Walgreens’ Balance Rewards for Healthy Choices program, a set of web, app and text-based programs designed to improve medication adherence, activity and immunization, among other things, may be simple, but it appears to be working.
 
In addition to high engagement rates with the app and positive reviews from users, Walgreens has found the use of its Balance Rewards program, which operates similarly to an airline miles-earning program, translates to real health improvement.

“Every second we fill a prescription from a mobile device scan, we get 8- to 10,000 pharmacy chats through the smartphone and we have over 40 partners on the platform,” Walgreens Digital Division Vice President Greg Orr said during a presentation at the Digital and Personal Connected Health event at HIMSS 17 in Orlando. “We’ve now had over 3 billion points awarded and over 1.25 million connected apps and devices and about $3 million in discounts given out to people purely from tracking their behavior.”

While the tracking isn’t clinical remote monitoring, it promotes self-awareness, Orr said. And as patients learn more self-awareness and interact with the Balance Rewards program more, Walgreens learns more about their customers.

“We have a lot of data at Walgreens that can be integrated, so we start with Balance Rewards Healthy Choices data only and ask, ‘What can I draw out from that?’” said Michael Taitel, Senior Director of Health Analytics at Walgreens. “We think of what we can segment from the population, then what we can merge with pharmacy data. We may have a million people looking at trackers and walking, but how do we blend that with data about diabetics? What about those with hypertension? I can look at what prescription they are filling and see with a pretty good degree of accuracy what condition they have.”

Sharing data from a collaborative study Walgreens conducted with Scripps Translational Science Institute, Orr said Walgreens found users vastly prefer automatic reminders and tracking compared to manual logging, from activity logging to medication adherence. 

The two organizations looked at activity tracking data from over 450,000 Balance Rewards Healthy Choices users, 315,000 of whom were first-timers. They found 77 percent of users manually recorded their activities and participated in the program for an average of five weeks. But those getting automatic activity-tracking from connected devices or apps stayed in the program for four times as long.

There was an initial, dramatic drop-off by about 50 percent of users by the third week, but numbers stabilized after that and those who remained tended to stay engaged.

“It drops off really quickly, and in some ways, that’s ok, because it’s an opportunity to engage those who stop participating,” said Taitel. “But the other half was still tracking, and they are tracking, on average, eight or nine activities.”

Walgreens is able to get robust datasets that show the digital extension of the pharmacy retailer’s capabilities is making a difference for those with three of the most common chronic conditions: diabetes, hypertension, and cardiovascular disease.

“We want to see how digital programs impact adherence, and then look at how adherence impacts their biometrics,” said Taitel.

Looking at the relationship between activity tracking and antihypertensive medication adherence among members aged 50 and older, those who were using the program improved their adherence by 12 percent.
 
“That movement is huge,” said Taitel. “That’s getting at the level of 80 percent adherence, which is what is considered a therapeutic dose.”

People enrolled in the Balance Rewards program were also more likely to keep up with their flu shots, the data showed. Compared to about 9 percent of a control group, 17 percent of those using a Balance Rewards program got a flu shot.

“That’s the difference of a more loyal, engaged patient group – they are almost 100 percent more likely to get a flu shot,” said Taitel. “Now, of course that is only tracking those who get their shots at Walgreens, so some people may be getting them elsewhere like at their doctor’s office or [a competitor]. We haven’t displaced these other options entirely.”

Taitel acknowledged that the data sets contain a lot of selection bias, and said Walgreens is looking to do more controlled studies wherein they are able to randomize by reaching people through email and text messages rather than the app, which is designed for everyone. That being said, Walgreen’s position as a retailer does offer another level of detail a traditional clinical study doesn’t.

“The unique asset of Walgreens is that we have this ability to look at point of sale data, “ said Taitel. “We can learn of more ways to engage them by what they are purchasing at the stores. So, say we already know they are diabetic and getting medication there, but what if they are also getting a lot of allergy medication? Or, what if they are buying a lot of potato chips even though they are on heart medication?”

The level of detail gets more complex from there, Taitel said.

“We have external data. We know where every patient lives, we can segment by census data, we can see educational levels … then we can look at the impact on their healthcare utilization and cost,” he said. “A lot of this is descriptive, but we do engage in a lot of studies that are empirical.”