Finally – New Blog Name July 5, 2009
Posted by George Van Antwerp in General Thoughts, Weblogs.add a comment
I mentioned a few weeks ago my need to get a new name since the people that had Trademarked “Patient Centric Healthcare” asked me to stop using it for the blog. I looked at a bunch of names. Finally, I’m going with “Enabling Healthy Decisions SM”. I think that summarizes what I’m interested in – healthcare communications, healthcare analytics, healthcare marketing, healthcare technology. I generally am most interested in those subjects when they relate to leading consumers to make better decisions about their health.
Regarding House Bill 458 (MO) On PBMs July 1, 2009
Posted by George Van Antwerp in General Thoughts, Healthcare, PBM / Pharmacy, Politics, Value Propositions.add a comment
To Whom It May Concern:
You should be embarrassed to produce this bill. It’s obviously based on a one-sided view of the world regarding Pharmacy Benefit Managers which is generated by sensationalist journalists, jilted employees, independent pharmacists who have lost marketshare to chain drugstores, and pharma manufacturers who have seen their marketshare decline. This type of legislation will only serve to drive up healthcare costs and is exactly the reason why a government run plan won’t work in this country. They’ll focus on lobbyist interests and not the true interests of the consumer.
Let’s go point by point through your legislation and point out some flaws – (see bill here)
1 – Why would a PBM have to tell a consumer what they pay the pharmacy? That’s like Best Buy being required to tell the consumer what they pay for a TV. Most PBMs and/or pharmacies often print on the receipt what the consumer’s payor (employer, managed care company) paid for the drug (i.e., your insurance saved you $100).
2 – Why is the government telling businesses how to do their job? As an HR manager, if I can get a better discount for my employees on their prescription drugs by limiting the pharmacy network, why shouldn’t I have that option. We have preferred vendors in most companies. Why shouldn’t that be true in pharmacy? There are ~60,000 pharmacies in the US which is more than enough.
3 – Again, why is the government interfering in pharmacy law and telling me (the consumer) what I can or can’t do? Why can’t I move my prescription from one pharmacy to another based on discount, convenience, service, or other issues? All you are doing is creating a consumer burden and physician burden with no benefit to anyone.
4 – Now you want to take away my ability to manage drug coverage. There are plenty of circumstances where limiting or denying coverage makes sense due to inappropriate utilization, availability of lower cost options, abuse, and other issues.
5 – I’m completely confused here. You want to tell the insurance companies that they can’t increase the percentage of costs that the member pays (which is really a benefit design issue for the employer) unless the drug prices go up.
6 – This topic has been discussed a lot around switching medications. Of course, the communications should be clear. The patient should understand their choices. They physician should be in the loop (which they are since they have to write the new prescription). You hopefully realize that these are done to lower healthcare costs AND that physicians neither discuss costs with patients (generally) nor do they believe it’s their job to do this.
7 – Do you really believe that the dispensing physician who is focused on caring for their patients has the time to keep up with all the medical literature that a Pharmacy & Therapeutics (P&T) Committee reviews in determining protocols around step therapy? Look at the research…it shows that it takes 17 years for evidence-based standards to become standard practice. I personally don’t want to rely on my individual physician (who does a damn good job) to understand all the latest literature (w/o an EMR). And, I would hope no MD would willingly write an Rx that causes harm. All step therapy programs offer a prior authorization override to the MD and the PBM systems look for drug-drug and other types of interactions.
So, I guess the question is why are you (the legislation) trying to force me (the consumer) to have more administrative headaches, higher costs, and be treated with outdated protocols? And, at the same time, you’re going to force my employer to have higher costs and likely have to stop offering healthcare. And, you’re going to put more administrative burden on my physician who is already overworked and potentially underpaid.
Oh, wait, I get it…If you make the existing companies unable to run their business and unable to use evidence-based standards to lower costs then a government run experiment in socialized medicine will look much better. I hope that the Obama camp recognizes you for your hard work in advocating for them.
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.
Top Wealth Centers June 2, 2009
Posted by George Van Antwerp in General Thoughts, Healthcare, Research.add a comment
Since we know health disparities exist and we know (for example) that higher income and higher educated people are more likely to use generics, I think it’s important to understand some of the ways areas are evaluated and ranked by 3rd parties on their “wealth”.
Reading the St. Louis Business Journal last week, they showed the IL and MO cities and how they ranked. The metrics were interesting:
- Median household income
- Households with incomes above $200K
- Median home value
- Households with 4+ vehicles (really?)
- Adults with bachelors degrees
McLean, VA was the top ranked city:
- $156,292 median household income (vs. $50,007 nationally)
- 36% of households have an income above $200k (vs. 3.7% nationally)
- 79% of adults hold bachelors degrees (vs. 27% nationally)
Lake Forest, IL was the second ranked city and has 5% of households with an annual income of more than $1.15M and 7.4% of households had 4+ vehicles.
(This analysis that they did was based on US Census Bureau’s 2005-2007 American Community Survey.)
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.
Hint On Avoiding H1N1 (Swine) Flu May 1, 2009
Posted by George Van Antwerp in General Thoughts, Healthcare.add a comment
WASH YOUR HANDS!!!
(Note: This is not meant to be a product endorsement for Purell.)
So…Google Was Indicative April 15, 2009
Posted by George Van Antwerp in Business Tools, General Thoughts, Technology, Value Propositions.add a comment
I talked earlier about Google searches relative to the NextRx sale. In the 3 days before the acquisition was announced, the majority of the searches (by far) that I could see and brought people to my site were about Express Scripts (or ESRX) and Wellpoint (or NextRx). So, I am not sure if that was PR people looking for things to respond to or insiders doing some analysis, but it seems like Google searches could tell us something.
Again…the power of data. Now, if I was a stock trader and had access to all of the Google search data, perhaps I would have a way to beat the market.
Finally Digging Out April 3, 2009
Posted by George Van Antwerp in General Thoughts.2 comments
As someone who is semi-compulsive about e-mails, I finally reached a point where I knew I was way too far behind.
When an e-mail comes in, I read it and either delete it, respond to it, file it, or leave it in the inbox for further reading before responding. Ideally, the e-mails in my inbox are less than 50 even when I get a few hundred a day.
The other day, I hit 500 in my inbox which was too much. It was stress inducing. Finally, I am back down below 250. I hope I can get below 100 before Monday. I would feel so much better.
Taxing Cigarettes – For Health or Financial Purposes? March 30, 2009
Posted by George Van Antwerp in General Thoughts, Healthcare.add a comment
I heard this discussion on the radio this morning and found it very interesting. Do we keep raising taxes on cigarettes to reduce smoking (i.e., improve health and long-term liabilities) or is it to drive money into our government since we don’t think people will quit?
It’s an interesting question because if it’s for health purposes then there might be lots of different things that could be done – subsidize patches (for example).
Economy On Food Choices March 30, 2009
Posted by George Van Antwerp in General Thoughts.add a comment
McDonald’s continues to do well in this economy although we all know fast food is not the healthiest food. I think an interesting question is whether the lower priced meals being rolled out at TGIF, Chilis, and other chain restaurants will be good (on a relative scale) for us.
Without really drilling down, I would assume that maybe the economy will finally address the portion size issue. One easy way to lower pricing would be to lower portion sizes and provide consumers with reasonably sized, simple meals at a reasonable price.
I think all of this points to how this economy (the Great Recession?) will make fundamental and long-lasting changes to our world.
Given The Link Between Money And Health March 29, 2009
Posted by George Van Antwerp in General Thoughts, Value Propositions.add a comment
As we have seen in numerous studies over the past six months, healthcare spending is clearly affected by the economy. It is not “recession proof” as many had believed. Adherence is down. People are skipping preventative care.
With that in mind, I just thought I would point people to Clark Howard who is the new consumer “advisor” on CNN that focuses on current issues.
Some of The Worse Lunches March 28, 2009
Posted by George Van Antwerp in Books / Articles, General Thoughts, Healthcare.add a comment
This whole article on restaurants is worth reading to show you just how bad some meals are for you. Let me pull out a few of the scariest meals:
QUIZNO’S
Large Prime Rib Cheesesteak Sub
- 1,490 calories
- 92 g fat (22.5 g saturated, 2 g trans)
- 2,620 mg sodium
- Fat equivalent: Like eating four Dunkin Donuts cheese danishes!
CHILI’S
Crispy Sweet Chile Glazed Chicken Crispers
- 1,930 calories
- 112 g fat (17 g saturated)
- 4,190 mg sodium
- Calorie equivalent: Like eating an entire medium Pizza Hut 12″
PANERA
Italian Combo on Ciabatta sandwich
- 1,050 calories
- 47 g fat (18 g saturated, 1 g trans)
- 3,050 mg of sodium
- Fat equivalent: Like eating 6 slices of Papa John’s cheese pizza!
HARDEE’S
2/3-lb Monster Thickburger
- 1,420 calories
- 108 g fat (43 g saturated)
- 2,770 mg sodium
- Saturated fat equivalent: Like eating 43 strips of Oscar Mayer bacon!
BURGER KING
Triple Whopper Sandwich with cheese and mayo
- 1,250 calories
- 84 g fat (32 g saturated, 2.5 g trans)
- 1,600 mg sodium
- Fat equivalent: Like eating 10 slices of Papa John’s cheese pizza!
Drug Importation March 26, 2009
Posted by George Van Antwerp in General Thoughts, Healthcare, PBM / Pharmacy, Politics.add a comment
From what I saw this morning, it looks like the administration is going to go down this path. I don’t think it’s a good idea. I will point to my post from a few months ago on why.
My prediction is that it’s an arbitratage opportunity which will appeal to the public, but will cost us more in the long run.
On the flipside, I guess it’s better than having people take buses to Canada to buy drugs and sneak them into the country risking arrest.
How Does Optimism Bias Affect Us in Healthcare? March 20, 2009
Posted by George Van Antwerp in Consumerism, General Thoughts, Healthcare, Marketing / Communications.add a comment
The optimism bias means people are less likely to believe that bad events will happen to them. They overestimate their likelihood of success. What are some probable implications in healthcare?
- Don’t believe they will get cancer or some other disease and not act preventatively.
- Believe they can improve their cholesterol by exercise and that they will exercise.
- Don’t believe that the extra calories will add on pounds.
- Don’t believe smoking will kill them.
- Don’t believe they need insurance because they won’t get sick or hurt.
Is glass half-full or half-empty?
How The Recession Could Impact Communications Forever March 11, 2009
Posted by George Van Antwerp in General Thoughts, Marketing / Communications.add a comment
This recession (or depression) has the potential to systemically impact how people communicate. Some potential impacts:
- Death of newspapers (discussed last week)
- Death of the land line (everyone has a mobile phone)
- Death of magazines (similar to the newspaper issue – drop in advertisements)
- Reduction in mail (as costs go up and if service were dropped to 5 days a week)
- Short-term reduction in use of high speed Internet (save money)
- Short-term reduction in use of text messaging (save money)
- Less use of cable (being replaced by online TV shows)
- Move to digital coupons
I think some of these will also be affected by the green movement where printing massive amounts of paper and sending those to people (who can get the same information online) will become important. [Although this has been talked about for years, costs may finally make it a reality.]
Some other things that could change:
- Reduction in the value of co-branding information as the employer relationship becomes less long-term and more fragile [Traditionally, this has been an important strategy in direct mail from health plans and PBMs where using the employer has improved response rates.]
- Improvement in use of online tools (Health 2.0) as people move away from print
- Increased use of virtual meetings and further loss of face-to-face contact as companies move to virtual offices and cut travel budgets
If you combine cost driven changes with environmental driven changes with likely technology changes, I suspect that the way we communicate and interact with people over the next 10 years will dramatically change. In the short-term, we may even see an increased number of new Luddites (people who shun technology to save money and over frustration with our overall economic situation).
Struggles Of A Working Family Report February 25, 2009
Posted by George Van Antwerp in Books / Articles, General Thoughts, Healthcare, Research.1 comment so far
The Kaiser Family Foundation has released a report and video that they did on several families looking at their struggles to pay bills and survive.
The report, Snapshots from the Kitchen Table: Family Budgets and Health Care, is based on interviews with 27 families from six cities across the U.S.. It finds pervasive uncertainty over job security and households teetering on the financial brink, stretching to pay for basics such as food and housing and ill-equipped to cope with unexpected costs for things such as a medical emergency or a necessary home repair.
Health care costs were of particular concern, with many families forgoing doctor visits, skipping prescription medications and postponing needed care. Even those with health insurance reported delaying care in order to avoid co-payments, rising deductibles and out-of-pocket expenses for uncovered services. Despite barely being able to meet the cost of basic needs, many families did not qualify for public programs like Medicaid and the Children’s Health Insurance Program.
Time To Sell? February 25, 2009
Posted by George Van Antwerp in General Thoughts, Healthcare, Managed Care, PBM / Pharmacy, Value Propositions.add a comment
There is always debate about captive PBMs (i.e., those owned by a managed care company). In theory, I have always argued that they should have a leg up. But, since pharmacy represents only 10% of total healthcare spend, the majority of the strategic focus is typically on the health insurance side of the business. [BTW - The 3 largest captive PBMs are Wellpoint, Aetna, and Cigna.]
So, if you look at the stock charts below, you can see that while the PBMs (Express Scripts, Medco, and CVS Caremark) have all held up pretty well the managed care stocks (Aetna, Cigna, United Healthcare, Humana, and Wellpoint) have not held up as well.
If I owned a captive PBM, would this be the time for me to consider selling? I have heard this debate a lot more recently than in recent years.
PBM 5-Year Stock Chart
Managed Care 5-Year Stock Chart
[As I have disclosed before, I do not hold any individual stocks.]
Trickle Down Healthcare February 24, 2009
Posted by George Van Antwerp in General Thoughts, Healthcare, Leadership, exercise.add a comment
Many of us know the term “trickle-down economics” which is generally associated with Ronald Reagan. (Obviously not a concept bought into by the current administration.) I was thinking about this today from the concept of workplace culture around healthcare.
I have not seen any research to this point, but it would seem to make sense that companies where the senior executive team is focused on exercising – running, triathalons, tennis, etc. – would generally be healthier companies. As we have seen multiple times, peer pressure works. So, does it work from a top-down perspective also?
I know one healthcare company where they were refining what was served at the cafeteria and what was in the vending machines. Obviously, there are ways to control diet through what the company “encourages”. Do they have bowls of fruit or bowls of chocolate?
Happy Paczki Day February 24, 2009
Posted by George Van Antwerp in General Thoughts.add a comment
Do you know what a Paczki is? It is a Polish donut that is traditionally eaten on the Thursday before lent, but here in the US is usually eaten on Fat Tuesday (today).
The concept of indulging before being good in Lent is very counterproductive to good health. It’s always better to eat consistently well and never over eat or starve yourself. I had one friend who was on a “diet” which was strict all week, but they could eat anything on the weekends. Do you really think that works?
I compare it to Aitkens where as long as you stick with it you lose weight, but as soon as you stop, you bloat back up.
Ultimately, it’s simply about calories in and calories burned. Watch what you eat and exercise.
Friends Don’t Let Friends February 21, 2009
Posted by George Van Antwerp in General Thoughts, Healthcare, Innovation, Managed Care, Marketing / Communications, PBM / Pharmacy.add a comment
If they can use this concept for selling DirectTV over cable, why don’t we use this more in healthcare?
It could be…Friends Don’t Let Friends:
- Pay too much for medication
- Use brand drugs unnecessarily
- Use retail for maintenance drugs
- Call into the call center when the information is on the web
- Go to the ER when they can call the nurse line
- Pay too much for individual insurance
Maybe, in today’s economy, it will be time for healthcare companies to look for seriously at referral programs.
- Get a friend to come to mail order or the local CVS and get your next prescription copay waived.
Everyone is focused on saving money. Social networking is all the rage. People trust their friends.
Now, I may not want to tell my friends that I am on cholesterol lowering medication so that may change it. But, certainly people talk about higher level items like shopping for individual insurance.
Siftables: Very Cool Tools From TED February 16, 2009
Posted by George Van Antwerp in General Thoughts, Innovation, Research, Technology.add a comment
A friend shared this video this morning with me. Very cool. This is a presentation by David Merrill from MIT about Siftables. He has integrated new technologies with our traditional building blocks to build interactive, high tech blocks that can be used for spelling, math, music, and other ideas.
Imagine the ability to use these to teach people.
Walking Surveillance Device February 10, 2009
Posted by George Van Antwerp in General Thoughts, Marketing / Communications, Technology, Value Propositions.add a comment
There is always lots of debate on the issue of privacy. Clearly, there are military reasons to collect data (with debates on appropriate use). There are programs we willingly opt into (like when I sign up for an organizations e-mail list). Within healthcare, we have HIPAA that tries to protect our personal data. Then there is the constant paranoia about how much your employer monitors on your computer – what sites you visit, your keystrokes, what you say on the phone. Then on the more debated side there is what information is it okay for a company to aggregate and use to push information to me that makes me healthier or saves me money. I don’t expect this will get solved anytime soon.
I think this is why I found the story about Google’s G1 interesting in yesterday’s paper where it talks about how Google aggregates information from you to better target you with advertisements.
“It enables Google to field your search queries quickly when you’re on the run. It also gives Google access to your contact lists, IMs, e-mails, personal calendar, social networking and video downloading — the videos you’d fess up to publicly, as well as the ones you might not. As for all those “personal photos” swapped with pals on Facebook, MySpace and Twitter: Google can grab those, too.
Everything gets crammed into your personal “file,” so to speak, along with a lot of other stuff — such as where you bank, shop and cruise on the Web when you’re lonely, bored or just in the mood for a little fun.
Once your information has been collected and stored, there’s no way to get rid of it. You can’t see what’s been collected or have it expunged. It’s Google’s for as long as it wants to hold onto it.”
Obviously, more and more people use mobile devices and the mobile web. It’s one thing to have your information aggregated when you use a service (i.e., Google search). It seems another thing for them to pull information from your device and aggregate it. I am not sure how this will play out, but I expect there will be a lot of discussion on blogs about this topic.
Cooking With Google February 3, 2009
Posted by George Van Antwerp in General Thoughts, Healthcare, Technology.1 comment so far
This is an interesting thing that someone told me about a few weeks ago. They said that they come up with recipes by simply typing some ingredients into Google and then seeing what it produces. I tried it with a few random lists of items and came up with long lists of ideas.
Now, if we could just blend a personal coach, a personal chef, and an automated kitchen that tracked all my products by barcode, I would have a very cool “smart house” type of feature for helping me eat healthy.
Healthcare…The Growth Area In The Economy? February 3, 2009
Posted by George Van Antwerp in General Thoughts, Healthcare, Managed Care.1 comment so far
I keep reading that the growth in employment in the US is coming in healthcare. Since I have heard that Aetna, Cigna, and BCBSMI have all let go 1,000+ people, that seems hard to believe. Combine that with multiple large healthcare companies that have said they won’t pay bonuses this year and the fact that pharma has let go about 30,000 people.
My take is that we are seeing a shift from large companies to smaller companies in the healthcare industry much like I could argue has happened in manufacturing and other services. This plays to the concept of the Starbuck’s Economy and driving to subsegments of the population.
I also think you are going to get all these people with big company experience that go on to become entrepreneurial (as long as capital frees up).
