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Valuable Patient Support
[object Object],Matthew P. Hall , CEO Human Care Systems, Inc. Direct: 617.649.2118 Mobile: 617.501.1818 [email_address] www.humancaresystems.com Matt founded Human Care Systems (HCS) in 2008 in order to impact one of the largest levers in healthcare: patient self-management. HCS was spun-out from the Kerdan Group, a biopharma and medtech  consulting firm.  Matt co-founded Kerdan in 2001.  Prior to Kerdan, Matt ran several healthcare related businesses, worked in venture capital and was a consultant at Bain & Company.  Matt has lived and worked in the US, Europe, Japan, South Africa, and South Korea. Matt has a BA with honors from Williams College.
[object Object]
[object Object]
[object Object],All stakeholders - the high co-pay US patient, Japanese regulator, EU National Payer and physician in Brazil – want one thing:  solutions to meaningful health problems, where the potential upside is worth the cost, risk, hassle and unknowns of the therapy . You might call this the ‘total value equation.’ The opportunity is to pull one of the levers that can impact the equation:  diagnostic or therapy, clinical practice, patient self-management, reimbursement. Valuable Patient Support is about a new type of relationship with patients and families, as well as clinicians. This entails a move from narrow, transactional interactions with these stakeholders to deep, valuable relationships.
[object Object],Levers to impact Value Equation: Real World Outcomes Change diagnostic or therapy Change clinical practice Change patient self-management Change reimbursement Costs  (financial, hassle, safety) Total Value =
[object Object],Source: New England Health Care Institute, Client Conference, May 20, 2008 Health Determinant
[object Object],What doesn’t work
[object Object],Incentives (a/k/a ‘behavioral economics’):  In the long term, monetizing individual behavior results in decreased motivation, self-determination and self worth. As soon as the monetary reward is removed, undesired behavior resurfaces.  Reminders and other one-off tools:   By themselves mail, phone, or device reminders fail to modify internal and external behavioral environments. Antecedent stimuli (reminders) either have no meaning or produce an adverse meaning (nagging) and actually result in avoidance, fleeing and other forms of reactivity. Generic education:  Dense information that lacks interaction and misses opportunities for real internalized education, insight and knowledge assimilation. As a result, patients feel reactive, overwhelmed, and confused.
[object Object]
[object Object],Would you ask an ad agency to form a relationship on your behalf with your spouse, children or business partners?  Why not?  Standard ad agency approach: 1. Start with the objective of “building the brand.” 2. Get an agency to create “the big idea” that would get the brand noticed and admired. 3. Understand the averages of your customers.  4. Push out messages in maximum volume to those averages.  Often these messages are seen by target customers as intrusive, empty and cluttered.
[object Object],© Universal Pictures
[object Object],Remote monitoring has been searching for a business model for 20+ years. Computer chip makers, telephone companies, handset manufacturers, health IT, medical device manufacturers and many others have tried, and so far largely failed, to make remote monitoring a success.    Conservatively, $25b in capital has been consumed to-date in remote health monitoring. The core problem has been focus on measurement, not on actionability and value to the physician and patient. While that data holds great promise, the ultimate link to changed outcomes and health economics has been tenuous. What is needed is integrated and actionable lenses for clinicians, patient knowledge and the ability to take the right self-care actions to manage the disease and improve the numbers.
[object Object],What works
[object Object],ROI driver ROI basis Increase clinician willingness to initiate therapy ,[object Object],Cause clinicians to pay for service ,[object Object],Cause patients/family to pay for service ,[object Object],Increase reimbursement ,[object Object],Increase approval rates/indications ,[object Object],Make your solution the obvious first choice for therapy therapy ,[object Object],Fulfill regulatory requirements ,[object Object]
[object Object]
[object Object],Value-Driven Patient and Professional Communications New, More Integral Role for Medical Coherent Programs Based on Validated Behavioral Science Productively Involving Family
[object Object],[object Object],[object Object],“ There is so much out there, but it’s  hard to figure out what I really need  to know. So many of the websites just scare you with all the horror stories. It would be  great to have a program that made sure I learn what I need, but also just made me feel like I’m not on my own . My family is helpful, but they don’t know about these things.” 50 y.o. Pre-Transplant patient “ Sometimes you can  feel bombarded  with the information – there is so much. It is not helpful. I  don’t look at it and say ‘oh yeah, this is for me , this is made for me.’” 32 y.o. Multiple Sclerosis patient
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],User scenario:   Chelsea is a 28 year-old married mother of two. She works in sales and is an avid runner.  Following experiences of leg numbness, Chelsea visits a neurologist who diagnoses her with MS. Dimensions of Change Examples Guided Intervention Modules Outcomes Cognitive This must be a mistake, Chelsea thinks. I don ’t want to end up in a wheelchair!  (Confusion, Denial, Misconception) ,[object Object],[object Object],[object Object],[object Object],Chelsea learns that every person with MS has a different experience and outcome.  She accepts that she has MS. (Balance, Integration) Emotional It seems to Chelsea that her world has stopped. Sometimes she feels numb, and sometimes she trembles with rage. (Shock, Anger, Fear) ,[object Object],[object Object],[object Object],[object Object],Chelsea moves through two stages of grief. She learns that, with initiative and proper care,  she can manage MS. (Hope, Openness)  Behavioral Chelsea doesn ’t follow the treatment plan. She Googles her symptoms and changes doctors. (Avoidance, Compensation, Displacement) ,[object Object],[object Object],[object Object],[object Object],Chelsea follows her doctor ’s orders and makes appropriate subsequent appointments.  (Self-Care Action, Safety Monitoring) Environmental Chelsea wonders how she can succeed in sales or stay active with MS. She tests her friendships and fears abandonment. (Questioning Self-Concept, Strained Relationships) ,[object Object],[object Object],[object Object],[object Object],Chelsea joins an online MS support group, redefines her identity, and finds new hobbies. (New Community, Self-Discovery)
[object Object],Chelsea, continuing to engage through multiple channels, builds appropriate action into her life via Behavior Modification Theory Chelsea decides to try the website associated with the program where she experiences effective education, based on  Pedagogical Science Chelsea gains insights into thoughts and feelings that might be getting in her way, using the tools of Cognitive Behavioral Therapy Chelsea might initially learn of the program through a clinician, disease advocacy group, pharmacy or DTC Take Action Engage Gain Insight Learn
[object Object],Value-Driven Patient and Professional Communications New, More Integral Role for Medical Coherent Programs Based on Validated Behavioral Science Productively Involving Family ✔
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],Value-Driven Patient and Professional Communications New, More Integral Role for Medical Coherent Programs Based on Validated Behavioral Science Productively Involving Family ✔ ✔
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Behavior Modification Therapy Cognitive Behavioral Therapy Effective Pedagogy Thoughts Feelings Actions Classical Operant Social Integrative Personal Timed
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],Source:  Wright JH, Wright AS, Albano AM, Basco MR, Goldsmith LJ, Raffield T, Otto MW. Computer-assisted cognitive therapy for depression: maintaining efficacy while reducing therapist time.  American Journal of Psychiatry . 2005; 162:1158–1164.
[object Object],Identify major patient pathways and inflection points in patient experience using focus groups, expert interviews. Identify major adherence target behaviors for patients using focus groups, expert interviews. Identify cognitive, emotional, behavioral, social barriers to adherence. Collapse core psychological themes in non-compliance among target patients, using quantitative and qualitative research methodology, framed in terms of patient need. ,[object Object],Apply proven behavior science program of “Explore”, “Insight”, “Action” with standard protocols. ,[object Object]
[object Object],Sources:  BCG analysis; Harris Interactive 10,000 Patients Survey, 2002. Sometimes forget to use or refill Don ’t want the side effects The drug costs too much Don ’t think I need the drug Can ’t get prescription filled, picked up, or delivered Don ’t know how to use the drug Other PATIENT VIEWS Reasons why patients don ’t fill prescriptions or comply with therapies (patient views) (Percentage of patient respondents citing each reason) Source:  Human Care Systems Physician Survey, 315 physicians, 2010. . PHYSICIAN VIEWS Reasons why patients don ’t fill prescriptions or comply with therapies (physician views) (Percentage of physician respondents citing each reason) Cost/co-pay Side effects Forgetfulness Lack of motivation and self-confidence Doesn ’t think he/she needs drug Underlying emotional issues Doesn ’t think drug works Other Patient is suspicious of pharmaceutical companies  Doesn ’t understand how to use/administer drug Lack of productive family involvement Can ’t get prescription filled, picked up or delivered
[object Object],Behavioral Drivers Adherence Barrier Doesn ’t understand how to use/administer drug Information processing style, misconceptions, emotionality, self-efficacy Lack of productive family involvement Avoidance, relationship skills / strain, stimulus control, living environment  Can ’t get prescription filled, picked up or delivered Social capital, problem-solving, communication, self-efficacy Doesn ’t think drug works Defense mechanisms, interpersonal skills, learning style, social capital Underlying emotional issues Cognitive skills, mind / body relationship, life environment Doesn ’t think he/she needs drug Defense mechanisms, cognitive-emotional skills, life environment Lack of motivation and self-confidence Self-efficacy, social capital, mind / body relationship, cognitive skills Forgetfulness Emotionality, defense mechanisms, cognitive dysfunction Side effects Cognitive skills, mind / body relationship, self-efficacy, stimulus control Cost/co-pay Cognitive skills ( coping ), emotionality ( anger ), problem-solving ( prioritizing )
[object Object],In a trial of medicine adherence (refills) among 50 diabetic patients (42 completed), HCS significantly improved adherence. Trial conducted March 1, 2009 to August 31, 2010 in United States
[object Object],Value-Driven Patient and Professional Communications New, More Integral Role for Medical Coherent Programs Based on Validated Behavioral Science Productively Involving Family ✔ ✔ ✔
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],Kidney Transplant
[object Object],“ I need a transplant” “ They found me a kidney” Surgery and Recovery “ I’m going home” “ I still have to actively manage my health” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],Effective Pedagogy Cognitive Behavior Therapy Behavior Modification Therapy
[object Object]
[object Object],Effective Pedagogy Cognitive Behavior Therapy Behavior Modification Therapy
[object Object]
[object Object],Effective Pedagogy Cognitive Behavior Therapy Behavior Modification Therapy
[object Object]
[object Object],Questions?

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Valuable Patient Support

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Editor's Notes

  1. Traditional Patient Support Approaches One-off tools ( e.g. iPhone tracking app) : Individual tools don ’t actually change any of the underlying behavioral drivers ( e.g. intrinsic motivation, self-confidence, resilience and others). Simple Incentives: In the long term, monetizing individual behavior results in decreased motivation, self-determination and self worth. Monetization and other contrived reward strategies contradict well established behavior science that says that effective rewards should meaningfully relate to the behavior. As soon as a monetary reward is removed, undesirable behavior almost always relapses. Reminders : By themselves mail, phone, or device reminders fail to modify internal and external behavioral environments. Antecedent stimuli (reminders) either have no meaning or produce an adverse meaning (nagging) and actually result in avoidance, fleeing and other forms of reactivity. Information overload ( e.g. generic education) : Dense information that lacks interaction misses opportunities for real internalized education, insight and knowledge assimilation. Instead, patients feel reactive, overwhelmed, and confused. Guided, step-by-step programs delivered through multiple, integrated channels. Behavioral : Personalized strategies leverage triggers and consequences in formulaic relationship contingencies. Cognitive Correct myths and develop the practical knowledge and skills to manage MS and medicines. Learn motivation, build self-confidence and practice resilience. Emotional : Overcome barriers to adherence and deal with difficult emotions like anger, fear, guilt, anxiety and shame. Environmental : Work more effectively with healthcare providers and family. Direct engagement to more effectively involve family ( co-patients) to leverage their roles.
  2. Traditional Patient Support Approaches One-off tools ( e.g. iPhone tracking app) : Individual tools don ’t actually change any of the underlying behavioral drivers ( e.g. intrinsic motivation, self-confidence, resilience and others). Simple Incentives: In the long term, monetizing individual behavior results in decreased motivation, self-determination and self worth. Monetization and other contrived reward strategies contradict well established behavior science that says that effective rewards should meaningfully relate to the behavior. As soon as a monetary reward is removed, undesirable behavior almost always relapses. Reminders : By themselves mail, phone, or device reminders fail to modify internal and external behavioral environments. Antecedent stimuli (reminders) either have no meaning or produce an adverse meaning (nagging) and actually result in avoidance, fleeing and other forms of reactivity. Information overload ( e.g. generic education) : Dense information that lacks interaction misses opportunities for real internalized education, insight and knowledge assimilation. Instead, patients feel reactive, overwhelmed, and confused. Guided, step-by-step programs delivered through multiple, integrated channels. Behavioral : Personalized strategies leverage triggers and consequences in formulaic relationship contingencies. Cognitive Correct myths and develop the practical knowledge and skills to manage MS and medicines. Learn motivation, build self-confidence and practice resilience. Emotional : Overcome barriers to adherence and deal with difficult emotions like anger, fear, guilt, anxiety and shame. Environmental : Work more effectively with healthcare providers and family. Direct engagement to more effectively involve family ( co-patients) to leverage their roles.
  3. Traditional Patient Support Approaches One-off tools ( e.g. iPhone tracking app) : Individual tools don ’t actually change any of the underlying behavioral drivers ( e.g. intrinsic motivation, self-confidence, resilience and others). Simple Incentives: In the long term, monetizing individual behavior results in decreased motivation, self-determination and self worth. Monetization and other contrived reward strategies contradict well established behavior science that says that effective rewards should meaningfully relate to the behavior. As soon as a monetary reward is removed, undesirable behavior almost always relapses. Reminders : By themselves mail, phone, or device reminders fail to modify internal and external behavioral environments. Antecedent stimuli (reminders) either have no meaning or produce an adverse meaning (nagging) and actually result in avoidance, fleeing and other forms of reactivity. Information overload ( e.g. generic education) : Dense information that lacks interaction misses opportunities for real internalized education, insight and knowledge assimilation. Instead, patients feel reactive, overwhelmed, and confused. Guided, step-by-step programs delivered through multiple, integrated channels. Behavioral : Personalized strategies leverage triggers and consequences in formulaic relationship contingencies. Cognitive Correct myths and develop the practical knowledge and skills to manage MS and medicines. Learn motivation, build self-confidence and practice resilience. Emotional : Overcome barriers to adherence and deal with difficult emotions like anger, fear, guilt, anxiety and shame. Environmental : Work more effectively with healthcare providers and family. Direct engagement to more effectively involve family ( co-patients) to leverage their roles.
  4. Traditional Patient Support Approaches One-off tools ( e.g. iPhone tracking app) : Individual tools don ’t actually change any of the underlying behavioral drivers ( e.g. intrinsic motivation, self-confidence, resilience and others). Simple Incentives: In the long term, monetizing individual behavior results in decreased motivation, self-determination and self worth. Monetization and other contrived reward strategies contradict well established behavior science that says that effective rewards should meaningfully relate to the behavior. As soon as a monetary reward is removed, undesirable behavior almost always relapses. Reminders : By themselves mail, phone, or device reminders fail to modify internal and external behavioral environments. Antecedent stimuli (reminders) either have no meaning or produce an adverse meaning (nagging) and actually result in avoidance, fleeing and other forms of reactivity. Information overload ( e.g. generic education) : Dense information that lacks interaction misses opportunities for real internalized education, insight and knowledge assimilation. Instead, patients feel reactive, overwhelmed, and confused. Guided, step-by-step programs delivered through multiple, integrated channels. Behavioral : Personalized strategies leverage triggers and consequences in formulaic relationship contingencies. Cognitive Correct myths and develop the practical knowledge and skills to manage MS and medicines. Learn motivation, build self-confidence and practice resilience. Emotional : Overcome barriers to adherence and deal with difficult emotions like anger, fear, guilt, anxiety and shame. Environmental : Work more effectively with healthcare providers and family. Direct engagement to more effectively involve family ( co-patients) to leverage their roles.
  5. Traditional Patient Support Approaches One-off tools ( e.g. iPhone tracking app) : Individual tools don ’t actually change any of the underlying behavioral drivers ( e.g. intrinsic motivation, self-confidence, resilience and others). Simple Incentives: In the long term, monetizing individual behavior results in decreased motivation, self-determination and self worth. Monetization and other contrived reward strategies contradict well established behavior science that says that effective rewards should meaningfully relate to the behavior. As soon as a monetary reward is removed, undesirable behavior almost always relapses. Reminders : By themselves mail, phone, or device reminders fail to modify internal and external behavioral environments. Antecedent stimuli (reminders) either have no meaning or produce an adverse meaning (nagging) and actually result in avoidance, fleeing and other forms of reactivity. Information overload ( e.g. generic education) : Dense information that lacks interaction misses opportunities for real internalized education, insight and knowledge assimilation. Instead, patients feel reactive, overwhelmed, and confused. Guided, step-by-step programs delivered through multiple, integrated channels. Behavioral : Personalized strategies leverage triggers and consequences in formulaic relationship contingencies. Cognitive Correct myths and develop the practical knowledge and skills to manage MS and medicines. Learn motivation, build self-confidence and practice resilience. Emotional : Overcome barriers to adherence and deal with difficult emotions like anger, fear, guilt, anxiety and shame. Environmental : Work more effectively with healthcare providers and family. Direct engagement to more effectively involve family ( co-patients) to leverage their roles.
  6. Traditional Patient Support Approaches One-off tools ( e.g. iPhone tracking app) : Individual tools don ’t actually change any of the underlying behavioral drivers ( e.g. intrinsic motivation, self-confidence, resilience and others). Simple Incentives: In the long term, monetizing individual behavior results in decreased motivation, self-determination and self worth. Monetization and other contrived reward strategies contradict well established behavior science that says that effective rewards should meaningfully relate to the behavior. As soon as a monetary reward is removed, undesirable behavior almost always relapses. Reminders : By themselves mail, phone, or device reminders fail to modify internal and external behavioral environments. Antecedent stimuli (reminders) either have no meaning or produce an adverse meaning (nagging) and actually result in avoidance, fleeing and other forms of reactivity. Information overload ( e.g. generic education) : Dense information that lacks interaction misses opportunities for real internalized education, insight and knowledge assimilation. Instead, patients feel reactive, overwhelmed, and confused. Guided, step-by-step programs delivered through multiple, integrated channels. Behavioral : Personalized strategies leverage triggers and consequences in formulaic relationship contingencies. Cognitive Correct myths and develop the practical knowledge and skills to manage MS and medicines. Learn motivation, build self-confidence and practice resilience. Emotional : Overcome barriers to adherence and deal with difficult emotions like anger, fear, guilt, anxiety and shame. Environmental : Work more effectively with healthcare providers and family. Direct engagement to more effectively involve family ( co-patients) to leverage their roles.
  7. Traditional Patient Support Approaches One-off tools ( e.g. iPhone tracking app) : Individual tools don ’t actually change any of the underlying behavioral drivers ( e.g. intrinsic motivation, self-confidence, resilience and others). Simple Incentives: In the long term, monetizing individual behavior results in decreased motivation, self-determination and self worth. Monetization and other contrived reward strategies contradict well established behavior science that says that effective rewards should meaningfully relate to the behavior. As soon as a monetary reward is removed, undesirable behavior almost always relapses. Reminders : By themselves mail, phone, or device reminders fail to modify internal and external behavioral environments. Antecedent stimuli (reminders) either have no meaning or produce an adverse meaning (nagging) and actually result in avoidance, fleeing and other forms of reactivity. Information overload ( e.g. generic education) : Dense information that lacks interaction misses opportunities for real internalized education, insight and knowledge assimilation. Instead, patients feel reactive, overwhelmed, and confused. Guided, step-by-step programs delivered through multiple, integrated channels. Behavioral : Personalized strategies leverage triggers and consequences in formulaic relationship contingencies. Cognitive Correct myths and develop the practical knowledge and skills to manage MS and medicines. Learn motivation, build self-confidence and practice resilience. Emotional : Overcome barriers to adherence and deal with difficult emotions like anger, fear, guilt, anxiety and shame. Environmental : Work more effectively with healthcare providers and family. Direct engagement to more effectively involve family ( co-patients) to leverage their roles.
  8. Traditional Patient Support Approaches One-off tools ( e.g. iPhone tracking app) : Individual tools don ’t actually change any of the underlying behavioral drivers ( e.g. intrinsic motivation, self-confidence, resilience and others). Simple Incentives: In the long term, monetizing individual behavior results in decreased motivation, self-determination and self worth. Monetization and other contrived reward strategies contradict well established behavior science that says that effective rewards should meaningfully relate to the behavior. As soon as a monetary reward is removed, undesirable behavior almost always relapses. Reminders : By themselves mail, phone, or device reminders fail to modify internal and external behavioral environments. Antecedent stimuli (reminders) either have no meaning or produce an adverse meaning (nagging) and actually result in avoidance, fleeing and other forms of reactivity. Information overload ( e.g. generic education) : Dense information that lacks interaction misses opportunities for real internalized education, insight and knowledge assimilation. Instead, patients feel reactive, overwhelmed, and confused. Guided, step-by-step programs delivered through multiple, integrated channels. Behavioral : Personalized strategies leverage triggers and consequences in formulaic relationship contingencies. Cognitive Correct myths and develop the practical knowledge and skills to manage MS and medicines. Learn motivation, build self-confidence and practice resilience. Emotional : Overcome barriers to adherence and deal with difficult emotions like anger, fear, guilt, anxiety and shame. Environmental : Work more effectively with healthcare providers and family. Direct engagement to more effectively involve family ( co-patients) to leverage their roles.
  9. Traditional Patient Support Approaches One-off tools ( e.g. iPhone tracking app) : Individual tools don ’t actually change any of the underlying behavioral drivers ( e.g. intrinsic motivation, self-confidence, resilience and others). Simple Incentives: In the long term, monetizing individual behavior results in decreased motivation, self-determination and self worth. Monetization and other contrived reward strategies contradict well established behavior science that says that effective rewards should meaningfully relate to the behavior. As soon as a monetary reward is removed, undesirable behavior almost always relapses. Reminders : By themselves mail, phone, or device reminders fail to modify internal and external behavioral environments. Antecedent stimuli (reminders) either have no meaning or produce an adverse meaning (nagging) and actually result in avoidance, fleeing and other forms of reactivity. Information overload ( e.g. generic education) : Dense information that lacks interaction misses opportunities for real internalized education, insight and knowledge assimilation. Instead, patients feel reactive, overwhelmed, and confused. Guided, step-by-step programs delivered through multiple, integrated channels. Behavioral : Personalized strategies leverage triggers and consequences in formulaic relationship contingencies. Cognitive Correct myths and develop the practical knowledge and skills to manage MS and medicines. Learn motivation, build self-confidence and practice resilience. Emotional : Overcome barriers to adherence and deal with difficult emotions like anger, fear, guilt, anxiety and shame. Environmental : Work more effectively with healthcare providers and family. Direct engagement to more effectively involve family ( co-patients) to leverage their roles.
  10. Traditional Patient Support Approaches One-off tools ( e.g. iPhone tracking app) : Individual tools don ’t actually change any of the underlying behavioral drivers ( e.g. intrinsic motivation, self-confidence, resilience and others). Simple Incentives: In the long term, monetizing individual behavior results in decreased motivation, self-determination and self worth. Monetization and other contrived reward strategies contradict well established behavior science that says that effective rewards should meaningfully relate to the behavior. As soon as a monetary reward is removed, undesirable behavior almost always relapses. Reminders : By themselves mail, phone, or device reminders fail to modify internal and external behavioral environments. Antecedent stimuli (reminders) either have no meaning or produce an adverse meaning (nagging) and actually result in avoidance, fleeing and other forms of reactivity. Information overload ( e.g. generic education) : Dense information that lacks interaction misses opportunities for real internalized education, insight and knowledge assimilation. Instead, patients feel reactive, overwhelmed, and confused. Guided, step-by-step programs delivered through multiple, integrated channels. Behavioral : Personalized strategies leverage triggers and consequences in formulaic relationship contingencies. Cognitive Correct myths and develop the practical knowledge and skills to manage MS and medicines. Learn motivation, build self-confidence and practice resilience. Emotional : Overcome barriers to adherence and deal with difficult emotions like anger, fear, guilt, anxiety and shame. Environmental : Work more effectively with healthcare providers and family. Direct engagement to more effectively involve family ( co-patients) to leverage their roles.