and adherence, 12, 1225–1230. https://doi.org/10.2147/PPA.S165404
[3] Hales, C. M., Servais, J., Martin, C. B., & Kohen, D. (2019). Prescription Drug Use Among Adults Aged 40–79 in the United States and Canada. CDC/ National Center for Health Statistics Data Brief. https://doi.org/347
[4] Thomsen, L. A., Winterstein, A. G., Søndergaard, B., Haugbølle, L. S., & Melander, A. (2007). Systematic review of the incidence and characteristics of preventable adverse drug events in ambulatory care. The Annals of pharmacotherapy, 41(9), 1411–1426. https://doi.org/10.1345/aph.1H658
[5] Beijer, H. J., & de Blaey, C. J. (2002). Hospitalisations caused by adverse drug reactions (ADR): a meta-analysis of observational studies. Pharmacy world & science : PWS, 24(2), 46–54. https://doi.org/10.1023/a:1015570104121
[6] Gurwitz, J. H., Field, T. S., Harrold, L. R., Rothschild, J., Debellis, K., Seger, A. C., Cadoret, C., Fish, L. S., Garber, L., Kelleher, M., & Bates, D. W. (2003). Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA, 289(9), 1107–1116. https://doi.org/10.1001/jama.289.9.1107
