Adherence is the name of the game. Nothing even comes close as an effective way to reduce costs and improve health outcomes.

“Studies consistently find significant cost savings and increases in effectiveness that are attributable to low-cost interventions for improving adherence,” according to the World Health Organization (WHO).

Yet even in developed countries, adherence to long-term therapies for chronic conditions averages no better than 50 percent.

In the United States, for instance, less than 2 percent of adults with diabetes perform the full level of care recommended by the American Diabetes Association. Only 30 percent of patients in the U.S. have good command of chronic hypertension, and the range of non-adherence to asthma treatments falls somewhere between 30 percent and 70 percent, according to the WHO.

Ayogo and Get Real Health offer a care coordination platform and mobile application, respectively, that seek to improve on those abysmal adherence statistics.

Let’s look at each product.

Ayogo

Target Market:  In addition to the usual clients for Ayogo’s adherence platform – healthcare providers who are seeking higher levels of patient engagement – Ayogo is now targeting pharmaceuticals who are looking to play a greater role in the wellness movement by taking a more holistic view of each patient. It’s an approach that is predicated on the belief that educated patients are more likely to be both persistent and adherent to their drug therapy because they see their medication as part of a larger treatment solution.

Offering: Ayogo  has two major components: a customizable platform, GoodLife, and its mobile-ready, patient-facing application, Empower.

To encourage adherence, the GoodLife platform enables communication between caregivers and patients as well as offering a social networking platform for caregivers, family members, friends and others with the same chronic condition. Empower sends out a daily four-part interactive “call to action” aligned with the patient’s condition. The call includes a hook (usually an SMS, text notification or e-mail), a daily to-do activity (i.e., actionable educational content that can be done in 1-5 minutes) and components explaining how to do the recommended tasks and why they are important.

A “social interaction” component engages the patient in a conversation with both caregivers and those with the same condition that focuses on their daily activity. The interaction allows patients to share how they did and encourages one another by “liking” content or, if necessary, flagging inappropriate material.

Tying it all together is the “virtual economy” component, which includes rewards received in the form of a virtual currency system. The “economy” is built from gamification elements.

Empower was originally created for people newly diagnosed with Type 2 diabetes. However, using the GoodLife customizable platform, the application can be used for many types of treatments, including preparing for a difficult surgery and rehabilitation.

Benefits: Game mechanics and social connectivity engage a patient in a positive way, addressing not only the practical needs with reminders, alerts, logging and integration with wearables but also the emotional need to have a sense of mastery and feel socially connected. “Short term feedback is a necessity in building engagement,” says Michael Fergusson, one of two Ayogo co-founders.

The daily habit of briefly checking in with Empower promises to encourage the formation of healthy habits including medication adherence, physio- therapy and lifestyle changes. The positive feedback (in the form of interesting online experiences for the individual) encourages the production of dopamine, Fergusson noted, adding that positive social feedback from can trigger the body to produce oxytocin.

Pricing: Flexible and based on customer size and patient demographics.

Founders: Michael Fergusson. For his work with Ayogo, Fergusson was named Ernst & Young’s Social Entrepreneur of the Year, and he was recently named one of the 100 most inspiring people in Life Sciences. Paul Prescod helped to design the modern Web as one of the original members of the XML working group. He is also the champion of RESTful programming style and the Python programming language.

Funding: The company is bootstrapped by the founders.

Get Real Health

Target Market: In the U.S., Get Real Health targets large hospital systems like the New York Health and Hospitals Corp., Geisinger Health System, KeyHIE and MedStar Health, with its InstantPHR product. In Canada, the company works with private healthcare delivery providers, and InstantPHR is the patient access platform for the province of Alberta’s 3.5 million residents. In the UK, it’s the government-sponsored delivery entity.

Offering: InstantPHR is an adherence application that coordinates chronic disease management among the patient, the care professional and the wider circle of caregivers.

InstantPHR offers a provider portal to generate an action plan for patients that can be customized to specific conditions via a catalog of templates for many chronic management issues, including diabetes, hypertension and depression, as well cancer, gastroenterology and wound and pain management.

On the patient side, various tasks are presented that must be completed to stay in compliance. Goals are set within those tasks, such as keeping blood sugar within a certain range or completing a health journal. To ensure that patient engagement stays active and that the patient is remaining compliant, InstantPHR has a sharing mode that sends alerts to all members of a care team if readings are out of a given range or if the person indicates a depressed mood three days running.

The app also features a “reminder framework” that comes with its own set of templates.

“We do a lot of reminding so users don’t have to remember to refill a prescription or take their blood pressure on Fridays,” co-founder Mark Heaney said.

E-mails or text message alerts can be sent to and from iPhone and Android mobiles to the care team’s mobile device, tablet or desktop within a minute of taking a reading.

To ensure patient privacy, alerts serve as pointers to the specifics. The user must type in a PIN number to get the actual content of the alert. The mobile capabilities also allow family members to manage the system.

Beyond care management, InstantPHR also has components for care transition, readmissions management and patient engagement and meaningful use.

Benefits: Heaney says Get Real Health solves the last mile in healthcare, meaning that while there is often a good deal of coordination between various caregivers, the patient is frequently not invited to the discussion. “The patient should be the subject, not just the object of healthcare,” he said.

With 30 consumer healthcare applications under their belt, Get Real Health has learned how to engage the patient, knowing it’s easy to send reminders, alerts and educational material to a smart phone but the real task is to get the patient to use that information for self-improvement.

MedStar Health research compared InstantPHR to a control population in a study of A1C levels. Users of InstantPHR reduced their A1C levels by 1.7 points, and the stats on the continued use of InstantPHR indicate there was an improved understanding on the part of the patients of their condition.

Financial benefits for the providers come in the form of reduced readmission rates as well as a reduction in the need for a monthly session with the doctor.

Price: Get Real Health offers a hosted version as well as installed licenses, based on number of patients.

Founders: Mark Heaney designed and architected dozens of consumer health applications for organizations like the American Heart Association, UnitedHealth Group, Microsoft, Premera Blue Cross, Medstar Health, The American Cancer Society and Kaiser Permanente. Robin Wiener, prior to co-founding Get Real Health, served as director for USWeb/CKS. Wiener oversees all sales and marketing efforts for Get Real Health and is responsible for building and cultivating Get Real Health’s strategic partnerships around the world. Jason Harmon worked as vice president of software development for USWeb/CKS and was the chief architect of its iFrame platform for hosted applications.

Funding: TELUS Ventures made a $2.5 million strategic investment in July 2013.

Ephraim Schwartz is a freelance writer based in Burlington, Vt. Schwartz is a recognized mobile expert and columnist, having spent 15 years as Editor-at-Large for InfoWorld, half of them covering the mobile space. Prior to that he was Editor-in-Chief of Laptop Magazine.