Kieran Daly, general manager and co-founder of HealthBeacon, argues that although healthcare has moved into the home, our support systems haven’t.
An injection before the school run, a dose taken after a long shift, medication squeezed into an already crowded fridge, treatment routines fitted around travel, exhaustion and the competing demands of family life – this is what healthcare looks like today.
There is no denying that modern medicine has made extraordinary advances. We are lucky enough to have earlier diagnoses, more precise treatments and better overall management for health conditions. That being said, there is a major flaw in our system. Currently, clinical trials show what therapies can achieve under controlled conditions, but everyday life decides what is achievable in practice.
This is where adherence becomes the deciding factor. Too often it is treated as something to measure after the fact, instead of something care pathways should be built around from the start. Just look at The World Health Organization, which has long estimated that adherence to long-term therapies for chronic conditions averages only 50% in developed countries.
The Centers for Disease Control and Prevention has previously reported that around one in five new prescriptions are never filled, and as mentioned, of the ones that are filled, only half are taken correctly. A point the WHO has made evidently clear is that improving adherence can deliver a bigger population health impact than improving specific treatments alone. So why are we ignoring this?
Access is not adherence
In the UK specifically, the pushback is often, “we don’t have an adherence issue, we deliver 100% of the medicines”. Home delivery and repeat dispensing have improved access, but access is not adherence. Having medication in the home is not the same as taking it as prescribed, and that gap is where outcomes quietly unravel.
If we look closely at the numbers, these lapses are anything but marginal. Non-adherence has been associated with an estimated 200,000 premature deaths each year and a financial cost of roughly €80 to €125 billion annually in the EU. In the US, direct healthcare costs have been estimated at approximately $100 to $300 billion a year. If we look behind the numbers, we would see avoidable admissions, unnecessary complications and treatment potential left on the table.
When adherence fails, it is rarely because patients do not care. More often, the system makes it too hard to succeed. Care has moved into the home, but many pathways still behave as if patients are being managed inside clinics.
We still design care as if patients have spare time and perfect routines. Appointments, workflows and standard instructions assume life will make room. It will not. Work, family, travel, stress and exhaustion turn a straightforward plan into something that is surprisingly difficult to sustain.
Adherence rarely collapses in the same dramatic moment, rather it fades. We see regimens that are fiddly, instructions that are unclear, or life simply gets chaotic for a week and routines are off knocked track. When follow-up is patchy and communication inconsistent, support usually arrives after the damage is done, not at the first sign of trouble.
Health systems that do better treat adherence as infrastructure, not aftercare, and design for the home from the start. The goal here is not to police people, it is to make the right behaviour the easiest behaviour, and to step in early when a plan stops fitting.
Technology of course has its role here, but only when it reduces guesswork and leads to action. What does this mean? Smart packaging, connected devices and digital tools can highlight patterns that clinicians rarely see, where routines slip, which days are hardest, whether someone is stretching doses, or whether side effects are driving avoidance.
What technology will never do, is replace care. A reminder does not answer “is this normal?”, a notification does not resolve conflicting advice and data that never reaches someone who can help, changes nothing. The value appears when insight triggers practical support, a timely check-in, a clearer explanation, an adjustment to simplify the regimen, or a plan for managing side effects.
Ruthless simplicity
What does an adherence-ready pathway look like in practice? It starts with ruthless simplicity, regimens, onboarding and instructions designed for tired people on busy days, not ideal circumstances. It builds continuity into the first months, when uncertainty and side effects are most likely to derail routines, and patients need answers quickly. It uses technology for early signals, not late reporting, so teams can respond to friction before it becomes a failure. It measures what matters, distinguishing between cannot and will not and recognising the practical barriers underneath adherence, affordability, access, health literacy and mental load.
As funding models shift towards outcomes rather than activity, the long middle of care and the months after initiation becomes the part that defines value. That is where systems either prevent deterioration early, or pay more later to manage avoidable setbacks. I have always believed that a breakthrough therapy only earns its promise when it can be sustained in ordinary life, both consistently and safely.
The next major leap in healthcare will come from closing the gap between prescription and persistence, meaning a system designed around people’s lives, built to be supportive, practical, intuitive and dependable.
