Deloitte 2009 Survey of Health Care Consumers July 5, 2009
Posted by George Van Antwerp in Books / Articles, Consumerism, Healthcare, Managed Care, PBM / Pharmacy, Research.add a comment
This is based on a Deloitte web-survey of 4,001 Americans in October 2008.
- 73% are confused about how the US healthcare system works
- Over 1/2 believe that 50% or more of healthcare dollars are wasted
- 7 of 8 Americans believe themselves to be in good health
- 1 in 3 are interested in working with a health “coach” to help them create and stick to a plan
- 68% are interested in home monitoring devices that would check their condition and send results to their MD
- 3 in 5 say financial penalties would improve their adherence
- Only 1 in 3 Rx users say they compared treatment options
- 22% say they looked or asked for information about a health insurance plan in the last 12 months
- 9% have a PHR
- Physicians who are more prescriptive (paternal) were preferred by a ratio of 2:1
- 8 in 10 say they would consider switching from a physician recommended Rx if a pharmacist (RPh) indicated a cheaper alternative was available
- Only 12% said they understood the term – biologics (should they?)
- 35% are willing to accept a smaller provider network for a reduced premium and lower copayments
- Only 25% favor increasing taxes to help cover the uninsured
Their major conclusions were:
- Health care is a consumer market
- The health care market is not homogeneous
- Cost concerns are changing behaviors
- Consumers want holistic care and resources to pursue wellness and healthy living
- Consumers embrace innovations that enhance self-care, convenience, personalization, and control of their personal health information
Could / Should Healthcare Follow The Car Dealer June 16, 2009
Posted by George Van Antwerp in Consumerism, General Thoughts, Healthcare, Politics.add a comment
Healthcare is one of the few industries where more supply equals more demand. (Maybe the only one.)
So, as we look at the healthcare shortage of PCPs, RN, and RPhs, should there be more discussion of closing locations? Should we pursue the tact of the car manufacturers in closing dealerships to have less locations? This would fly in the face of the MinuteClinic type of strategy.
Or, I guess the better question is whether there are certain points in the process where more access points are needed, but there are other points in the process where less access points are needed. For example, do we really need 6x,000 retail pharmacies in the US. Certainly, in some urban and suburban locations where the average person passes more than 3 pharmacies to get to the one they use, the answer is no. In some rural locations, there is no option other than the one pharmacy that is 20 miles away.
Would this change our behavior? I believe analysis would show that less testing facilities and more difficult access to certain tests would certainly change their use. Would this address the problem or simply create more services that were being done outside the system (i.e., cash businesses)?
I don’t know the answer, but I haven’t heard anyone talking about what seems like a logical discussion.
Finding A New Name June 12, 2009
Posted by George Van Antwerp in Blogroll, Consumerism.add a comment
I have received notice that I can no longer use the “Patient Centric” term. Apparently, it’s a Trademarked name.
As I am looking at new names, I have come across a new series of blogs and sites.
1. I first looked at “The Engaged Consumer”
2. I looked at “Healthcare Communications”
- A new book and blog around this.
3. I looked at “Health Engagement”
4. I looked at “Member Engagement” which is open, but I’m not sure it’s the right terminology.
I welcome any thoughts. I am working on a few more right now.
New Clinical Webinars – HEDIS, Adherence, Engagement June 8, 2009
Posted by George Van Antwerp in Consumerism, Events, Healthcare, Managed Care, Marketing / Communications, Methodology, PBM / Pharmacy, Research, Silverlink.add a comment
In June, we are offering three complimentary webinars to our clients and prospects on key topics of discussion.
Increasing the Effectiveness of Population Health Program Engagement
June 16th | 1:00 PM ET
Getting consumers to take charge of their healthcare behaviors and choices is critical to controlling costs and improving outcomes. Successfully welcoming and engaging consumers in DM and health management programs can be the toughest road for health plans and population health organizations. Strategies that motivate participatory engagement are key – but it takes more than a friendly voice and the right script.
Join Silverlink for a complimentary webinar where we will discuss the challenges of moving health behaviors and effective strategies organizations can implement to get ahead of the behavior change curve.
In addition, learn how to:
- Leverage tailored messaging to drive high engagement rates
- Enable continued engagement over time
- Maximize buy-in and acceptance of health coaching
- Combine multichannel approaches to elicit engagement and re-engagement
- Optimize engagement campaigns through predictive analytics to drive results
Drive Positive Health Behaviors and Improve HEDIS Results
June 23rd | 1:00 PM ET
Whether your focus is on the HEDIS measures for women’s health, the diabetes metrics or a broad range of effectiveness of care measures, Silverlink can design communications strategies that increase your reach, motivate member action and improve HEDIS results.
With the backdrop of the economic slowdown, communicating with members about the importance of key preventive screenings is more critical than ever. Explore the many routes to break through health prevention challenges by tailoring communications interventions that work for your populations.
Join Silverlink for a complimentary webinar where we will present the results and lessons learned over several years in supporting HEDIS screenings including a recent campaign aimed at reducing health disparirities in African American and Hispanic populations related to colorectal cancer screenings.
In addition, learn how to:
- Use a flexible framework that supports national teams in delivering effective outreach in local markets
- Drive performance on high-profile HEDIS measures where plan performance has hit a plateau
- Segment your membership to deliver highly personal messages using multiple levers
- Design and target messages to help reduce health disparities
- Combine multiple messages to support members with more than one gap
- Leverage multichannel campaigns to maximize reach and action
Rethinking Medication Adherence
June 30th | 1:00 PM ET
More than 50% of consumers become nonadherent around their maintenance medications within the first 12 months of therapy. And, today’s economy is putting even more pressure on people to make economic tradeoffs that threaten their health. Several studies have shown that more people are skipping doses or not refilling medications. Non-adherence leads to $177B in direct and indirect costs to the healthcare system per year.
Silverlink provides a comprehensive suite of communications services to drive medication adherence from targeting and messaging to multi-channel campaign management and execution. Join Silverlink where we will discuss some of the common myths around and key strategies related to medication adherence.
In addition, you will learn about:
- Critical success factors in designing adherence solutions
- Important conditions to focus on for adherence
- Success metrics and key measurements
- Comprehensive solutions for all phases of the patient’s therapy from initiation through long term maintenance
Expanding the Role of the Clinic June 8, 2009
Posted by George Van Antwerp in Books / Articles, Consumerism, Healthcare, Value Propositions.add a comment
I think the fact that Walgreen’s and CVS Caremark are expanding the role that the clinics can play in healthcare is a positive thing. There will be lots of debates about how much can be handled at the clinics versus the physician’s office, but I think the key point should be that today’s model doesn’t work. Chronic diseases are not managed. We provide sick care not well care.
Launched over the last four years to care for such simple ailments as ear and sinus infections, strep throat or pinkeye, retail clinic operators now are training nurses to do specialized injections for such chronic conditions as osteoporosis and asthma.
In addition, they are offering treatments for advanced skin conditions that include removal of warts and skin tags or closing minor wounds. Care for minor “sprains and strains” also is being offered at some retailers, and pilot projects are underway for breathing treatments and special infusions of drugs derived from biotechnology.
We need to figure out how to lower the costs, make the system more accessible, get patients engaged, and drive people to preventative care. I don’t know if the clinics can do this, but if they can, we should embrace them. I think both companies are very well positioned to drive change with their breadth of services. They touch the consumer on a regular basis and have the ability to use data, technology, and localized care to engage patients.
Medco 2009 Drug Trend Report May 25, 2009
Posted by George Van Antwerp in Books / Articles, Consumerism, Healthcare, PBM / Pharmacy, Research.add a comment
Here are my highlights from Medco Health’s 2009 Drug Trend Report:
- Overall trend was 3.3%. (1.3% excluding specialty drugs.)
- Specialty trend was 15.8%.
- Their generic fill rate was 64.1%.
- Interestingly, they broke out trend to show that clients with over 40% mail use had a trend of -0.7% while those with less than 40% had a trend of 5.8%.
- I do like the generic distribution chart below although it is for 2008 Q4 while their 64.1% number is for the average of 2008.
- They point out that utilization growth was negative 1.1% last year which was the first time in a decade. What I was surprised at is that they didn’t “blame” the economy for this. Most surveys I have seen say or imply that people are taking less medications because of the increasing cost burden while their overall wealth is decreasing.
- Medicare costs increased 6.8% for their PDP (prescription drug plans).
- I think it’s interesting in helping companies focus their management efforts when they project that “in the next 3 years more than 85% of drug trend will be driven by drugs in six categories: cardiovascular, endocrine/
diabetes, central nervous system, musculoskeletal/rheumatology, respiratory, and oncology”. - In a brief section about the unwired state of healthcare, they share some scary statistics:
- A review involving the medical records of 41 million Medicare patients identified $8.8 billion in error-associated costs and 238,837 preventable deaths. Moreover, a large subset of these errors are medication errors.
- An estimated 1.5 million preventable serious medication errors occur each year, with $217 billion (2006 dollars) in associated costs.
- Since people are always asking for quantifiable value around adherence, I liked the chart below which showed the survival rates over years based on adherence vs. non-adherence.
- They introduce a new metric – Generic Opportunity Score (GOS). It takes into account both chemical and therapeutic opportunities for generics to be used.
- They also provide some details on a brand-to-generic $0 copay waiver program which had a 14% success rate. That’s pretty good from what I have seen.
- Here is a breakout of the specialty pharmacy categories:
- Now, where they do credit the economy is with improving generic fill rate, mail order utilization, and client’s use of trend management programs.
- They show trend by age group with the lower age groups growing faster. They also showed a nice graph of utilization by state.
- Below is their chart on where trend growth in the future is projected to occur (which should tell you where to focus preventative action).
Do Consumers Understand Cost of Individual Insurance? May 19, 2009
Posted by George Van Antwerp in Consumerism, Healthcare, Managed Care, Marketing / Communications, Research.add a comment
In a study done by Kelton Research on behalf of eHealthinsurance.com, I found a few interesting data points:
- 65% of people don’t think they could afford health insurance for more than 6 months if they lost their job. (Since most Americans live paycheck-to-paycheck, that shouldn’t be surprising.)
- Only 26% knew that individual health insurance is cheaper than COBRA although COBRA can be a lot less expensive with the Obama subsidiary.
- 31% think that they would be denied coverage by another plan versus the actual denial rate which is closer to 11%.
- To stay covered, only about 50% would be willing to spend less on cell phones or cable TV.
- Only 40% would be willing to pay more than $200/ month.
Why Does WSJ Villanize CVS Caremark? May 13, 2009
Posted by George Van Antwerp in Blogroll, Books / Articles, Consumerism, Healthcare, Managed Care, Marketing / Communications, PBM / Pharmacy, Value Propositions.2 comments
I was so annoyed when I read the WSJ this morning about CVS Caremark charging more for members that go outside the CVS store or mail order. Come on guys. This is a basic tiered network design. It’s not unlike tiered formularies or preferred drug lists.
First, it’s a plan design that was created and offered to clients. Some clients choose it. That’s not CVS Caremark’s issue. Anyone could do this and offer it.
Second, what’s different between this an mandatory mail or retail buy-up. If you choose a higher cost location, you have to pay more. You’re getting the same drug at a higher cost facility.
What frustrates me the most here is that we will never reform healthcare and drive out costs if people want to have their cake and eat it too. You think you can have total flexibility and manage costs. We have to make some hard decisions and push people to drugs, locations, treatments, etc. that offer similar quality at a lower cost. That’s not going to be easy.
Express Scripts 2009 Drug Trend Report May 9, 2009
Posted by George Van Antwerp in Books / Articles, Consumerism, Healthcare, Marketing / Communications, Methodology, PBM / Pharmacy, Research.2 comments
I always enjoyed being part of the team that put the Drug Trend Report out when I was at Express Scripts from 2001-2006. With that in mind, I do await anxiously to see what new information they will share each year. I will say that the core fundamentals (as always) were very strong in the 2009 report, but I missed not having any client case studies in the document.
They reported drug trend of 1.5% (without specialty) and 3% with specialty.
Specialty drug trend was 15.4%.
Patients paid an average of $12.82 per Rx.
They say that more patients converted to Home Delivery (aka mail order). [I have to check this. My recollection is that mail volume was relatively flat and this would be hard to achieve unless they had more people filling less drugs on average at mail.]
They reported PMPY utilization of 14.32 Rxs.
Their members paid 29% of the generic drug costs; 19.6% of the brand costs; and 22.3% overall for traditional drugs. For specialty drugs, they paid 2.3% (or 20.2% for all drugs including specialty).
They have a section on compliance (which is rapidly becoming a key discussion point in the PBM world). I was a little surprised they didn’t call it adherence which is more common these days. But, they revealed some surprisingly high MPR (medication possession ratio) numbers for antidiabetics, antihypertensives, and lipid-lowering drugs. Considering adherence is where a member has an MPR of greater than 80%, they showed 77%, 83%, and 83% respectively. Since we know that 50% of people (on average) drop therapy within 12-months, this seems improbable on a book-of-business basis. (Maybe I’m just becoming a cynic in my old age.) The only reason I could find to explain this example was that this was not based on new starts (i.e., NRxs) unless they came in the first quarter. Therefore, there might be some selection bias in that they are taking MPR on people that started the year on the medication and may therefore have been people who were more likely to be adherent. I would rather see this done on a rolling 12-month basis.
As I often use, they define waste in the system and give you a potential GFR (generic fill rate) goal for the top therapy classes.
Their analysis shows that 55% of the costs for specialty drugs were billed through the medical benefit rather than the pharmacy benefit.
55% of their members are in plans with at least one step therapy module.
They talk about a few studies they have published showing that targeted and framed messages are more effective than general messages. And, that those messages are more effective with mail order users than people at retail.
Again, there might be some selection bias here as people at Home Delivery may simply be more active in managing their healthcare. The other question I have had for a few of my friends there has been whether we are comparing apples-to-apples. Since I ran a few of the programs before I left, I know we did a lot more interventions (web, inbound IVR, outbound calls, messaging on the invoice, letters, POS rejects) than we did for retail (letters and outbound IVR). If they’ve adjusted for that, than this is clear. If not, I would want to see that adjustment made.
As anyone who reads the blog knows, I am a big supporter of the theory behind their Consumerology story. I think Larry Zarin and Bob Nease have done a great job putting together their advisory board, creating case studies, and using behavioral economics. I always talk with our clients about these theories, and our analytics team is constantly helping clients define test plans that use these.
- Social comparison
- Hyperbolic discounting
- Loss aversion
In comparing adherence at retail and mail, one thing that came into my mind was whether a driver of better adherence was a longer time window to refill. Typically, you have a refill-too-soon (RTS) edit in place until 2/3rds of the medication has been used (based on days supply dispensed from dispense date). At retail, that means you have about 10 days. At mail, that means you have about 30 days (less the 7 days for shipping). Does that make a difference?
I was also surprised under the methodology section that they now include rebates in calculating costs. It’s a quick one-line comment but how did that effect trend or other metrics here…and if so, how significantly?
As always, I love the therapy class reviews in the back that give you great numbers like:
- Cost PMPY
- # Rxs PMPY
- Prevalence of Use
- Average Cost / Rx
- # Rxs / User / Year
The Personalization of Health Care May 7, 2009
Posted by George Van Antwerp in Consumerism, General Thoughts, Healthcare.add a comment
With genomics and other tools, it seems possible that we could one day see completely personalized health care. Of course, the immediate reaction will be won’t this mess up risk pools. [I am sure there is someone smarter than me that will figure out how to make that piece work.]
What I see is the following:
- Understanding personality types would allow patients to be matched to providers.
- Genetic testing would allow for better predictive models on what individuals with need in terms of coverage.
- Genetic testing will allow for the creation of personalized medicine.
- Better predictive models will allow for better care plans and preventative medicine.
- More transparency will allow people to make better decisions (e.g., calories displayed at restaurants).
- Ubiquitous technology will integrate health decision making into everyday processes and tools.
- Technology will allow companies to develop personalized, targeted communications that are based on patient preferences, historical responses, personality type, and experience to drive healthy behaviors.
Could we eventually get to the point where each of us had an adaptive plan that covered different things as we grew older and constantly optimized our care team or medical neighborhood based on our needs?
Of course, the risk comes when the models are wrong, but if you applied some of the chaos theory logic to a traditional modeling strategy and the current underwriting programs, who knows?
Not something for the next few years, but something I was noodling on the other day.
CVS Caremark TrendsRx Report 2009 May 5, 2009
Posted by George Van Antwerp in Books / Articles, Consumerism, Healthcare, Innovation, Leadership, Marketing / Communications, PBM / Pharmacy, Research, Silverlink, Technology, Value Propositions.1 comment so far
This is one of my favorite times of year. After working on the Drug Trend Report at Express Scripts for several years, I love to get all the trend reports from the PBMs and read them. The first one that I have had a chance to review is the one from CVS Caremark. I found it an easy to read document with good case studies and a mix of strategy and tactics.
Here are some of my highlights and observations:
- 3 out of 4 clients cited “reducing health care costs” as their primary measure of PBM success…AND 2 out of 3 prioritized “plan participant behavior change” as the way to reach that goal. [Maybe the plan design bigot is finally dead.]
- With pharmacy spend approaching $1,000 PMPY, I found their chart on potential cost reduction a simple way of pointing people to things they should think about.
- A 10% improvement in diabetes adherence can save $2,000 in annual health care costs. [I assume this is based on improving MPR and would definitely like to learn more on how the health care costs are quantified.]
- They layout three objectives – improve use of lower cost drugs, improve adherence, and get people to take better care of their health. [Similar to the concept I laid out in my white paper of needing to be broader than just Rx benefit management.]
-
They talk about two of their solutions:
- Consumer Engagement Engine (CEE) which is very similar to what Silverlink does and provides business logic for targeting the right member at the right time with the right message.
- Proactive Pharmacy Care is their “medical neighborhood” concept to stitch together their entities – Mail Order, CVS retail, Specialty, MinuteClinic, and their disease management company.
- Consumer Engagement Engine (CEE) which is very similar to what Silverlink does and provides business logic for targeting the right member at the right time with the right message.
- Their trend was 3.9% PMPM in 2008 (or 2.8% excluding specialty drugs).
- Medicare Part D utilization was up 4.1% compared to 0.8% for the rest of their BOB (book of business).
-
Their GDR (generic dispensing rate) averaged 65.1% for 2008 and was 66.3% in December 2008.
- Best in class employers = 68.2%
- Best in class health plans = 73.4%
-
As they remind you, a 1% increase in GDR is roughly equal to a 1% reduction in pharmacy spend.
- [What I would like to see is improvements in GDR from new drugs coming to market in 2008 versus improvements that came from clients implementing plan design.]
- They say [which I preach all the time} – "proactive consumer engagement improves results and lowers the risk of disruption. For best results, provide personalized actionable information at a range of touchpoints."
-
I saw a few interesting things in one of the case studies they share about their "Generous Generics" program. [Does that name get used with consumers? What's their reaction to it?]
- $0 generic copay at mail [that should drive volume]
- 10% coinsurance penalty for not shifting to mail after the second fill [similar in concept (I believe) to the Medco "retail buy-up" concept]
-
Top Ten Therapeutic categories (53% of spend):
- Antihyperlipidemics
- Ulcer drugs
- Antidiabetics
- Antidepressants
- Antiasthmatics
- Antihypertensives
- Analgesics, Anti-inflamatory
- Anticonvulsants
- Analgesics, Opioid
- Endocrine and Metabolic Agents
-
They state that the population of diagnosed diabetics is growing by roughly 1M a year.
- Executive Summary, Economic Costs of Diabetes in US in 2007, American Diabetes Association, March 2008
- Executive Summary, Economic Costs of Diabetes in US in 2007, American Diabetes Association, March 2008
- They state that a generic for Lipitor is now expected in Q4 2011 [which I think is about a year later than originally expected]
-
They show some data from their Maintenance Choice program which I think has a lot of opportunity.
- This is where you can get a 90-day Rx from either mail or a CVS store for the same copay. [The key here is for them to understand member profitability and for CVS Caremark to understand how to drive consumers to the preferred channel.]
- [I would really need to understand their profitability by channel because if I read the chart in here right, it would appear that given the choice 45% of those at mail would choose 90-day at retail…a scary concept for mail order pharmacy.]
- They give a case on Maintenance Choice which leaves me looking for a key fact. They state that a recent implementation has a goal of 70% of the client’s day’s supply will go through the preferred network (CVS) or mail and that 20% of it goes through mail today. [What percentage goes through CVS today? If it's a client in Boston, that one scenario. If it's a client in Chicago, that would be another feat.]
- Specialty pharmacy trend was 13.5%.
- They say that pharmacogenomic testing is being used more frequently for specialty drugs. [I would love to know more…how often? For what drugs? Has it improved outcomes? Are their clients covering it? How are they playing in this space?]
- They talk about adherence which continues to be one of the hottest areas in the Rx arena today. They give stats showing 15-48% improvement across different metrics and up to $142 in cost avoidance in one case. [Are these again control groups? What was the cost / benefit analysis or ROI? Is this improvement in average MPR (Medication Possession Ratio) or improvement in the % of people with an MPR of >80%?]
- They talk about 88% of heart failure patients maintaining optimal prescription adherence compared to a norm of less than 50%. [My questions here (which isn't apparent) is whether this was an opt-in program so the 88% is for engaged and active participants or whether it was across all targeted members.]
-
They provide a quick list of factors that will impact drug trend:
-
Driving costs:
- Aging
- Obesity
- Diabetes
- Specialty pipeline
- More aggressive treatment guidelines and earlier diagnosis [which hopefully would lower total healthcare costs]
- DTC advertising
-
Reducing costs:
- Economy – reduced utilization and improved GDR
- Increased availability of generics
- FDA safety reform
- Lackluster non-specialty drug pipeline
- Utilization and formulary management
- Consumer price transparency
-
Swine Flu (H1N1) Continues To Top News May 1, 2009
Posted by George Van Antwerp in Books / Articles, Consumerism, Events, Healthcare, PBM / Pharmacy, Social Media.add a comment
(picture from http://www.myfox8.com/lifestyle/health/la-sciw-swine-masks28-2009apr28,0,4461177.story)
It’s amazing how this has dominated traditional media and blown away the online media.
- CDC on Twitter
- CDC website
- PandemicFlu.gov site
- Video of the CDC director
- Podcasts, videos, buttons, widgets, etc.
I few things that stick out for me:
-
The CDC’s policy on school closing would shut schools for 14-days when there is a confirmed case nearby. That would shut down work and be a huge strain on people if they didn’t get paid.
- I’m sure it’s the right thing to do to wait out the gestation period, but it would be a huge strain on the system.
- High school sports being cancelled in Texas.
- College graduation being held but no hand-shaking.
- People wearing masks which really don’t do anything.
- Biden telling his family not to travel.
- Companies not allowing workers that were recently in Mexico to come back to work.
- Pork futures are down.
- My church is no longer going to have communion wine where there could be shared germs.
- I have heard about huge spikes in prescribing of Relenza and Tamiflu and pharmacy shortages.
One of my favorite pictures that goes right to the health literacy issue is the following.
NOTE: This is not what H1N1 flu is about…hence the dropping of the “swine flu” term.
(picture from http://cuteoverload.com/)
7 Points in 7 Minutes April 23, 2009
Posted by George Van Antwerp in Blogroll, Consumerism, Events, Healthcare, Marketing / Communications, Methodology.add a comment
In looking at the Ix Therapy blog about the conference they just had with Health 2.0, I found this note which I found very interesting…
James Hereford made 7 fabulous points in 7 minutes about building Ix into the delivery system:
- You have to deliver what patients want (doesn’t matter how cool the technology is).
- It has to make sense for clinicians from a clinical perspective.
- It has to make sense for from a clinical workflow perspective.
- Focus processes on the value proposition for the patient (I may have mangled this one a bit).
- Information needs to be common, ubiquitous, and well-designed.
- Health care is all about trust; whatever we do needs to enhance trust in the patient-provider relationship.
- Incentives are critical.
Pharma Rx Costs Tied To Outcomes April 23, 2009
Posted by George Van Antwerp in Blogroll, Books / Articles, Consumerism, Healthcare, Innovation, Managed Care, Marketing / Communications, Value Propositions.add a comment
Given our opinion that the PBM industry would be moving to more outcome based pricing, the articles today about Merck and Cigna’s deal on pricing based on outcomes is very timely. I “tweeted” about it early in the AM, but I have got the article sent to me by a lot of people. So, here are a few of the things being said:
WSJ Blog -
Now Merck and Cigna have announced what they’re calling a “performance-based contract” for Merck’s diabetes drug Januvia. But the deal is actually the reverse the pay-for-performance ideal: Merck will get paid less per pill, not more, if the drug works well.
Under the deal, Cigna will get a discount on the drug if patients’ blood sugar falls. Cigna will get additional discounts if patients faithfully take the drug when they’re supposed to. (These two variables often go together — taking the drug faithfully helps keep blood sugar down.)
Cigna PR -
“Merck should be recognized as the first major pharmaceutical company to offer increased discounts on its oral anti-diabetic products, supporting CIGNA’s efforts to reduce A1C levels for individuals with diabetes, regardless of what medication they may be taking,” said Eric Elliott, president of CIGNA Pharmacy Management. “Improving people’s health comes first for both CIGNA and Merck. We hope this agreement will become a model in the industry.”
So…it seems like an aligned deal. Merck and Cigna want adherence. Employers want lower costs and better outcomes.
Consumers Don’t Care About Wellness April 23, 2009
Posted by George Van Antwerp in Books / Articles, Consumerism, Healthcare, Marketing / Communications, Value Propositions.add a comment
Here’s a good provacative quote from Forrester…are all the wellness efforts doomed or are incentives the minimum requirement to play?
“Health plans keep saying that they have to improve consumer engagement and that one of the best ways to do this is by engaging them in wellness initiatives. The data tell me that consumers don’t care about wellness. Employers do. But while most employees may hear the [wellness] message, they also ignore it….”
— Carl Doty, VP and research director at Forrester Research, told AIS’s INSIDE CONSUMER-DIRECTED CARE.
Promotion vs. Nudging vs. Mandatory Mail April 21, 2009
Posted by George Van Antwerp in Blogroll, Consumerism, Healthcare, Innovation, Marketing / Communications, PBM / Pharmacy, Silverlink, Technology.add a comment
Although there is always a dialogue about the lifecycle of mail order, I think some of the work out of the Consumerology group at Express Scripts is interesting. The frameworks that they apply internally are very similar to the technology and approach that Silverlink uses with the rest of the market. [Kudos to Sean Donnelly and Bob Nease for their work on this new approach.]
The traditional ways of driving mail order have been:
- Over a copay incentive (and hope)
- Letter and calls encouraging member to convert
- Providing a call center to facilitate the conversion to mail (from an inbound call or from a transfer on an automated outbound call)
- Mandatory mail – requiring the member to use mail or pay the full cash price for the drug
- Retail buy-up – allowing the member to keep getting the maintenance drug at retail (after 2 fills typically) but requiring them to pay a penalty for choosing a higher cost channel
Now, “Select Home Delivery” uses the 401K approach of opt-out vs. opt-in to drive participation. As behavioral economics would suggest, inertia will carry the momentum and by getting the member signed up in mail and moving them to mail will drive success versus requiring them to take an action. The idea here is to “nudge” the member versus force them or leave it up to them to take action.
Select Home Delivery optimizes the use of cost-saving Home Delivery, requiring members to opt out of the program rather than the traditional approach of requiring members to opt in. The program is based on the psychological principle of hyperbolic discounting, which says immediate events (for example, the hassles of signing up for Home Delivery) loom large compared to downstream benefits (such as a lower overall copayment and receiving a 90-day supply). Dr. David Laibson, an economics professor at Harvard and member of the Center’s advisory board, conducted research showing that applying this principle to 401(k) programs dramatically improved participation rates.
“Opt-out and active decision programs for 401(k) enrollment dramatically improved low employee participation rates. We wanted to explore whether these tools could also solve healthcare challenges,” Laibson said. “This is one of the first marketplace adaptations that successfully applies behavioral economics to improve healthcare.” [quotes from Consumerology blog]
I think the new results from their blog (below) are impressive. [BTW - If you're a member at Lowe's or another client which has used this, I would love to hear your reactions.]
Express Scripts Outcomes Conference Begins April 21, 2009
Posted by George Van Antwerp in Blogroll, Books / Articles, Consumerism, Events, Healthcare, Innovation, Leadership, Marketing / Communications, PBM / Pharmacy, Research, Value Propositions.add a comment
As with each annual Outcomes conference, Express Scripts (ESRX) has released their annual trend numbers. Here are a few of the highlights from the press release:
- Overall pharmacy trend = 3.0% (down from 5.5% in 2007)
- Estimate consumers and employers are paying $42B too much in 13 therapy classes by not optimizing generics.
- On average, a generic drug is over $90 cheaper than a brand name drug.
- Generic drug usage increased by 7.5 percent, while utilization of brand name medications decreased 11 percent.
- 67.3 percent of all prescriptions that Express Scripts filled were for generic drugs by the end of 2008. [I didn't like the comparison which was an average across the 12 months ending in Sept 2008 from IMS of 63.7%...not apples to apples.]
- In 2009, at least 20 branded drugs are expected to become available generically.
- Over the next five years, more than $66 billion worth of branded drugs are expected to lose patent exclusivity.
“Using generic drugs that are safe and effective can help lower costs while still driving value for patients and employers,” said Steven Miller, MD, senior vice president and chief medical officer at Express Scripts. “Our results indicate that cost control is achievable through careful management of appropriate use of drugs and delivery channels, without shifting costs to consumers. Although the trend is the lowest it has been in over a decade, significant opportunity to lower spending still exists.”
“Finding ways to reduce spending without compromising health outcomes is the top priority for healthcare reform, as the Obama administration recognizes,” said Alan Garber, MD, PhD, Henry J. Kaiser Professor and director of the Center for Health Policy at Stanford University. “We have long used financial incentives to try to eliminate waste. Now we’re finding that tools that build upon the insights of behavioral economics and psychology can have powerful, positive effects.”
“In today’s economy, we are not only tracking wasteful spending across the country but developing strategies to reduce it,” said George Paz, chief executive officer at Express Scripts. “By applying the principles of behavioral economics we are helping consumers make better and more cost-effective healthcare decisions. We understand we cannot eliminate waste alone and we are committed to working alongside likeminded organizations, such as the Federal Coordinating Council for Comparative Effectiveness Research, to continue to identify strategies to improve our healthcare system.”
“Studies have repeatedly shown that people work much harder to avoid losses than to pursue gains,” said Bob Nease, PhD, the company’s chief scientist. “This suggests that a ’stop wasting money’ message is more effective than a message focused on potential savings. In addition, by applying evidence-based segmentation, we have practical insight into which members are likely to be most sensitive to loss aversion. One size does not fit all.”
The $40B HealthCare Opportunity Around Retention April 18, 2009
Posted by George Van Antwerp in Books / Articles, Consumerism, Healthcare, Leadership, Managed Care, Marketing / Communications, Research, Value Propositions.1 comment so far
It’s obvious to anyone close to it, but harder to align the goals to take advantage of it. With people “aging-out” from group plans to Medicare and people leaving their employer coverage to go to the individual market, managed care has a huge opportunity to retain that business by providing them a transition path. According to McKinsey (and from what we see), that’s generally not happening.
A few facts from their report:
- 68 percent of all members aged 60 to 64 have never been approached by their current insurers to discuss retirement options.
- more than 80 percent of respondents aged 60 to 64 said they would consider purchasing an individual product from their current carrier if they left their jobs or retired.
- Only 33 percent of 60- to 64-year-olds thought that their insurers offered Medicare products, for example, when in fact almost all major carriers do.
It’s also a simple economic problem. They are less expensive to retain and convert while their a member than once they are on the open market. You may even save on broker fees. Developing a data driven approach to create timely and personalized communications along with a service to transition them should be a priority.
Medicaid Communications April 10, 2009
Posted by George Van Antwerp in Consumerism, Events, Healthcare, Managed Care, Marketing / Communications, Silverlink, Value Propositions.add a comment
Interested in hearing more about this topic. You can hear Margot Walthall from my team talking about this on an upcoming webinar.
The Medicaid Communications Lifecycle: From Onboarding through Redetermination
April 28, 2009 | 1:00 PM ET | 10:00 AM PT
Introducing your Medicaid members to your plan’s benefits as well as their responsibilities is critical to developing a successful member / health plan relationship. Sustaining positive impressions over the course of the member’s eligibility is equally important to retaining Medicaid members.
Silverlink has developed a broad set of communications outreach programs that have yielded strong results for Medicaid and CHIP populations. Join us for this complimentary webinar where we will explore how Silverlink can help you cost-efficiently support:
- The Medicaid onboarding process with welcome/HRA outreach
- Targeted messages about health screenings to drive HEDIS results
- Communications approaches that can reduce health disparities
- Effective methods for educating members about the redetermination process that can inspire loyalty
Sprint: What’s Happening Now April 9, 2009
Posted by George Van Antwerp in Business Tools, Consumerism, Healthcare, Innovation, Marketing / Communications, Silverlink, Technology, Value Propositions.add a comment
I am not sure how this helps Sprint sell more phones and/or services, but I enjoyed the advertisement. The concept of leveraging data to understand consumer behavior is essential. This is a topic we [Silverlink] are constantly working with our healthcare clients to address.
- How do you know what members or patients are doing?
- Do you understand their preferences?
- What have they historically done?
- Can you predict how they will act in the future?
- What data is needed to do analysis and create a predictive algorithm?
- How do you leverage that to create interactive and compelling communications?
- How do you study their behavior change? (e.g., did they get a flu shot after being reminded)
X-Ray Vision Carrots April 8, 2009
Posted by George Van Antwerp in Books / Articles, Consumerism, Healthcare, Innovation, Marketing / Communications, Research, Silverlink.1 comment so far
Behavioral economics can apply in many instances. It is the “hot” discussion topic in healthcare about how to understand how members (consumers / patients) make decisions and what factors influence their decisions.
In this article in Newsweek about getting kids to eat healthy, they talk about three things:
- Verbal encouragement
- Descriptive labels
- Improved access
Rather than calling them carrots, they talk about calling them “x-ray vision carrots”. These 3 “principles” are relevant to a lot of communications. You have to be proactive and provide encouragement to members to get a flu shot or do other preventative health actions. You then need to find a way to describe the action in a way that is compelling. And, finally, you have to make the action easy.
Big Month For Vasectomies April 8, 2009
Posted by George Van Antwerp in Consumerism, Healthcare, Managed Care, Research, Value Propositions.add a comment
Based on several articles over the past year, this should be a big month for vasectomies.
Last year, Forbes pointed out that the scheduling of vasectomies jumps dramatically before big sports events – The Masters, Final Four, Football. Apparently, people want to get “snipped” on the Friday and have a good reason to sit around all weekend and recover while they watch their favorite sport. Talk about planning.
And, last month, there was an article about the spike in vasectomies due to the economy. No hard data about why, but the article hypothesizes that people are concerned about the additional costs of children and want to get the procedure done while they have health insurance.
Teva On Year Of Affordable Healthcare March 30, 2009
Posted by George Van Antwerp in Consumerism, Healthcare, PBM / Pharmacy, Politics, Value Propositions.add a comment
Teva (a generic drug manufacturer) has rolled out a new site call Year of Affordable Healthcare to celebrate the 25th anniversary of the significant generic legislation (Hatch-Waxman Act). As part of that, they have rolled out a few videos in the Mac vs. PC approach.
u
Responsibility Based Healthcare March 25, 2009
Posted by George Van Antwerp in Consumerism, Healthcare, Managed Care, Politics.1 comment so far
Are we finally to a point economically where healthy people will get tired of bearing the cost burden of supporting their sicker coworkers? As costs continue to skyrocket, most people probably don’t realize that those are from a minority of their coworkers who have chronic conditions. (Or in the case of Medicare, are from the costs incurred in the final year of life.)
If you’re like me, I generally don’t mind the risk pool concept (since I don’t know where I might end up any year). And, I certainly don”t mind paying for people who are genetically pre-disposed to some condition (we all may be in that bucket someday), but I could take issue with paying for people who don’t comply with their physician’s recommendations (most of us), don’t act preventatively (most of us), abuse their body with things like smoking, and I could go on.
It got me thinking this morning about a model where we were able to push costs to people based on them taking responsibility for their care (i.e., “responsibility-based care”). While we certainly won’t be at a place in the near future where genomics dominates and we can pull out people who can’t control their health, we can track things like compliance and adherence once we get an integrated HIT (healthcare information technology) system in place.
Additionally, we might get someday to a place where we can offer incentives based on active management and results which are self-reported by remote devices that track blood pressure, weight, cholesterol, etc. But, many of these have issues around confidentiality and would challenge the risk pool process that we use today to underwrite medical costs.
I am not sure what the right answer is, but I think it’s about time for this debate to rear its head again with more energy.
