Archive | October, 2011

Candy For Cash (or Toys)

Is this what Halloween looks like at your house?  A big pile of candy!

Similar to the guns for cash program that many police departments have done, we’ve developed a candy for cash program at my house.  The kids can get as much candy as they want and eat a few pieces tonight.  But, they then have to pick their favorite pieces and can keep about a gallon ziplock full of candy.  For the past few years, we’ve actually taken the candy to ToysRUs and basically given it to the cashier as we buy something.  The kids think it’s actually being used to buy the toys while we both get rid of the candy and gives them some incentive not to rot their teeth and eat unhealthy amounts of sugar for months to come.

Hospital Social Media Stats

Here’s some interesting stats from Ed Bennett that were shared in PharmaVOICE (Oct 2011) based on 1,188 hospitals that are using social media.

  • 548 YouTube channels
  • 1,018 Facebook pages
  • 788 Twitter accounts
  • 458 LinkedIn accounts
  • 913 Foursquare
  • 137 Blogs
  • 3,952 hospital social networking sites

My one pet peeve is the “emergency room” locations that publish their wait time via Twitter.  If it’s really an emergency, shouldn’t I be going in to get care not focusing on wait times?  And, aren’t the wait times variable based on how urgent my need?

CMS Quote On Customer Experience

I really liked this AIS Quote of the Day and thought I would share it.  It makes the point that we should strive to create a world-class experience not simply be good for our market niche.

“Our goal [with exchanges] is not to say, ‘It’s better than it was before.’ Our goal is not to say, ‘It’s pretty good for government work.’ Our goal is not to say, ‘It’s pretty good for Medicaid.’ We set a goal for ourselves that we really wanted a 21st Century customer experience…an experience that people feel good about.”— Penny Thompson, deputy director for the CMS Center for Medicaid, CHIP and Survey and Certifications, speaking at a recent AHIP meeting, “Preparing for Exchanges.”

What Does A PBM Do (Video)?

A big question is always “what is a PBM“.  PCMA has developed a new video which shows some of the things that a PBM does.  Here it is…

Predicting Medication Adherence

Is there a secret sauce?  (Hint: past behavior)

It always important to be skeptical, but there are certainly attributes like the number of Rxs, gender, condition, copay amount, and other factors that contribute to the likelihood of a consumer being adherent.

But, one of the big discussions is around how to use other variables.  FICO, the company that creates credit scores, has created an adherence score.  In today’s WSJ, they shared this image about predicting adherence.  Interesting…

Why Not Make “Low Fat” Normal And Label Others “Full Fat”

One of the foods my kid loves comes in both normal and a low-fat version.  But, we’ve always bought the low-fat version.  One day, they were out so I bought the normal version.  I was surprised when he was upset.  Why did you buy me the full fat version he asked?

It got me thinking.  Like “loss aversion” would reversing the positioning of products work?  There’s always talk about the “fat tax“.  Why not try making low-fat the standard and requiring labeling that points out what products are full of fat?

 

What’s The Average Prescription Copay? (AIS Survey)

AIS conducts a quarterly survey on behalf of Drug Benefit News.  For the second quarter of 2011, the average copays were:

  • 1st Tier – $10.28
  • 2nd Tier – $26.66
  • 3rd Tier – $44.65

 

Basic Attributes Of The 7B People In The World

There was an article in the 10/31/11 Time magazine about the global population.  I found this list of basic statistics interesting:

  • 19% of the world’s population lives in China.
  • 33% of the world’s population is Christian.
  • 50.4% of the world’s population is male.
  • 50.5% of the world’s population lives in a town or city.
  • 29 is the median age of the world’s population.
  • $10,290 is the per capita gross world income.
  • 73% of the world’s population does NOT use the Internet.

Should Health Companies Be Brutally Honest With Consumers?

I saw a statistic today that said that the Domino Pizza’s stock price has gone up by 233% since they began acknowledging that they had a reputation of a low-quality product.  Fascinating!

Would that work for health plans or PBMs or pharmaceutical manufacturers?  If they acknowledged the perception that consumers have for them, would that engage consumers?  Would consumers respond well to that?

Imagine messaging around prior authorization that sounded more like this…

“We’re calling to let you know that you need a prior authorization to get your [drug, service, device].  I know you think we’re just doing this to cut costs and override your physician’s decisions, but that’s not true.  We care deeply about you, but our physician team determined that there’s a chance for overuse of this [drug, service, device].  All we’re asking is for your physician to answer a few questions to validate the proper use.  We’ve even launched a web service so this can be done with minimal disruption.” 

Lots Of Consumers Looking For Generic Lipitor

Assuming my blog volume is any indicator, it seems like consumers are increasingly looking for information on generic Lipitor.  My blog volume doubled last week.

If you type “Lipitor going generic” into Google, I’m the first page returned (after paid search).  [I always love finding these Search Engine Optimization (SEO) results.]

Do You “Give A Spit”?

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Have you seen this new campaign from BeTheMatch.org?

Only 2% of the US population is registered.  Are you one of them?  I am.

There are 10K people who need a transplant.  Whether you organize an event or just get yourself registered, you can help save a life!

Will The Stars Align To Drive Adherence?

We all know that adherence to prescriptions is a problem.  People don’t start on their medications.  People don’t stay on their medications.  But, another problem also exists which is finding the ROI on adherence.  While the ROI is clear to the manufacturer or even to the pharmacy, it’s often less clear to the payer.

This is not true in every category.  Diabetes and several other conditions have been shown to have an ROI associated with intervention programs that improve adherence.  But what about all the others.

In the short-term, I expect you’ll see the CMS Star Ratings and bonus payments drive behavior in three critical categories that are now measured in the 2012 for MAPD and PDP plans.  (see technical notes on 2012 measures)

If you’re not familiar with the Star Ratings system, you should read this.  In 2012, there were three new adherence measures added.  Not only are they now part of the evaluation process, but they were weighted more heavily than some of the operational measures.  A  good indication of focus on quality of care.

Getting more Stars is important since it is linked to bonus dollars that the plans can get.  And, there aren’t many Five Star Plans.  Only 9 plans received 5-Star Ratings for 2012 (see article).  [Interestingly, I think one of the unique assets that Express Scripts is buying in the proposed Medco acquisition is one of the 4 Five-Star PDP plans.]

“The Medicare star quality rating system encourages health plans to improve care and service, leading to better patient experiences across the board,” Jed Weissberg, a senior vice president at Kaiser Permanente.  (from 5-star article above)

The adherence measures focus on diabetes, high cholesterol, and hypertension and use Proportion of Days Covered (PDC) rather than MPR for their measurement.  Certainly, one of the things we’re seeing at Silverlink with our Star Power program is that many of these Star Measures can be influenced by communications.  Adherence is certainly one of those big areas of opportunity for plans to focus on.

While the benefit is obvious to the plan in terms of reimbursement, the big question is whether consumers care about Star Ratings or just focus on lowest price point and access to pharmacies or specific medications.  A Kaiser study that was done seems to indicate that the answer is no.

Conducted by Harris Interactive, the survey showed that only 18 percent of Medicare-eligible seniors said that they are familiar with the government’s rating system. Of those that are familiar, less than one-third have used the system to select their health plan. Moreover, only 2 percent of respondents were aware of how their current plans rates. 

Since we’re in open enrollment for Medicare right now (see Medicare.gov to evaluate options), perhaps we’ll get some data in early 2012.  2012 will also be the first year for the 5-Star plans to be able to market all year round and not be limited to the OEP (open enrollment period).

But, one of the things I found interesting as I looked on the Medicare.gov site to “select” a plan in my area is that there is an option to “Select Plan Ratings” but even I wasn’t sure what that was.  It’s not intuitive to the consumer that this is a quality rating for them to pay attention to.  And, it appears that the default order of options which is presented to you is based on price.

Infographic: Word Of Mouth Advertising

As healthcare moves toward a more retail model, word of mouth advertising becomes more important.  This is already true in terms of physician’s influence on prescription use or in some cases distribution location.  It’s also important from a Medicare perspective.  But, this will continue to increase in importance in the future with health reform.

I also believe that clients will require satisfaction scores as part of their SLAs (service level agreements) in many cases in the future and/or tie bonus dollars to this.  Will you be prepared?  Do you understand your customers’ satisfaction with you?  Do you know how to impact it?

Managing Stress As One Of 65M Caregivers

65 million Americans are caregivers which can be a stressful job.  I think more and more companies that I consult with are looking at how to engage the caregivers as part of the overall health team.  With that in mind, I thought I would share this quote.  Managing stress as a caregiver is important so you don’t burn out.

“When you have a bad job in a toxic workplace, you feel trapped, but you can always try to find another job,” said Sharon Brothers, a veteran social worker who is now executive vice president of Caregiver Village (www.caregivervillage.com), an omnibus Internet community and resource hub for caregivers that includes expert forum hosts and even an online caregiver game. “Caregivers, however, can’t just find another role. They are caring for a loved one, so the stress they live with is real and the boss they report to is themselves. They feel trapped by their love and obligation to their family members, which makes it exponentially more difficult for them to get a break, because they feel guilty whenever they try to take one.  In fact, studies show that being a family caregiver is one of the most stressful ‘occupations’ in the country today.”

Communications: Get To The Point

I got to catch up with one of my first bosses tonight.  He taught me a lot about strategy, consulting, and people.

One of the lessons I never forgot was about communicating.  I don’t always do it, but he used to tell me two things:

  1. If you’re going to leave me a voicemail, tell me the key points in the first 30 seconds.
  2. If you send me an e-mail, make sure you get to the point in the first few sentences.  I’m only going to look at what I see in the window in outlook and won’t open it.
What did I learn?
  • Think ahead about what I’m going to say.
  • Layout my key points and why to listen to the rest of the message (or read the entire e-mail)
  • Just provide enough information to justify a call or meeting
I’m always surprised at how people talk on and on in voicemails and e-mails.  I’m sure I do sometimes also, but I’ve tried to continue to practice what I learned years ago.

What Will Happen With Generic Lipitor (atorvastatin)?

Well, it finally looks like generic Lipitor will be on the market soon.  I think November 30th is still the date.

Of course, now the question is what will this mean to you (the consumer)?  Since atorvastatin will be distributed by only one manufacturer for the first six months after the patent expires, there will not be a significant price drop.  Therefore, I know at least one (and have heard two) PBMs will be blocking the generic drug during that time.  Consumers will be able to get Lipitor at a generic copay.

I’ve offered my opinion on scenarios like this before.  I think it’s confusing to the consumer.  It’s great for Pfizer and generally everyone wins since it’s the same out-of-pocket costs to the consumer and lower cost to the plan sponsor (employer) than the exclusive generic (due to rebates), BUT I think it sends a confusing message.  “You can and should use generics except for in some cases where the brand drug is cheaper.”  I’m not sure how this plays out in states where generic substitution is required by law.

Of course, your other option is to go use the Lipitor $4 coupon.  If I were the Pfizer brand manager for Lipitor, I would offer a $50 payment for a 1-year supply of Lipitor and lock people in for the year.  [A seperate discussion needs to be had about how cash and coupon claims which don't necessarily get adjudicated affect adherence measures for bonus payments like Star Ratings...and yes, I know that coupons aren't supposed to be used for Medicare members, but I don't think that's monitored well.]

So, you might go to get your generic Lipitor and leave with the brand at your generic copay.  On the other hand, I wouldn’t be surprised to see some PBM negotiate well enough to get a better price on the generic than Lipitor (net of rebate).  [Of course, these are the types of scenarios that cause friction in the supply chain.  Which drug can the retailer buy better?  Does the client get the rebates shared with them or not?]

I know this is what some companies like GoodRx are looking at with their application which compares drug prices across retailers.  It shows you if there’s a coupon available (see broader article on them).  It suggests savings like splitting the pill.  (No mail or 90-day promotion yet that I saw.)  Of course, this is from a cash paying customer perspective.  But, with atorvastatin, you may want to compare your plan design with the cash price with coupons.  You’ll want to know if it’s part of the $4 generics program or if you get a better price with the CVS or Walgreens discount card programs.

Here’s two examples from GoodRx.  One is for Lipitor which shows some variation (and has no generic today).  The other is for Prozac which has been available as a generic for a while.

There Is Never A Good Time To Be Sick

Whenever I get a cold or have to go to the physician’s office, I always complain about how busy I am or what else has to be done. We schedule our lives so tightly that there is rarely time for acute health needs much less preventative measures. (Or else I’m the exception.)

But, I was thinking about this when I read the Walgreen’s study the other day on the impact of the flu. It takes survey data and projects it forward, but I think it makes a big point about why to get a flu shot. You don’t want to be miss out on life’s events such as the estimated:

  • More than 600,000 graduations missed
  • More than 1 million weddings not attended
  • More than 3 million vacations canceled or interrupted
  • Nearly 5 million holiday celebrations missed
  • More than 5 million sporting events missed

And, the rest of us that are healthy don’t want the sick people coming and getting us sick!

“In addition to holidays and planned vacations, there may be other engagements and important dates that fall when flu is widely circulating. There’s no planning for an ill-timed illness, and these findings from last year’s typical flu season reinforce the importance of getting a flu shot each year.” (Dr. Cheryl Pegus, Chief Medical Officer, Walgreens in press release)

Touch and Body Language in the Physician Encounter

I was watching this TED video the other day from a physician and writer Abraham Verghese.  It was interesting since his whole point was about the ability to relate to your patient through human touch and the power that has on the patient’s trust and experience.  As we move towards move EMRs and other technologies, we have to make sure we don’t over-engineer the patient experience.

I was reminded of this again when reading KevinMD’s blog where there was a post on using body language.  How many of us think about what our body language is saying?

Or do we think about our clothing selection?  While the white coat may create trust, does the tie create a sense of being aloof?  Or should you consider different color sections to seem more approachable?

Food for thought.

Did IOM Overlook Literacy and Prevention With Their EHB Recommendations?

“The ACA requires that certain insurance plans—including those participating in the state purchasing exchanges—cover a package of diagnostic, preventive, and therapeutic services and products that have been defined as “essential” by the Department of Health and Human Services (HHS).

This package—commonly referred to as a set of essential health benefits (EHB)—constitutes a minimum set of benefits that the plans must cover, but insurers may offer additional benefits. The EHB are intended to cover health care needs, to promote services that are medically effective, and to be affordable to purchasers.”

The Institute of Medicine (IOM) put out a report recently about Essential Health Benefits (EHBs). While I haven’t fully digested the report and its implications, I noticed two things:

  1. There was no one from the pharmacy community on the committee.
  2. They seem to overlook the value of health literacy.

While I know observation #2 is an opinion that could be heavily debated, let me share my logic here.

If you look at the criteria for EHB selection (see below), they call out that it must “be a medical service, not serving primarily a social or educational function.” I would argue that it is risky to ignore education and its correlation with health. There are many educational functions around prevention which are important. Additionally, there is a lot of research these days around the social value of different networks and tools and their relevance to overall health.

This is Health Literacy Month so you can go visit several sites to see more about this topic. You could also look at research on social aspects of health from Pew. Or, I might even draw upon research around pets and their value in healthcare.

I’m sure the panel didn’t mean it to be interpreted this way, but we know how our government works. These comments become “law” and hard to overcome. I would think some clarification to say something more like the following would be better.

“Be a medical service or a program whose educational or preventative objectives have been demonstrated to improve health outcomes.”

Other articles on the report include:

Cartoon: Gap Btwn Customer Needs And Product Features

We’ve all seen these types of cartoons at one-time or another, but I liked this one (c/o Guy Kawasaki).

Increasing The Value Of Your Refill Reminder Call

The other day, I got a refill reminder call from my pharmacy. The call came to my home number and simply stated that your prescription is ready.

Thanks…BUT what prescription. Mine? My wife’s? My kid’s?

If mine, was it the one I stopped taking? Or was it the second fill or an anti-biotic that we switched since it wasn’t working?

Did they even have the right phone number? (They never said anyone’s name in the message.)

I was confused and annoyed. I don’t think this type of message is helpful.

IMHO…the ideal refill reminder call should be something like the following:

  • This is pharmacy X calling for George Van Antwerp. Please have him call us back.
  • Thanks for calling back in. Please enter (or say) your prescription number or date of birth.
  • We have a prescription for drug X ready to refill for you. Will you be coming to pick it up in the next 2 days?
  • (If no) Do you intend to refill it?
    • (If no) Why not? (and then address the barrier)
    • (If yes) When should we call you back to remind you?

This would minimize me calling the pharmacy to follow-up on the call. It would cut down on abandonment. It would also address adherence by capturing and addressing any barriers in the interactive call.  [Of course, you have to manage HIPAA and several other constraints to achieve this, but it is possible.]

Creating an interactive and effective communication is the type of work we do at Silverlink (campaign design, scripting, segmentation, behavioral economics, communication execution, analytics). Like many others, we’re seeing refill reminders move from blast calls to interactive calls and expanding to SMS, mobile apps, and e-mail. Ultimately, it’s about figuring out the patient’s preference and the right way to “nudge” them to refill at the lowest cost per success. And, it works. You can see more at our adherence site – https://adherence.silverlink.com.

  • What voice should you use?
  • When should you call?
  • Should you e-mail then call?
  • Should you call then send a text?
  • Should you talk about their condition and stress the value of adherence?
  • What’s important to the patient about being adherent?
  • What is their previous pattern of refills?

NCPA Announces “Simplify My Meds”

For patients with multiple prescriptions, it can be very annoying to have to constantly refill different medications on different cycles. This leads to waste (time) and forgetfulness around refills. It’s an age old problem.

The easy answer would be to work with the patient to consolidate the orders to refill on the same day of the month. This might involve a few split orders or short-fills to get them lined up. I’ve talked with multiple pharmacies about this over the years.

NCPA announced the other day that they were going to focus on this as part of their adherence program. This is great! If they can pull this off, I would expect the whole industry to try and follow.

“By coordinating exactly what day patient refills occur, the independent pharmacy staff’s workload is streamlined. Daily workloads become more predictable, labor costs go down, and staff stress levels decrease. Data analyzed from pharmacies using this model has shown as much as a 30 percent increase in prescription volume, a 50 percent decrease in labor costs, and $1.87 per script increase in gross margin.” (NCPA Press Release)

Monitoring Your Health Thru Existing Devices – Convergence

Not a big surprise, but a company [and probably many more] is focused on applications that leverage the smart phone for remote monitoring.  They are looking at respiration, pulse, heart rhythm, and blood oxygen level.

This reminds me of the Ford announcement about monitoring air quality for allergies and considering a diabetes app within the car.

This idea of convergence isn’t new.  I think we’ve all seen how our smart phones now replace our cameras in many cases.

The one that I keep wondering about is when monitoring will happen through the toilet.  You could monitor your kids for drugs or alcohol.  Your urine could tell you about a urinary track infection or the color can tell you about dehydration.  Your feces color or smell could also provide health information.  This has been a topic on Dr. Oz before (but I couldn’t get the video to play and embed here).

Maybe the “smart toilet” will be the next big thing in preventative health.

Using Hypothetical Questions To Influence Decisions

Most people don’t realize how questions can be persuasive, according to new research from the University of Alberta. Hypothetical questions usually start with the word “if,” meaning the information may or may not be true. Our brains process that information like the “if” isn’t even there, says study author Sarah Moore, Ph.D., a marketing professor at Alberta’s School of Business. “As a result, people accept the data you present at the beginning of a question as fact,” Moore says.

This is from an article in Men’s Health.  It made me think about lots of ways that hypotheticals could be used to drive consumer behavior in healthcare:

  • If you were able to avoid having your kids home with the flu shot this year, would you take them to get a flu shot?
  • If you were able to save $50,000 in healthcare costs over your lifetime, would you make sure to take your medications everyday?
  • If you were able to spend more time with your family rather than waiting in line at the pharmacy, would you be more likely to use 90-day prescriptions?
  • If you didn’t have to take any sick days next year, would you go in for your annual physical exam?
  • If you decreased your likelihood of losing your foot to amputation due to diabetes, would you go get a foot exam every year?

This fits well with a lot of the behavioral economics frameworks that companies are using today.

Patient Reasons For Participating (or not) in Genetic Test

Medco just put out a study that I found very interesting since it shares data around patients opting-in to a genetic test around use of statins.

In the big picture, it showed that those got the genetic test were more adherent.  Perhaps this points to a better belief in the therapy post-genetic test (similar to the placebo effect).

But, what first grabbed my eye was data on the consumers:

  • 53.8% participated in the study since they believed in the utility of genetic testing
  • Only 6.7% of those that declined cited privacy issues
  • Only 8.8% of those that declined cited anxiety about the results

This could be very promising for something that is complex but is certainly part of the future of medicine.

Infographic: Patient Education

This is a topic I often bring up in discussing adherence with clients.  We have to partner with MDs as a pharmacy community to address this.  There are fundamental gaps at the beginning of the process where patients don’t understand their disease or their drug.  Without that, it’s hard to believe that taking your medication will make you better or to understand that this is a lifelong process in some cases.

Will Insurers Continue To Cover Avastin?

In case you haven’t seen the news about Genetech’s Avastin, here’s the quick summary:

This will be a hot topic.  While it only affects a relatively small group of patients (~17K), this is an emotional issue.  Many patients strongly believe in the drug.  I would expect companies to be getting lots of questions on the topic.
At the end of the day, if the panel and FDA agree that the drug is not effective, I find it hard to believe that many insurers will cover it or if they do, it will be tightly controlled with prior authorization.

Health, Wealth, and Education

I was reading the article “The Preschool Wars” by Kayla Webley, and I thought I would share some of the comments from it. It certainly plays into why we need to think about all of these issues together – poverty, literacy, education, health, and wealth. They are correlated.

  • Long-term studies show high-quality early-childhood education is particularly beneficial to low-income kids, helping them to avoid repeating grades in elementary school, stay on track to graduate from high school, earn more money as adults, and spend less time in jail or on welfare.
  • Only 9 states and DC are even trying to offer preschool programs to all children that want to attend and 10 don’t even have any state-funded programs.
  • You get a 60:1-300:1 ROI for each dollar spent on these programs in terms of increased earnings, crime reduction, and other benefits to society. [And, I would argue that as the government is and continues to be the primary payer in healthcare that there are savings possible here also.]
  • 1 in 5 children live below the poverty line today.
  • 1 in 4 third-graders who have lived in poverty and are not reading at grade level will drop out or fail to graduate by age 19 (6x more than the rate for proficient readers).

It creates some good food for thought. We need to continue to think about how we help people teach their kids. We need to think about how we introduce health into the conversations at home and at school much earlier in life. These things can make a difference.

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