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1. Effective Adherence:
A complex problem addressed with
comprehensive behavioral programs
Boston | London | Los Angeles | Philadelphia 1

2. Standard of Care and Therapy Adherence
• For every disease, the Standard of Care includes multiple
behavioral and self-care elements.
• People struggle to adhere to their total therapies – medicines
as well as behavior modification and lifestyle changes –
negatively impacting outcomes and health economics.
• The Human Care Systems solution is a customizable software
platform to help biopharmaceutical companies engage with and
support patients and family to learn the habits of total therapy
adherence.
 Increase medicine adherence
 Add value and connect with patients and family
 Comply with regulatory requirements
 Differentiate to prescribers and remove prescribing barriers
 Improve health economics
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3. Personalized Adherence
Causes of non-adherence
Comprehensive solution for complex problem
Personalized adherence program: “Mary”
Efficacy data
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4. Question:
Why don’t people adhere to their medicine
regimens and other therapies?
Answer:
Each person has his or her own set of complex
and interrelated reasons.
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5. Patients Report Range of Non-Adherence Causes
Reasons why patients don’t fill prescriptions
or comply with drug regimens (patient views)
(Percentage of patient respondents citing each reason)
Other
Don’t know how to use the drug
Can’t get prescription filled, picked up, or delivered
Don’t think I need the drug
The drug costs too much
Don’t want the side effects
Sometimes forget to use or refill
Sources: BCG analysis; Harris Interactive 10,000 Patients Survey, 2002.

6. Physicians Report Range of Non-Adherence Causes
Reasons why patients don’t fill prescriptions
or comply with drug regimens (physician views)
(Percentage of physician respondents citing each reason)
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
Doesn’t think drug works
Underlying emotional issues
Doesn’t think he/she needs drug
Lack of motivation and self-confidence
Forgetfulness
Side effects
Cost/co-pay
Source: Human Care Systems Physician Survey, 315 physicians, 2010. .

7. Each Adherence Barrier has Behavioral Drivers
Adherence Barrier Behavioral Drivers
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)

8. Personalized Adherence
Causes of non-adherence
Comprehensive solution for complex problem
Personalized adherence program: “Mary”
Efficacy data
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9. The Problem Defines the Solution
Symptom Therapy
Physical Pharmacology
Cognitive
HCS Solutions
Emotional Behavior Science, Cognitive-Behavior
Therapy, Pedagogical Science,
Behavioral
Relationship Coaching, Mind-Body
Environmental Exercises
Complex Problem: Comprehensive Solution:
Nuanced interplay of cognitive, HCS behavioral approach addresses
emotional, behavioral, environmental patient thoughts, feelings, actions,
factors surroundings
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10. Effective Adherence is Holistic and Patient-centered
“The odds that an adherence strategy will be successful are
related to how well the strategy can first identify the varying
needs of individual patients, and then match services
accordingly.
An ideal adherence strategy should be patient-centered and
holistic taking into account everything from lifestyle to cultural
and belief systems.”
Source: New England Health Care Institute, Client Conference, May 20, 2008

11. A Holistic and Patient-centered Solution
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12. A Comprehensive Behavioral System
We use behavioral Behavior Pedagogical
science, translated to Modification Science
user-friendly software,
to help patients change
problematic patterns and Cognitive
learn new, healthy
thoughts, feelings, Classical Integrative
behaviors, and Conditioning Learning
relationships. Emotional
Operant Experiential
Conditioning Learning
Behavioral
Social Timed
Conditioning Learning
Environmental
Dimensions of
Change 12

13. Thoughts and Feelings are Biochemistry
Mind-body exercises change thought pathways
• Mind-body therapies have broad, dramatic impact on
perception, information processing, decision making, and neutral meditative
state state
lifestyle change
• Powerful interventions integrate all dimensions of change –
cognitive, emotional, behavioral, environmental elements
• HCS solutions use standard, scientifically proven mind-body
protocols
Proc. Natl. Acad. Sci. USA 2004 101 (46) 16369 - 16373

14. Human Care Systems
Who We Are
Experts in software, healthcare, psychology, user engagement, and
technology.
Clients are biopharmaceutical, medical device and diagnostics companies;
as well as health systems, employers and payers.
Headquartered: 1 Faneuil Hall, Boston, MA.
Other locations: Philadelphia, Los Angeles and London.
Formed as spin-out from the Kerdan Group (biopharma consultancy) in 2008.
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15. Personalized Adherence
Causes of non-adherence
Comprehensive solution for complex problem
Personalized adherence program: “Mary”
Efficacy data
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16. Therapy for Complete Adherence: “Mary”
Adherence Assessment Adherence Profile Adherence Guided Program
I’m skeptical, overwhelmed, My disease is physical. I must address myths
and agitated. I’d rather not My experience of my that cause my negative
think about this! I’m tired of disease is holistic. feelings. When I am
being nagged. What the heck My adherence involves all emotionally invested, I
is a mind-body relationship? of me. can move forward.
Thoughts 1. Education exercise
Perceptions of self and “Myths and misconceptions”
condition
2. Cognitive-behavior exercise
Feelings
“Shame”, “Fear”
Reactions of anger, fear, shame,
guilt, anxiety 3. Mind-body exercise
Behaviors “Self-awareness”
Compliance with providers and
4. Problem-solving exercises
treatment plan; self-care habits
“Cost”, “Inconvenience”
Environment
5. Goal-Setting and tracking
Relationship and tactical
obstacles to compliance “Goals and emotions”
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17. Mary Engages Through Multiple, Integrated
Channels
Web & Email Live Phone
Mobile & SMS Automated Phone (IVR)
Mail
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18. Mary Picks a Virtual Guide
Social conditioning involves interactions with others, including modeling, coaching, social learning, contracting, and
interpersonal support.
Virtual Guides
Guides are selected based on decades of robust socio-cultural research
including micro-expression analysis.
Guides can answer questions using a heuristics engine and database.
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19. Mary Follows an Integrated, Step-by-Step Program
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20. Mary Completes Simple Assessments to
Personalize her Experience
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21. Mary Engages in Tailored, Effective Learning
Multi-media options Challenging, calibrated to an 85%
Regulated by configured to learning style correct response rate
cognitive
dissonance as
a window for
insight
Hierarchically chunked
education (3-5 items at
a time) for optimal
working memory and
information processing
Continuous
reinforcement SEE MY LEARNING
STYLE
schedule drives PROFILE
engagement
Learner-centered, driven Flash animation is interactive Interactive, immediate feedback
by user choice and profile for optimal learning
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22. Mary Works on her Thoughts and Feelings,
in a Judgment free and Private place
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23. Mary does Personalized Exercises
Patients require multi-dimensional assistance for internal and external environments including prohibitive thoughts and feelings
like shame, anger, fear, guilt, anxiety.
Adherence to biochemical therapies
Smart software predicts and
involve mind / body learning.
times Mary’s questions.
The system
knows Mary
Mary’s profile tells
struggles with
the software that
shame.
her fear
immobilizes her,
keeping her from
compliance.
Just like in a
therapist’s
office, Mary
quantifies her According to her
feelings. profile, Mary will
become activated by
These are
converting fear to
included in
anger.
her treatment
algorithm.
Guides are selected based on decades Information combined with the right
of robust socio-cultural research emotional engagement leads to insight.
including micro-expression analysis.
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24. Mary Involves her Husband
Social interventions involve interactions with others, including modeling, coaching, social learning, contracting, and
interpersonal support.
Problem: Mary’s Solution: Mary’s spouse Problem: According to her
spouse has strong learns new relationship profile, Mary’s anger is
opinions, preventing skills like empathy, getting in the way of going
him from listening. support, and to the pharmacy.
Mary ignores him and communication.
her self care too!
Solution: The system
gives Mary an action
Problem: When her Solution: The system plan personalized to her
spouse comes home leads the spouse psychological profile.
from work angry, through self-awareness
Mary’s adherence is and de-stress exercises.
threatened.
Problem: Mary Solution: Smart software
resents her spouse guides family members
nagging, because he into behavior contracts with
doesn’t follow each other that are
doctors’ orders either. mutually reinforcing.
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25. Why does Mary Engage with her Program?
For the first time in my life, I „”I really like that it‟s
feel like I have the right plan just for me. It learns
and support for me. Like I‟m about me and grows as
in control.” I grow.”
“My husband used to always hassle me
about my weight. Now, he used the
coach training program a bit and he‟s
“it‟s reassuring and it gave me
actually somewhat helpful with meal
good steps.”
planning and our daily walks. He can
be objective now.”
“It helps bring out feelings that
I wasn‟t aware of before. It
was good in helping me
handle my feelings in some
kind of perspective.”
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26. Personalized Adherence
Causes of non-adherence
Comprehensive solution for complex problem
Personalized adherence program: “Mary”
Efficacy data
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27. Efficacy Evidence: Medicine adherence
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
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28. Efficacy Evidence: Cardiometabolic Markers
12 month study of 100 diabetics measuring four cardiometabolic markers: LDL, BP, BMI, A1c.
Started Trial Completed Trial
50 patients 46 patients
Final (12 months)
SBP decrease of 11mm
Hg vs. control*
5% average BMI reduction*
.3 A1c reduction*
50 patients 41 patients
(*) denotes statistical significance
(95% Cl)
Trial conducted April 1, 2009 to March 31, 2010 in United States
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29. Human Care Systems Value to Biopharma Clients
€
Differentiate to Engage and Support Comply with Regulatory Impact Health Track and Learn
Prescribers Patient & Family Requirements Economics
Prescribers and other Particularly in complex, REMS and other The largest lever to Multidimensional
clinicians want help multi-faceted diseases, regulatory requirements impact health economics reporting, including
encouraging therapy patients and family may increasingly require in any disease is therapy usage and efficacy data,
adherence. be overwhelmed. biopharmaceutical adherence: taking informs sales, marketing,
companies to support medicines, working regulatory, development,
Patient non-adherence Establishing a direct patients in managing productively with and health economics
is a source of connection to patients therapy, including physicians, managing outcomes.
frustration to clinicians. and family is critical in a adherence. behavioral and
world of increasing emotional issues.
Remove prescribing patient self-pay due to
barriers. higher co-pays.
.
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