Opportunity 

Cardiovascular disease is the leading cause of death in the United States. Statins lower cholesterol and reduce the risk of myocardial infarction by 30 percent, but even among patients who have had a heart attack, nearly half stop taking their statin medications within a year of their initial prescription. The effectiveness of statins on a population level is also limited due to underprescribing by physicians. 

Intervention 

A team of researchers at the University of Pennsylvania leveraged Way to Health to test whether physician financial incentives, patient incentives, or shared physician and patient incentives are more effective in reducing levels of low-density lipoprotein cholesterol (LDL-C) among patients with high cardiovascular risk. 

In this randomized controlled trial, primary care physicians were randomly assigned to a control, physician incentives, patient incentives, or shared physician-patient incentives group. The trial enrolled 340 primary care physicians and 1,503 patients. 

• Physicians in the physician incentives group were eligible to receive up to $1,024 per enrolled patient meeting LDL-C goals.  

• Patients in the patient incentives group were eligible for the same amount, distributed through daily lotteries tied to medication adherence.  

• Physicians and patients in the shared incentives group shared the incentives.  

Adherence was measured through electronic pill bottles. When bottles were opened, a signal was wirelessly transmitted to the Way to Health platform. 

Impact 

Shared financial incentives for physicians and patients, but not incentives to physicians or patients alone, resulted in a modest but statistically significant difference in the reduction of LDL-C levels after 12 months. Adherence was also higher and more sustained for patients in the shared physician-patient incentives group.