Archive | April, 2011

Looking Forward To The Silverlink Client Event – RESULTS2011

One of my favorite events every year is the Silverlink Communications client event in May in Boston.  Our marketing team does a great job of pulling together a mix of clients and external speakers to really motivate and challenge the audience.  It’s not much of a sales event, but it does a great job of pushing a lot of key topics for discussion.  (See prior posts – last year’s event, notes from RESULTS2010, and notes from RESULTS2009.)

This event was one of the things that originally convinced me to join Silverlink back in 2007.  Sitting and talking with clients about their experiences with the company, their shared passion for results and outcomes, and their interest in collaborating to improve outcomes for consumers was motivating.

This year should be no different.  This year’s theme is – “Seeing Healthcare Through The Eyes Of The Consumer“.  There are presentations on sustaining engagement, obesity, diabetes, health literacy, social media in healthcare, adherence, loyalty and retention, health reform, STAR, HEDIS, and many other topics.

Some of the speakers include:

  1. Dr. Atul Gawande (Harvard, The New Yorker, Author)
  2. Thomas Goetz (WIRED Magazine)
  3. Dan Buettner (Author, The Blue Zones)
  4. Mark Merritt (PCMA)
  5. Dr. Will Shrank (Harvard)
  6. Jim Wilson (WilsonRx)
And many other executives from across healthcare.
It promises to be another banner event.  I’ll share some summarizes as time allows via Twitter and eventually after the event.
I guess with attendance maxed out and the hotel sold out it’s time for me to buckle down and work on my presentation!

The Royal Wedding Symbolism For Healthcare

This is a day most of us will remember.  I still remember the wedding of Princess Diana.  Regardless of how you feel about the monarchy, it is a joyous celebration of life.

It made me think of several words that are key to healthcare – trust, passion, and engagement.  (Another great example here is the real Patch Adams.)

Let’s start with trust.  You have to trust your physician.  You have to trust that the course of treatment will work.  You have to trust that your actions can make a difference.  Those are fundamentals to getting better. 

Passion is another critical element (even if the royal couple was light on the PDA).  Healthcare runs the risk of becoming a “hot industry” with sustainable business which draws people towards it to be employed and get paid well.  That’s very different from the traditional people who were in healthcare because they felt passion for curing people.  I talked with one researcher recently that mentioned one of his client had to increase their staffing by over 10% to get the same jobs done.  They attributed that to a lack of passion for the job.  (On the flipside, healthcare needs those from outside the industry to help reform ourselves.  Change has to be a mix of internal and external.)

Engagement is a word I use often.  The idea here of the long-term engagement process, transition into being a royal, and the commitment the royal couple feels is very different than the quick engagement and wedding of Princess Diana.  I see that as very similar to the need for long-term solutions that engagement people around intrinsic motivators not the short-term boosts we see from things like financial rewards or quick diets.  Healthcare is a change.  Engagement is a process NOT an event.

The people over at Seduce Health pulled out a few other lessons from the wedding which I agree with. 

So…engage your employees, your family, your members, and your patients.  Build up their passion for life and health and help them believe that they can be successful.

Should You Worry About The Drug Dealer Or Your Prescriptions?

Drug abuse has been an issue for years. I think the advertisement on TV that has a drug dealer talking about getting less calls makes a point that I hear more and more – patients selling their prescription drugs to make money.  Some of this is intentional, but some of this is opportunistic.  You don’t have to go far to hear about seniors being arrested for selling their prescriptions to make money to pay bills (recent article). 

And, recreational use or overuse of controlled substances is a growing problem.

“Unintentional drug overdose is a growing epidemic in the U.S. and is now the leading cause of injury death in 17 states,” Center for Disease Control Director Dr. Thomas Frieden was quoted as saying in a statement from the White House’s Office of National Drug Control Policy. (source)

There are lots of stories about kids using prescriptions drugs for ADHD recreationally to help them study.  There has probably been a switch over the years from stealing liquor from parents liquor cabinet to borrowing a few of their prescriptions (see story on 5 drugs kids steal most often).  It’s a scary thought.  (Or, this article says that 20% of the time adults are asking kids if they can use their ADHD medicine.)

The Partnership For a Drug-Free America‘s latest survey has 61 percent of teens reporting prescription drugs are easier to get than illegal drugs, up significantly from 56 percent in 2005. And 41 percent of teens mistakenly believe abuse of medicines is less dangerous than abuse of illegal street drugs.

Provider Satisfaction From ACSI

The American Customer Satisfaction Index (ACSI) is out with their new data.

One area they track is providers. In that group, satisfaction has generally continued to rise over the past 15 years Here’s what they found:

- patient satisfaction is 78.4 overall
- satisfaction for ambulatory care including visits to MDs and dentists is 80
- ER satisfaction is a drag on the sector at 72 which is up 13%

“Improvements in ER wait times and the quality of inpatient care, combined with a trend toward more outpatient treatments and shorter hospital stays, appear to have contributed to a better overall experience for patients.”

When Lifestyle Changes Aren’t Enough…

A story in the Lifetime Fitness publication focused on the this line which you often hear in pharmaceutical advertisements “When lifestyle changes aren’t enough . . . ”  But, obviously, their pitch is that changing your life can and does work with a blend of diet and exercise.

In fact, research shows that basic shifts in nutrition, activity, stress and other lifestyle factors can be more effective than drug protocols in treating inflammatory health conditions — dramatically improving overall health and fitness in the process.

They provide a nice summary of articles in a PDF that I thought were worth sharing.  It includes articles on the following suggestions:

  1. Eliminate processed carbs
  2. Avoid sugars and alcohol
  3. Emphasize healthy fats
  4. Pack in phytonutrients
  5. Get more food-based fiber
  6. Aim for a blend of activity — high and low
  7. Get plenty of rest
  8. Set boundaries around work
  9. Meditate regularly
  10. Manage stress
  11. Minimize inflammation

Does Changing Drugs Erode Trust

One of the big tools that PBMs use to manage drug trend and improve generic fill rate is step therapy. Another one is therapeutic substitution. Both of them rely upon the patient to change medications.

Based on a study published last year, one of the issues identified for adherence was the patient’s belief or trust in their physician. Switching medications (I.e., trial and error) was viewed as eroding that trust.

It creates an interesting question about these tools. Do they erode trust? Do they impact adherence? I think the standard perception would be that lower cost medications would improve adherence. I know research by Shrank has shown that starting on generics leads to better MPR. Is that true for patients that start on a brand and move to a generic?

On the other hand, the research points to the need for the physician to explain to the patient about the plan for care which might include “trial and error”. Certainly personalized medicine may change this need in the long-term, but in the interim, does this create a chance for PBMs to support MDs in a new way by providing this context to the patient?

More questions here than anwers, but an interesting topic.

Patient Educ Couns. 2010 Jul 30.
“Practicing medicine”: Patient perceptions of physician communication and the process of prescription.
Ledford CJ, Villagran MM, Kreps GL, Zhao X, McHorney C, Weathers M, Keefe B.
George Mason University, Fairfax, VA, USA.

Abstract
OBJECTIVE: This study explores patient perceptions of physician communication regarding prescription medications and develops a theory of the effects of perceived physician communication on the patient decision-making process of medication taking.

METHODS: Using a grounded theory approach, this study systematically analyzed patient narratives of communication with physicians regarding prescription medications and the patient’s resulting medication taking and adherence behavior.

RESULTS: Participants described concern about side effects, lack of perceived need for medications, and healthcare system factors as barriers to medication adherence. Overall, participants seemed to assess the utility of communication about these issues based on their perceptions of their physician as the source of the message.

CONCLUSION: The theory generated here includes patient assessments of their physician’s credibility (trustworthiness and expertise) as a critical influence in how chronically-ill patients process information about the need for prescribed therapy. Trial and error to find appropriate medications seemed to deteriorate patients’ perceptions of their physicians’ credibility.

PRACTICE IMPLICATIONS: A practical application of this theory is the recommendation for physicians to increase perceived expertise by clearly outlining treatment processes at the outset of treatment, presenting efficacy and timeline expectations for finding appropriate medications.

More Generics = Slower Rx Cost Growth

I’m not really sure if this surprises anyone, but it seems to be making news. Generics drug prices increase much slower than brand drug prices, and with the huge increase in GFR over the past 5-10 years, trend has slowed down.

The total 2010 spend on prescriptions was $307B. This was up just 2.3% from 2009.

The interesting point in this recent data from IMS is that the utilization growth rate for Rxs has slowed to historically low levels also.

One might attribute some of this to saturation although I think we’re far from that. Others might see a backlash against medicine and a search for more natural remedies. But, the key fact that they talk about is the drop in MD visits which can certainly be correlated to the economy. In 2010, there were 1.54B office visits…a decline of 4.2%.

The research also said

“Pharmacies filled 0.5 percent fewer prescriptions in 2010 than in 2009 for pills, capsules and nasal spray medications — about 60 percent of total spending on medications. For medicines that are injected or infused, total volume rose even less, just 0.2 percent.”

IVR: Beep or Barge-In

Here’s a common question in the voice services world – should I use a “chime” or beep, no sound, or let people barge-in?

What do I mean?  When you get an automated call or call into an IVR system, how do you know when to respond?  For example:

If the question is “Is this George Van Antwerp?  Please say yes or no.”

  • In the first instance, you would say “please say yes or no after the beep”.
  • In the second instance, you wouldn’t add anything but you couldn’t reply until the system is done talking and starts listening.
  • In the third instance, you would be able to respond as soon as you knew what to say (i.e., barge-in).

Of course, intuitively, you want the third scenario, but it creates a series of issues:

  • If there’s background noise, the system can be very clunky…you keep hearing “I’m sorry, but I don’t understand you.  Can you please say yes or no?”
  • You can get false positives
  • You can get people who respond too quickly missing some or all of the question

I personally prefer a window of time to respond where I left with some finite parameters in which to respond (i.e., no barge-in).

Could CVS Caremark Become A Kaiser?

I know the popular opinion is to talk about CVS Caremark splitting up.  Let me go radically in the other extreme. 

I think everyone has an appreciation for what Kaiser has created – insurer, provider, pharmacy, …  They’ve created an integrated system with impressive outcomes, passionate consumers, and a connected technology backbone.  There are a few other organizations that have had regional success doing the same – HealthPartners, Geisinger, … 

The question I would have is who is in the best position to build themselves into an integrated system.  The two companies that jump out at you are United Healthcare and CVS Caremark.  Of course, neither of them have the provider (aka hospital) assets. 

But, I think the point here is that most people I talk to agree that an integrated model is the right model “on paper”.  It can (in theory) offer the best patient experience.  It can drive the best integrated data.  It can coordinate across business lines to accomplish the best outcomes. 

So, it makes me wonder why we let Wall Street dictate the strategy here.  In many cases, structural changes take time.  If building an integrated model is the right concept, why isn’t the talk about CVS Caremark buying a health plan and subsequently jumping into the provider space with ACO models?  Why isn’t the discussion about United Healthcare buying up hospitals and physician groups?

Maybe I’m just trying to present a different scenario or maybe I have rose-colored glasses on, but I think it’s an interesting question to ponder.

(Note: As I’ve disclosed before, I both own CVS Caremark stock and have a business relationship with them.)

Prescriptions – Good or Bad?

I think we all buy into the fact that medications work.  That’s why we’re the most medicated generation.  So, what happens when someone challenges that assumption.  Aren’t these drugs rigorously tested and approved by the FDA?  Isn’t this why we have clinical trials?  Isn’t everyone using many of these drugs?

I get confused and I work in the business.

Here’s an article from the LifeTime Fitness magazine that talks about drugs for high cholesterol, hypertension, and acid reflux.  I’ll let you make your own decisions, but I think this is just another example of the contradictory information that consumers have to struggle with.

Three common classes of prescription drugs in the United States — statins for reducing cholesterol, angiotensin II antagonists for lowering blood pressure, and proton pump inhibitors for reducing stomach acid — can all cause side effects worse than the problems they aim to treat. And the symptoms caused by one drug may necessitate the use of the others.

For large numbers of people with questionable risk factors, these drugs deliver little or no benefit, but that hasn’t stopped pharmaceutical manufacturers from aggressively marketing them as preventive treatments. Underlying their marketing strategy is a host of scientific studies that “exaggerate positive results and bury negative ones,” says Shannon Brownlee, author of Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer (Bloomsbury USA, 2007). “The science on which so much of prescribing is based is biased, shaky, over-marketed and misinterpreted. These are excellent drugs when used on the right people. The problem comes when they’re marketed to everyone on the planet. There’s benefit to a few people, but when you start giving them to everybody, they may do more harm than good.”

Interview With Dr. Victor Strecher (Founder of HealthMedia) From #WHCC11

While I didn’t get to meet Victor at the World Healthcare Congress in DC, I got a chance to do a phone interview with him last week. For those of you that don’t know who he is, here’s a quick bio:

Victor J. Strecher, PhD, MPH
Professor, Health Behavior & Health Education; Director, Health Media Research Laboratory; Director, Cancer Prevention and Control, University of Michigan School of Public Health;
Chairman & Founder, HealthMedia, Inc.
Dr. Victor J. Strecher graduated in 1983 with an M.P.H. and Ph.D. in Health Behavior & Health Education from the University of Michigan. After positions as Assistant and Associate Professor in the School of Public Health at the University of North Carolina, Dr. Strecher moved back to the University of Michigan, where he became Professor of Health Behavior & Health Education and Director of Cancer Prevention and Control in the University of Michigan’s Comprehensive Cancer Center.

Dr. Strecher also founded the University of Michigan’s Center for Health Communications Research (CHCR): a multidisciplinary team of behavioral scientists, physicians, computer engineers, instructional designers, graphic artists, and students from a wide variety of disciplines. For over a decade, Dr. Strecher’s center has conducted research studies and demonstration projects of computer-tailoring and interactive multimedia programs.

In 1998, Dr. Strecher founded HealthMedia, Inc.– a company designed to create interactive health communications solutions for medical care, employer, pharmaceutical, and government settings. The intention of HealthMedia, Inc. is to bring the highest quality science, operational capabilities and creativity to the marketplace.

My key takeaways from the conversation were:

  1. We have to focus on intrinsic motivators in healthcare.
  2. A little help at the right time is a lot better than a lot of help at the wrong time.
  3. Selecting physicians based on organic chemistry scores without weighing empathy may be a issue.
  4. You have to listen to the patient, assess their needs, and provide them with tailored information.
  5. Social media has to embrace “collaborative filtering”.
  6. Most behavior change companies are hitchhikers while some like PBMs are tollbooths. It’s better to be a tollbooth.
  7. Choice has to expand over time.

Intrigued? You should be. Dr. Strecher was a fascinating person to talk with (see some of his insights). We only spent 30 minutes together, but I could easily imagine sitting with him in at my alma mater (University of Michigan) and talking for hours about healthcare communications and how this can impact the country and our outcomes.

We started off by talking about the shift in focus to the consumer over the past decade and how even while this has happened we (healthcare companies) have been guilty of seeing the patient from our perspective not from their perspective. This took us down the path of talking about motivation and what gets people to take action. We focused on the fact that health (in and of itself) isn’t a big motivator, but being healthy to see your kids or grandkids certainly is. We talked about how financial rewards aren’t the right (or only answer) and how there is a need to really understand and articulate intrinsic motives (see write-up on Drive by Daniel Pink).

We talked about his company HealthMedia (owned by Johnson & Johnson) and what they do to collect information on motivation. We talked about the use of stories (a topic that keeps coming up) and providing the right amount of help at the right time. He talked about how HealthMedia monitors consumers, provides them with coaching, and continuously evaluates their goals. He also talked about how they use online technology and mobile technology to get the right connection at the right time.

This led us into a discussion about how important behavior is in health outcomes. He mentioned that 70% of cancers are related to behavior – scary. But, at the same time, we don’t chose candidates for medical school based on their abilities to engage patients or show empathy. We choose them based on their organic chemistry scores. (As a physician, he could say that while I’d probably get tomatoes thrown at me for that comment.)

At this point, I really wanted to understand what HealthMedia has learned to get people off the couch and engaged. It all sounded a little too theoretical to me. He talked about their core process:

  1. Listen to the issues. Assess the patient using branching technology and feedback to them.
  2. Try to figure out what they need using a software algorithm.
  3. Tailor information to them based on what you’ve learned (e.g., if they are concerned about gaining weight when quiting smoking, help them with that). And, I thought a key point here was to help them prioritize their actions rather than giving them a laundry list of things to do.

But, one of the keys in getting them to engage is to work through their intermediaries – employers and payers. For example, while you might encourage consumers to take an HRA for a financial reward, you may need a “health champion” at the employer site to really motivate people at a personal level. Or in another example, he talked about how Kaiser uses Epic and how HealthMedia integrates there. This creates an opportunity for “information therapy” which can be given to the consumer as a follow-up action from their encounter.

We went on to talk about social media which is one of those big topics in healthcare today. Obviously, there is lots of research that talks about the “peer pressure” effect on weight and smoking and other topics. (He mentioned the book Connected here.) But, how to you build trust (see recent post on this) and route consumers to the relevant information. He brought up a concept which was new to me called “collaborative filtering”. My interpretation of this is essentially having an expert monitor and guide consumers to relevant information within the social media realm. You want to find relevance in the data which means it has to be from “friends” who have experience with the topic.

I was asking him about the challenge of building trust given how many companies are out there and the amount of information which consumers are bombarded with. This is when he created the great visual of most companies as being hitchhikers in the behavior change world while others like PBMs are tollbooths. The tollbooths create a pause in the process which is triggered around an event. This event is an opportunity to get the consumer engaged. Of course, in general, these “golden moments” (my phrase) aren’t taken advantage of as much as they could be.

But, if they were, consumers would understand what they want and how a particular behavior maps to those desires. This would lead to improvements in adherence and other outcomes.

We wrapped up by talking about preference-based marketing and the impact of choice. He had some great points here which is an area of interest for me since there’s not much research. He pointed out that choice is instrumental since it appeals to autonomy. BUT, not everyone wants autonomy. Too much choice can be overwhelming. In summary, he suggested that less choice is best early on when the consumer is overwhelmed (e.g., newly diagnosed), but as they become more of an engaged patient over time, more choice is better.

QR Codes – The Ultimate Opt-In Tool

You probably are starting to see them more (those 2D barcode boxes).  They’re called QR codes.  Here’s a few articles about them:

I find this a fascinating area.  Imagine a few examples here:

  1. You want to get a member to opt-in to a program (e.g., auto-refill).  You can put a QR code on their invoice.
  2. You want to offer an educational video about a condition.  You can put a QR code on the Rx label.
  3. You want to get consumers to opt-in to a SMS program.  You can put a QR code on a mailing.
  4. You want to offer a physician access to the clinical studies about a drug.  You can fax them some information with QR codes on it. 
  5. You want a patient to learn more about a condition.  You could put up DTC materials in the provider’s office with QR codes. 

I think you get the point.  I expect this will grow rapidly especially as the smart phone market grows and more and more people have cameras in their phones (devices). 

One of the biggest uses right now in pharmacy is from Walgreens where they allow you to order a refill by scanning the QR code on their bottles using their mobile app.

Can (Should) Generic Rx Companies Differentiate Themselves?

With the traditional brand market getting smaller every year, generic pharmaceutical companies are filling the majority of the billions of prescriptions filled here in the US.  Right now, there is a premium paid if they are first to market with a new generic, but that’s it.  The rest of the market is essentially a “how low of a price point can I maintain”.  At Express Scripts, we did a blind, reverse-auction process for generics that rewarded the company that could (would) sell their generics at the lowest price.

We’ve certainly seen commodity products like potatoes being branded.  We’ve seen fish and beef get branded. 

So, why not generic drugs?  I would certainly want to escape the “race to the bottom”.  It’s the opposite of the specialty discussion from the other day about justifying their premium, but I think one solution is the same. 

How can you wrap services around your generic that makes people want to pay a premium for it?  (That’s likely much less expensive that trying to build a consumer brand so people ask for Dr. Reddy’s generics or Teva’s generics.)  But, in this case, you don’t have the specialty dollars to fund a complex offering.  You want something simple, scalable, low-cost, and effective.  It’s not easy.

Has anyone tried this?  Do you think it’s feasible?

The CVS Caremark Drug Trend Report (Insights) Is Out

The new CVS Caremark Insights 2011 report (Drug Trend Report) is out.  I haven’t read it yet, but here’s the summary from the press release:

  • 2.4% overall trend
  • 13.7% specialty trend
  • GDR of 71.5%

“The continuing increase in the use of expensive specialty drugs, as well as the growing prevalence of chronic disease, calls for innovative health care solutions such as an integrated pharmacy home to help patients deal with complex therapy regimens and stay adherent,” says Troyen A. Brennan, MD, MPH, Executive Vice President and Chief Medical Officer of CVS Caremark. “Developing a pharmacy home was one of the recommendations raised by our recent research conducted with Harvard Medical School and Brigham & Women’s Hospital. That work and this report make it clear we must devise better ways to serve the chronically ill. This trend report shows we are making headway in that fight.”

Real-Time PBM “Pricing” From Prescription Solutions

I don’t do a whole lot in the PBM pricing world these days, but I remember some of the process and the underwriting steps.  That being said, I was really impressed with the new Prescription Solutions online Pharmacy Benefit Advisor Tool (go to http://mybenefitpreferences.com). 

You go through a few basic steps to get an idea of how much you (payer) could save (with a very nice GUI). 

  1. Rank the features that matter to you – net cost, compliance, shifting cost to the consumer
  2. Rank the importance of different clinical programs
  3. Make some trade-offs in programs (A is more important than B)
  4. Enter some baseline data

Now, in reality, PBM pricing is never that simple, but what it effectively does is help articulate the savings that different decisions can create in a real-time setting.  It also forces some dialogue around issues – adhererence versus drug cost…which matters more to you?

I also think it could be a great way to help consumers understand the costs and savings associated with certain decisions.  I would also guess that the sales team at Prescription Solutions will find it helpful especially in the smaller, self-funded world.

The Express Scripts 2010 Drug Trend Report – Waste and Intent Focused

As I’ve talked about in the past, after working on the Express Scripts Drug Trend Report (recent copy here), I really enjoy getting the chance to read through them every year (see 2009 review or 2008 review). Over time, they’ve become less about the clinical side of the business and more about the programs used to engage the consumer with consolidated class specific data still included.

This year’s report is similar, but it is built around a new study that Express Scripts just completed with Harris Interactive. It comes to a rather surprising but interesting conclusion –

We discovered that the majority of people want to engage in the same behaviors plan sponsors seek to promote, but these desires often remain dormant. That is, there is a persistent intent–behavior gap. The key is structuring interventions that close the gap between what patients already want and what they actually do.

What’s the key point here? The point is that this says that consumers really want to move to generics and move to mail order, but they don’t do it. Is it that simple? I’d love to think so. And, for generics and mail order, I’m more likely to believe that inertia is a large factor. BUT, as I’ve talked about before, adherence has lots of complicating dimensions.

They focus on the gap between the physician and the optimal outcomes. This is certainly a major factor, but beyond consumer intent, there are issues of health literacy and physician beliefs that have to be addressed. Regardless, the point is correct…how do we engage and motivate consumers to change behavior especially if they are pre-disposed to change (when presented with the right facts).

They did continue to build on last year’s focus on WASTE. They estimate that the waste in 2010 was over $403B as broken down below:

As adherence is a key issue here, they highlight the difference in adherence rates between retail pharmacy and mail pharmacy.

The focus of the report and the early press I’ve seen has been on the following chart. What it shows is some of the data from the Harris study saying that 82% of people would chose a generic (that are on a brand) and (depending on copay savings) 55-71% would chose retail.

One topic that I was glad was in the survey was limited networks. This is a topic everyone’s talking about from ReStat to Wal-Mart to Walgreens to CVS. Here’s what the research said with some explanation for what it means:

Of note is that about 40% said they would be willing to switch retail pharmacies to save their plan (or employer, or country) money. This fi gure is not as low as it fi rst appears because before a plan implements a more narrow retail network, a large fraction of members already use these pharmacies and therefore don’t have to switch pharmacies. It is not unusual, for example, for a client using a broad network to have 70% of prescriptions processed through pharmacies that are in the narrow network; members currently using these pharmacies do not have to make any changes. When a narrow network is implemented, if 40% of the users of the remaining 30% of prescriptions would willingly move to a lower-cost network pharmacy (as suggested by the survey), we estimate that the resulting overall market share within the narrow network would rise to 82% {70 % + (30% x 40%)}. (page 14 of the DTR)

All of this tees up their family of “Select” offerings (see Consumerology page) which builds on the success of Select Home Delivery and applies the concept of “Choice Architecture” from the book Nudge.

They talk about some of their work with adherence and their Adherence IndexSM. This metric is certainly one that has the industry’s attention as people wonder about the predictive value, how this is used, and how to craft solutions around such an index. My perception has been looking at studies like this one by Shrank and colleagues that past behavior remains the best predictor of future behavior, but I’m happy to be wrong.

So…what were the trend numbers?

  • 1.4% in the traditional (non-specialty drugs)
  • 19.6% in specialty
  • 3.6% overall

One of the other lists that I always find helpful to have is what are the top 15 drug classes and the PMPY spend.

Of course, in today’s world, you really want to know this for specialty medications:

So, as always, I would recommend you read the report. Lots of great information in here. Interesting research. Good thoughts on consumer behavior and how to change it.

I think this week is their Outcomes conference which was always a good event.

How does luxury “framing” impact decision making?

Are people who travel in town cars and on corporate jets different—on a psychological level—from you and me? Does the availability of luxury goods “prime” individuals to be less concerned about or considerate toward others? The answer from new research seems to be yes.

It’s an interesting question with relevance for us in healthcare.  Does the environment in which we work and make decisions impact our decisions?  Is that true for day-to-day work?  For conferences?  For delivery of care?

In general, I believe most of us that work in healthcare are passionate about improving outcomes.  We want to understand how people make decisions.  We want to understand why things happen.  This isn’t just a job.  Given that, these types of studies are important as we think about healthcare communications.  What types of images should we use in our print media, web, and e-mail?

It also makes me wonder about verbal queues or sonic branding.  Can certain words or noises make us more or less likely to make choices that are in the best interest of the group.  For example, if we framed decisions as savings money which would be provided to a charity would more people respond to take that action (e.g., moving to a generic drug) than if we framed it as saving money for the company and therefore allowing more earnings-per-share (EPS). 

“people who were made to think about luxury prior to a decision-making task have a higher tendency to endorse self-interested decisions that might potentially harm others.” (HBS professor Roy Y.J. Chua on what they found in their research)

Save Lennox Campaign Points To Two Health Issues

Have you heard about the Save Lennox campaign?  It’s a sad story of a little girl’s dog in Ireland that’s been incarcerated.  The girl is disabled and the dog is her service dog.  I had the chance to hear Victoria Stillwell from It’s Me or The Dog (TV show) talk about this last night.

What struck me (beyond the story) were two things:

  1. The importance of service dogs within healthcare.  They now do a lot of things beyond simply help the blind.
  2. The rising issue of dog bites and the fact that breed specific legislation (BSL) doesn’t work.  Dog bites have gone up in areas where pit bulls have been banned.

 

Hosted IVR In Healthcare – Go To Silverlink

This is a term I’ve never used before when thinking about what we do at Silverlink Communications, but it seems relevant since people use it as a search term.

We talk about:

  • Speech recognition
  • Personalized communications
  • Preference-based marketing
  • Automated calls
  • Outbound IVR
  • Coordinated multi-channel communications
  • Data driven communications
  • Intelligent interactions
  • Smart calls
  • Interactive dialogues
  • Technology enabled disease management
  • Condition management
  • Campaign management
  • Rules-based communications

I could go on, but my point is that if you’re looking for a “hosted IVR” solution for healthcare you should call us at Silverlink.

[For my regular readers, sorry about the "advertising" but have to mix it in here once and a while.]

Increasing Specialty Drug Refill Rates

Adherence is one of the primary topics of discussion today both within pharmacy and (after reform) within other areas of healthcare.  Adherence drives costs.  Adherence impacts productivity.  And, with a few rare exceptions (CBO type budget analysis looking only at fiscal year returns), everyone’s interests are aligned on the value of improving adherence.

For now, let’s skip over the traditional pharmacy market which is rapidly becoming generic. Let’s look at specialty where the average cost is $1,800 per month and can run into the $10,000′s.

So, what if I told you there were simple solutions that could improve your monthly refill rate on your drugs by 20-40%?  What if that also reduced the gaps-in-care and improved patient awareness of their condition?  What if that also incorporated a feedback mechanism to the care team?

How much would that we worth?  What about all that for $2 / month per member?  Much less that copay waivers or many other solutions out there on the market.

Sound interesting…Go learn more at Silverlink.

Why I Quit Facebook

For someone who is so active in social media (blogging, tweeting), I think people are surprised that I quit my Facebook account (technically deactivated). Maybe, like Twitter, I’ll take a break and return later.  [Unfortunately, I'm sure there are several people out there who think I de-friended them and won't realize I just quit.]

But, why quit? Isn’t it a great tool for communicating?

I did find it interesting, and there is more and more information out there…BUT

  1. It changed how I interacted with people.
  2. It sucks up valuable time (and I didn’t even get into Farmville and the other games).
  3. I’m an introvert so I’m not sure I care to share that much.

Ultimately, I felt like my relationships online where different than reality. I would categorize them as follows:

  1. People who I should talk to offline (e.g., family) but where it became easier to talk via Facebook.
  2. Professional friends that I all of a sudden knew more about them then I normally would or needed to.
  3. Acquaintances who I all of a sudden kept in touch with on a semi-regular basis.
  4. Old friends that I would never talk to without Facebook and where I now was in a constant high school reunion.

It essentially became technology enabled voyeurism. Which might be interesting for a few times but gets old.  Even staying involved with Facebook on an occasional basis uses up time. I would think about saying that I didn’t have 30 minutes to work out when I know I spent 15 minutes online.  Maybe I’m being a little “fuddy-duddy”, but at the end of the day, I have

  1. Friends who I want to talk to live (although rarely have the time).
  2. Professional friends and acquaintances for which LinkedIn gives me everything I need.
  3. High school reunions every 5 years which is plenty.

Facebook essentially reverses the trend of having a smaller and smaller circle of friends as you get older.  You create a body of friends from every era of your life and keep them with you over time.  It’s certainly interesting, but unnecessary in my perspective.

Health, Wealth, and Extreme Couponing

Have you seen this new show – Extreme Couponing?  Here’s a clip -

We all know that poverty can have a great impact on health. From limiting your access to fresh food and access to housing and including risks associated with work environment. Health and wealth are intertwined. Preventative medicine, dental care, and simply filling medications can be an issue for people with limited means.

So, what does this have to do with Extreme Couponing…

Well, it go me thinking about how charities and food banks really need these people. If they can buy thousands of dollars of goods for $50, imagine the impact that could have in a community. A single resource could activate a network of people to provide coupons and go pick up goods at no cost. Those goods could be shared with those that need them thereby reducing their out of pocket costs and improving their access to healthy foods.

Much like the pharmaceutical manufacturers have PAP programs and clinics that help patients get access to drugs, we need to look at what the food companies are giving us in a more organized way to help get this to those that need it most.

And…that can impact our overall health as a nation.

How the application changes your experience? Flipboard and Twitter

I’ve found Twitter to be a great way to get news.  You follow a core group of people who talk about topics that you care about and can quickly sort through mainstream and other news and events. 

But, I was shocked to see the difference in experience moving from using Twitter in a standard format to using it within Flipboard.  Flipboard takes the links and activates them.  It pulls in images, and it makes it into a book.  See the two images here from my new iPad2.

Interview With Dr. Olivier Raynaud At #WHCC11

I had an opportunity to sit down with Dr. Olivier Raynaud from the World Economic Forum while I was at the 8th Annual World Healthcare Congress in DC. If you don’t know them, they put on DAVOS.

It was a great discussion as Dr. Raynaud brings a wonderful macro-economic view of the healthcare problem with lots of global experience. Let’s start by talking about three areas of focus:

  1. Better health from better data
  2. Creating the right health ecosystem connecting different players
  3. Building leadership

These all sound so simple – right?

The first one – data. This is critical and something that the World Economic Forum worked on to create a data charter for healthcare. Getting multiple constituents to agree even conceptually would be a battle (in my assessment).

The second one – ecosystem. His prospective was so much broader that the typical – patient, provider, pharmacist, payer. For example, he talked about the city mayor as critical. He talked about how addressing smoking, exercise, and food choices was systemic and had a profound impact on our work, our lives, and ultimately our taxes. He talked about employers and how 54% of the world’s population is an employee.

We talked about how employers or cities are more likely to take a long-term view of health than an entity that has to show Fiscal Year results. We talked about the impact on productivity, reputation, and loyalty that health can have for a company and how those things impact costs like recruiting costs.

The third topic – leadership. Here we talked about the need to think differently and create global efforts. We spent a lot of time talking about starting Electronic Health Records during pregnancy since there are certain behaviors (smoking, drugs, eating) that can impact the child and ultimately their health. This framework is just starting to be discussed by people and is becoming easier with the proliferation of technology and low-cost of data.

We talked about the fact that 60% of costs are preventable. He suggested that the history of how AIDS has been addressed offers some great lessons learned around Access, Awareness, and Education. Just getting people to get tested has had a big impact.

[Meanwhile, someone else at the conference talked about the general failure of health programs across the world and the percentage of spend that doesn't contribute to improved outcomes...a complicating factor.] The World Economic Forum has an opportunity to identify and spread best practices by getting all the constituents together and aligned.

We then finished up talking about engagement and trust. He had a great perspective about different search algorithms. For example, if you search for vaccines in the US, the CDC has most of the top placements. But, that’s not true outside the US. You might see lots more about fear of vaccines. There is a need ultimately for some type of “trust certification”. But, that has to meet the academic’s and clinician’s needs but be useable by the general public and take into account peer-to-peer and other data that is now appearing.

It was an interesting discussion that just helped open my eyes to a broader perspective. I wish them a lot of luck in pulling these groups together to expand the ecosystem and create leaders that know how to use data to make a difference.

The 2010 Express Scripts Drug Trend Report Is Out

The new report is out.  I haven’t read it yet, but here’s the teaser graphic from the website.

Specialty Rx Offerings Not Rxs Only

I’ve spoken about this for a while, but I was pleasantly surprised to hear one of the Chief Medical Officers in the industry make this point to a large number of manufacturers. He was talking about lots of the changing dynamics in the industry from personalized medicine to new research. He talked about the challenge of adherence and how we needed to think differently. He even suggested that pharma should start talking with payers much earlier in the pipeline so that their research tracked metrics that the payers cared about.

At the end, one of his summary perspectives was that they should stop thinking about just bringing a drug to market and think about how they bring an offering for the condition to market which centers around a drug. This goes back to what the book BLUR presented years ago. You have to blend products and services to create offerings.

In the case of specialty, you have a very sick patient who often has a symptomatic condition that they are living with everyday that might affect their ability to live or potentially debilitate them. It affects their family. And, there may be additional co-morbidities associated with the condition.

Right now, there are solutions that try to engage these patients especially in clinical trials or when a drug is first launched, but over time, that “energy” decreases. It’s important to think about these specialty patients from an experience perspective.

  1. Diagnosis – What happens after they’re diagnosed? How much do they really remember from the physician encounter? Do they understand the drug they’ve been prescribed? Do they know where to go to find more information? Do they understand what resources are available to support them?
  2. First Fill – Do they understand the drug’s side effects? Do they believe that this is going to help them? Do they know how to get the prescription? Do they understand how to use the specialty pharmacy?
  3. Ongoing Therapy – Do they continue to refill the medication? What are their barriers (cost, convenience, literacy, beliefs, side effects)? Can they afford the medication? What support is there (financial, education, counseling) and how do they access it? Does their physician understand the disease? Have they gotten engaged with a community or support group?
  4. Changes In Condition – As they progress, what should they expect? How do you monitor these changes? Do these changes have an impact on the drug or strength? How does adherence affect this?

This creation of a solution blending services and pharmaceuticals creates some new ways for a manufacturer to differentiate themselves in the marketplace. Imagine the power of going to the physician, pharmacy, or PBM and telling them that you have a solution which does the following:

  • Provides a highly effective drug (cue traditional data)
  • Improves awareness and understanding of the condition for the patient
  • Decreases the likelihood of abandonment
  • Helps the patient with their out-of-pocket costs
  • Increases the patient’s likelihood of refilling
  • Helps the patient become an e-patient and engages their support system
  • Provides ongoing monitoring of changes in their condition

Interested? I have some ideas if you’re a brand manager.

The Physician As Island Versus Support From Intermediaries

Should physicians have the final say in patient care?

Someone tweeted me this question the other day. It made me start to think…

Logically, individuals trust their physician to act in their best interest and make the best decisions (based on the information they have).  But, this has shifted from the MD as the primary source of knowledge to the MD as a part of a care team.

There are probably more, but I can think of 5 important things that need to be fixed for the physician to be seen as an ‘information island’ where they can make the best decisions without intermediaries (PBMs, managed care, disease management companies) intervening:

1.  They have to be able to not practice defensive medicine.

2.  They have to understand my costs.

3.  There have to be no meaningful differences based on geography or income or race.

4.  They have to adopt best practices quickly.

5.  They have to be able to be paid based on outcomes.

Some of these are systemic changes that have to be addressed (#1 and #5). The other three can be addressed thru technology (as long as physicians are willing to embrace the science of medicine not just the art).  As a quick example, look at Dr. Atul Gawande’s book. – The Checklist Manifesto or look at some of the work by companies like Health Dialogue on shared decision making.

Now, maybe the person that asked the question is taking a more radical stand and physician’s embrace the support these companies provide them, but that hasn’t historically been true.

The New Kaiser Center For Total Health (#WHCC11)

While I was at the World Healthcare Congress yesterday, I had the opportunity to go into DC to visit the new Kaiser Center for Total Health. This is their showcase in the East to facilitate discussions around improving healthcare. It’s not a replacement for the Garfield facility in CA, but it will create an more accessible forum for dialog with policymakers and international visitors. (NYTimes post about the opening)

It’s one of those fun places where you can go and interact with technology. It’s full of technology like telemedicine and telemonitoring. It provides you with demos of the world’s smallest ultrasound device and connected devices. It showcases Kaiser’s rich history and their MyHealthManager tool.

Their online tools have some great stats:

  • 3.3M members signed up
  • 25.8M test results viewed in 2010
  • 10.7M emails sent to MD’s in 2010

There are a lot of videos where you can hear employees, members, clinicians, and others talk about what they think “total health” is. And, they have a massive interactive mural about their walking initiative.

It seems like this type of interactive, high technology space is becoming an asset at several companies. We used to have this innovative, brainstorming space at E&Y years ago and clients loved it. I believe IDEO has this type of space.

I enjoy it. It’s interesting, inspiring, and creates a dynamic work environment. I look forward to see how this space gets used and what others think.

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