Medication adherence rose from 54% to 81%
Company overview
Medivia Health is a chronic-care platform serving 240,000 patients across cardiometabolic, respiratory, and behavioral-health programs. Revenue is split between payer contracts (PMPM) and value-based outcome bonuses, meaning every percentage point of medication adherence translates directly into reimbursement.
The business problem
Adherence sat at 54% — slightly below the 60% CMS benchmark — and avoidable inpatient admissions were eroding shared-savings bonuses. Reminder notifications and SMS nudges produced a 90-day decay curve; patients muted them within weeks.
Strategic analysis
The team was solving a memory problem, but the underlying issue was identity and meaning. Patients on long regimens disengaged because daily pill-taking offered no felt progress, no social context, and no narrative of recovery. Self-Determination Theory and the COM-B model both pointed to the same gap: low capability felt-progress, absent social support, and no motivational reward beyond avoidance of harm.
Gamification solution
We designed a four-layer adherence system: daily check-in streaks with freeze tokens for sick days, caregiver squads (1–3 family members or care-coaches who see anonymized streak status), symptom-log quests that turned passive tracking into active mastery, and a 'Care Champion' status ladder unlocking pharmacist consults and wellness perks.
Implementation process
Rolled out across six clinics in 11 weeks, then expanded to the full network over Q2. Clinical messaging was rewritten to fit identity framing ('You're a Care Champion in week 6') rather than compliance framing. Caregiver invites became part of onboarding, lifting opt-in to 71%.
Results
Medication adherence rose from 54% to 81%. Avoidable admissions dropped 29%. Patient NPS lifted 38 points. Shared-savings bonus revenue grew enough in Q3 to fund expansion to two additional payer markets.
Mechanics breakdown
| Mechanic | Purpose | Psychological trigger | Business impact |
|---|---|---|---|
| Adherence streaks | Habit cadence | Loss aversion, consistency | +27pts adherence |
| Caregiver squads | Social accountability | Relatedness, social proof | -29% admissions |
| Symptom quests | Active mastery | Competence, IKEA effect | +38pt NPS |
| Care Champion tiers | Identity reinforcement | Status, sunk cost | +retention into yr 2 |
Future optimization
Next phases: predictive risk-of-lapse scoring with proactive pharmacist outreach, and a 'graduated patient' alumni program turning long-tenure patients into peer mentors.