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No Fat Customers Please – #BoycottAbercrombie

May 14, 2013 by George Van Antwerp 0 Comments

My kids have worn Abercrombie and Fitch clothes for the past few years even thought I find the advertising suggestive and the store environment not particularly inviting for the average adult (loud music, small aisles, very young staff). Even with that, I was shocked to see some of the recent news about their attitude towards their customers in response to why they don’t stock XL and XXL clothing sizes. With today’s focus on customer experience and competitive retail environment, this seems like not only a bad business model, but one that is shallow and unhealthy.

“In every school there are the cool and popular kids, and then there are the not-so-cool kids. Candidly, we go after the cool kids. We go after the attractive all-American kid with a great attitude and a lot of friends. A lot of people don’t belong [in our clothes], and they can’t belong. Are we exclusionary? Absolutely. Those companies that are in trouble are trying to target everybody: young, old, fat, skinny. But then you become totally vanilla. You don’t alienate anybody, but you don’t excite anybody, either.” (source article)

But, a bad business model and a shallow minded CEO isn’t a reason to boycott a company. And, after growing up in a family where we boycotted many companies due to business practices, I never saw myself as someone who would support this “hippie” approach. That being said, I think that Abercrombie’s attitude is a real issue for the health of our kids for 3 reasons.

  1. We have a major obesity issue in the US. (from CDC)
    1. Childhood obesity has more than doubled in children and tripled in adolescents in the past 30 years.
    2. The percentage of children aged 6–11 years in the United States who were obese increased from 7% in 1980 to nearly 18% in 2010. Similarly, the percentage of adolescents aged 12–19 years who were obese increased from 5% to 18% over the same period.
    3. In 2010, more than one third of children and adolescents were overweight or obese.
    4. Overweight is defined as having excess body weight for a particular height from fat, muscle, bone, water, or a combination of these factors.3 Obesity is defined as having excess body fat.
    5. Overweight and obesity are the result of “caloric imbalance”—too few calories expended for the amount of calories consumed—and are affected by various genetic, behavioral, and environmental factors.
  2. We have a bullying issue in the US. (source)
    1. Over 3.2 million students are victims of bullying each year.
    2. 1 in 4 teachers see nothing wrong with bullying and will only intervene 4 percent of the time.
    3. Approximately 160,000 teens skip school every day because of bullying.
    4. 1 in 7 students in grades K-12 is either a bully or a victim of bullying.
    5. 56 percent of students have personally witnessed some type of bullying at school.
    6. Over two-thirds of students believe that schools respond poorly to bullying, with a high percentage of students believing that adult help is infrequent and ineffective.
    7. 71 percent of students report incidents of bullying as a problem at their school.
    8. 90 percent of 4th through 8th graders report being victims of bullying.
    9. 1 out 10 students drop out of school because of repeated bullying.
    10. Harassment and bullying have been linked to 75 percent of school-shooting incidents.
    11. Physical bullying increases in elementary school, peaks in middle school and declines in high school.  Verbal abuse, on the other hand, remains constant.
  3. We have a suicide issue in the US. (CDC fact sheet)
    1. Among young adults ages 15 to 24 years old, there are approximately 100-200 attempts for every completed suicide.
    2. In a 2011 nationally-representative sample of youth in grades 9-12:
      1. 15.8% of students reported that they had seriously considered attempting suicide during the 12 months preceding the survey;12.8% of students reported that they made a plan about how they would attempt suicide during the 12 months preceding the survey;
      2. 7.8% of students reported that they had attempted suicide one or more times during the 12 months preceding the survey; and
      3. 2.4% of students reported that they had made a suicide attempt that resulted in an injury, poisoning, or an overdose that required medical attention.

 

As adults, I believe we have a responsibility to break the cycle of bullying and set an example. This isn’t time to create a fraternity culture in adulthood. We have systemic issues to address in serious ways. I know we won’t be shopping at Abercrombie again, and I think my kids have lost their interest in wearing the clothes.

Books / Articles, Consumerism, General Thoughts

Presidential Physical Fitness Award – Reasonable? Role Models?

May 6, 2013 by George Van Antwerp 0 Comments

I must admit that I don’t remember taking the presidential fitness test as a kid. With that being said, I was surprised to learn from my daughter that in her class of club soccer, volleyball, and baseball players she was the only kid to meet the highest level (greater than the 85th percentile across several measures). She made it today by running her mile in 7:37.

So, what does this require? It made me curious. Here’s what you have to do:

benchmarks_presidential_large

Could you do that?  These seem pretty difficult to me.  I could probably do the mile in 6:06, but I doubt I could do 53 pull-ups.  And, I doubt I could sit and reach 7 inches beyond my toes.  (Looking at the 17 year old male standards.)

On the other hand, we certainly need our kids to be more fit.  We have a big childhood obesity issue.

Childhood Obesity

But, it also made me think about Michelle Obama’s efforts in this space.

Lets Move

I think these programs are good starts, but lets not forget that obesity is a social issue and kids learn from those around them.  Let me ask the uncomfortable questions about those who our kids look up to.

  • How many overweight coaches do you know?
  • How about overweight teachers?
  • How about policemen and firefighters?
  • How about clergy?

These are all key role models…not to mention us parents who are often overweight.

I guess my suggestion here to the President would be to think about how to use our massive government payrolls as a foundation for change. Let’s think about the Presidential Fitness Challenge and create a broader wellness solution to change the visual role models for our kids and figure out how to help companies invest in this.

For example, we know that sleeping is correlated to weight and health.  I was talking to my brother-in-law who is a police officer when he told me that they are expected to get 8 hours of sleep a night.  Imagine if companies set this expectation for their employees (sleep impact on work).  

“Sitting Disease” may make a great late night comedy story line, but it’s a reality of our information economy that has to be addressed.

sitting-disease-how-sitting-too-long-can-affect-your-health_5123e1818a55e

Books / Articles, Business Tools, exercise, General Thoughts, Healthcare, Infographic, Innovation, Leadership, Marketing / Communications, Methodology, Value Propositions

Is Healthcare An Investment Or A Cost?

February 26, 2013 by George Van Antwerp 0 Comments

As I’ve been looking at the employer view of healthcare, it strikes me that there are two different fundamental approaches.

  1. Healthcare expenses are a cost.  We want to drive down the costs as much as possible.
  2. Healthcare is an investment in our human capital.  We want to optimize our spend with the best outcomes.

Unfortunately, this likely means that the most vulnerable population is disadvantaged in this model (i.e., the hourly worker who is in a job where they are easily interchanged with another employee).

But, for companies where their biggest asset is their people (e.g., Microsoft), it seems clear that they would want to focus on healthcare as an investment.

This might drive you to make different decisions.

  • What if you looked at your formulary (for medications) based on side effects not necessarily costs?
  • What if you were willing to pay more for drugs with a clear impact on productivity (e.g., no drowsiness)?
  • Would you pay more for facilities that were better able to get people back to work?
  • Would you really push people into high deductible plans when this forces them to spend more time figuring out the system and navigating it?
  • Would you provide them all with devices to help them manage their healthcare?
  • Would you hire health advocates to help them navigate the system?
  • Would you provide them all with second opinions for major diseases (e.g., cancer) at no additional out-of-pocket costs?
  • Would you make sure to implement a telehealth solution so they weren’t away from the office as much?
  • Would you provide them with an onsite gym?
  • Would you provide them with healthy food onsite?

It seems like you would look at these types of decisions differently.  It wouldn’t be about the lowest healthcare premium.  It wouldn’t be about pushing them to a limited network.  It wouldn’t be about limiting their choice.  It wouldn’t be about shifting costs.  It would be about guiding them to make choices that kept them happy, productive, and engaged so that they could do the best work for you.

This would involve addressing stress.  It would involve addressing sleep patterns.  It would involve helping them create a work-life balance.

General Thoughts, Healthcare, Leadership, Value Propositions

New Year Blog Survey

January 1, 2013 by George Van Antwerp 0 Comments

Happy New Year!

For those of you that are regular readers, I’d love to get your thoughts on the following:

  1. Do you like me including infographics in the blog?
  2. Do you like the mix of content from mHealth to PBM to population health management?
  3. Do you like the mix of short posts sharing articles and other information or would you prefer less posts that were more detailed analysis of a subject?
  4. What would generate more discussion / comments on the blog?

Thanks for your time.  You can comment here, e-mail me at gvanantwerp at mac dot com, or respond anonymously to the survey embedded here.

Blogroll, General Thoughts, Value Propositions, Weblogs

Sandy Hook Tragedy – Gun Laws? Mental Health Impact?

December 18, 2012 by George Van Antwerp 0 Comments

The tragedy at Sandy Hook Elementary School was a shock for everyone.  In a connected world, it doesn’t take six degrees of separation to know someone who lost a child.  I’m only one degree away from several people.  And, for those of us with kids, it really makes you look at your school and their processes.

I wanted to take a moment to say that my thoughts and prayers go out to those families and the community and to capture a few thoughts.

moment of silence

General Thought #1:  While we have a clear gun violence issue in this country (see infographic below), we’ve been slow to make any meaningful changes.  Will this finally push us over the edge?  I’m not sure.  Certainly, those that like to own guns believe it might as you can see the sales of guns have spiked in the past few days.  This seems like an opportunity for Obama to create a legacy for himself by changing this paradigm.

General Thought #2:  The other big question or potential impact here is whether this will change the way schools or society in general deal with mental health issues.  Even at the simplest level, I think about the stigma placed on people on anti-depressants.  People who have depression don’t often openly discuss it, but the reality is that 16% of Americans are taking an anti-depressant (almost 1 in 5).  If you assume there are many others that aren’t diagnosed or aren’t medicated, it becomes a significant population.

Interesting Video: The one thing I saw last night from a 9-year old was the video below which wasn’t made about Sandy Hook but was released and dedicated to them.  It covers the broader topic of bullying and violence including school violence.

Gun Violence in America

Browse more data visualization.

Events, General Thoughts, Healthcare, Infographic

What I Learned Day One at the mHealth Summit #mhs12

December 4, 2012 by George Van Antwerp 3 Comments

I only had time to attend one day of the mHealth Summit in DC. Overall, it seemed like a well attended event with a good vendor area.

But, what I saw left me with concerns about the maturity of the space.

1. Every vendor has their own portal. There was no idea of convergence or sensitivity to the care manager or provider or patient having to access multiple sites to collect data. Of course, there were a few exceptions.

2. There’s still some heavy lifting for the consumer, but it’s getting better. For example, one food application lets you scan in your food but that calorie counter isn’t integrated into any activity monitor. Another application was trying to monitor social activity for part of their depression algorithm but they weren’t leveraging the data sitting on the phone itself – numbers of calls, movement, etc.

3. There are some really creative solutions being tried but the scale of the studies is small. I was excited to see what was being done with obesity, but the case studies were less than 150 participants.

4. There are a lot of non-healthcare people jumping in which is great from an innovation perspective, but healthcare is tricky and making sure to apply consumer literacy filters to the clinical guidance you get is important. For example, I asked one vendor why he had several chronic diseases covered but ignored high cholesterol. He pointed out that he had a heart disease component, but IMHO I don’t know many people with high cholesterol that would self select into heart disease.

On the other hand, there were some really positive things.

1. The user interface on a lot of these is very elegant.

2. The devices are getting smaller and smaller with a few disposables on the way.

3. The data captured and reporting is really interesting and insightful although I’m not sure how it will all be used by patients, physicians, or companies.

4. Technology is much more scalable than people centric strategies which is critical in the US and globally.

5. Several companies really get it and are focused on device neutral approaches for capturing and disseminating data.

Overall, it reminded me of some of my concerns about the Health 2.0 movement a few years ago in terms of business models and distribution models. But, keep the innovation coming. It’s fascinating and thought provoking. But, there will definitely be a shakeout in the years to come.

Events, General Thoughts, Healthcare, Innovation, Technology
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Can Sushi Be Delivered As A Custom Food Chain? – How Do You Roll

November 27, 2012 by George Van Antwerp 0 Comments

 

Until a few months ago, I would eat sushi once a month (at the most).  Now, I’ve been lucky that our Charlotte office is right across the street from How Do You Roll which allows you to come in a build your own sushi roll (ala Subway).  This is a franchise model which has been around for a few years. 

My quick summary is:

  • Good choices of fresh meat
  • Good fresh vegetables
  • Lots of options for creating unique sushi rolls
  • Quick
  • Good service
  • Reasonably priced (e.g., combo of roll with edamame and drink for <$10)
General Business, General Thoughts

What Would You Pay For A Week Of Life?

August 2, 2012 by George Van Antwerp 0 Comments

I was at an Oncology meeting earlier today, and there was a brief discussion about pharmaceutical costs which is certainly one factor in overall healthcare costs.  (See article on the 11 most expensive drugs ranging from $200-$410K / year)  Ultimately, this always brings you back (at some point) to the topic of Quality Adjusted Life Year (QALY) or (a new term to me) “futile care” meaning care done essentially with a very low probability of working. 

Of course, like the lottery, we all like to believe that we’ll be the 1% for which this effort pays off.  (see Prospect Theory or a broader article on use of incentives in healthcare).  This can often be a very cost effective way to get people excited.  This is especially true for poorer people who spend as much as 3% of their income on lotteries which have a very low return. 

But, the question at the center of this is what you would pay for a week of life?

  • $100
  • $1,000
  • $10,000
  • $50,000

And, would that answer change based on timing?  I believe so.  If asked today, when you were healthy, would you agree to spend $50,000 to gain one week of life?  Perhaps not.  When you’re on your death bed and realize that you still want to see a few more people, your answer may change.  And, your family’s answer might change.  If you had to make that decision for your parent, it might be tough to make at the hospital, but if you sat down with them when they were healthy and asked them whether they would like you to spend your kid’s college savings account on gaining them a week of life, the answer might change.

But, what about when the money’s not yours.  We all know the infamous diner’s dilemna where we’re likely to spend more money when your splitting the bill with everyone.  When you’re covered by insurance or by the government, it’s not always your money being spent.  So, what if it was positioned differently?  If you knew that spending $50,000 for that one week of life meant that there wouldn’t be money to fund a shelter for 3-months that provided 20 homeless families with a place to sleep.  Would that change your answer?

It’s a tough question.  No one like to put a financial value on life.  I don’t have an easy answer other than having the discussions earlier with the patient and framing them the right way. 

Never mind the question about quality of life…Would you rather die in 2 days at home or would you rather live 8 days in the hospital where your throwing up all the time?

I don’t know the economic tradeoff of these treatments or drugs so this isn’t specific to any scenario, but is a situation which come up and everyone runs away from.  I understand why.

Books / Articles, General Thoughts, Healthcare, Marketing / Communications, Politics, Value Propositions

Are You Turning Data Into Knowlege?

June 18, 2012 by George Van Antwerp 0 Comments

I’ve used this framework for years, but I wanted to post it here as I think about outcomes reporting. (image source)

This is key as you move to add value around data and use the knowledge and wisdom to create informed actions.

 

Business Tools, General Thoughts, Methodology, Technology

Sports As Training For Real Life

June 18, 2012 by George Van Antwerp 0 Comments

A former sales executive once pointed out to me the fact that he liked to hire people that had competed at the highest level in sports.  I didn’t understand why, but his explanation made a lot of sense to me. 

  1. They learned how to set goals and train and prepare for those goals.
  2. They knew how to win.
  3. They knew how to lose, reflect on the loss, move on, and prepare to win again. 

I think number three is what gets lost in the “trophy generation” that we see out there today.  Kids that only know how to win and throw their rackets or get upset if they lose.  They don’t understand the value of competition, of being pushed, and of learning how to lose with grace.

Books / Articles, General Thoughts, Leadership

Do You Push Your 10 Year Old To Be An Olympian?

June 18, 2012 by George Van Antwerp 0 Comments

When I was watching the movie The Tooth Fairy last week, it really got me thinking about how some people push their kids so hard into sports at such an early age.  I heard one 10 year old parents talk about their kid being in the next Olympics (when their not even the best at their sport that I know). 

Here’s some examples of what I’ve seen which seem wrong:

  • A 6-year old that is home schooled so he has more time for private lessons in his sport
  • A kid who is only rewarded if she sets 3 records this summer
  • A kid who is paid to beat certain people at her sport
  • A kid who is punished by extra practice if she doesn’t perform perfectly
  • Multiple kids playing on 2 or 3 different teams simulateously in the same sport
  • Kids training 4-5 hours per day / 6 days a week at age 9

I see more and more parents (of kids under 11) video tapping their performances and then breaking down their play after they perform with them.  The focus is always on the negative.  As I heard one kid say, “be my parent not my coach”.  I think that’s important.  Parents can’t project their expectations of paying for college and fame on their kids at such an early age. 

This leads to self-esteem issues.  It leads to burnout.  It leads to over training.  And, it can lead to false expectations that manifest themselves in poor sportsmanship. 

For example, I know one kid that my kid has to compete with came up to her and said “why are competing on this team…I can’t win if you compete”.  Never mind the team spirit.  This kid wants the personal recognition even in a category that she doesn’t compete in year-round, but she thinks she should be a star in whatever she does.  This is what leads kids to cheat and be bullies. 

Here’s a few other articles on this topic:

Here’s a quote from an interview with David Ellis a sports nutritionist about specializing too early:

Early bloomers typically have an advantage on these AAA teams, and while they dominate the domestic stage with their early maturity and specialization, they are not as competitive on the international stage once other competitors have matured. In fact there is evidence that the athlete who didn’t specialize early and was a little later in maturation might end up being the better athlete! Why you ask?

That multi-sport athlete kept on developing motor skills and competitive vision that might have been more challenging in totality than the narrowed focus of the specialized athlete. These multi-sport athletes are hungry to compete as they approach their prime, and because many were late bloomers, they had to be smarter players to make up for their lack of size and strength. So when their bodies do catch up maturation-wise, they often times have a sharper set of skills, and the net result is an athlete who has the tools and the motivation to compete at an elite level versus the burn out early specialized athlete who often seems to have peaked too early and below their net potential.

Books / Articles, exercise, General Thoughts, Healthcare

Bad Pitch

February 24, 2012 by George Van Antwerp 0 Comments

I was just reading an email pitch that I received from a healthcare social networking vendor talking about their system for engaging patients and physicians.

Maybe, it’s just me but that seems to imply some understanding of how to engage people and use social media. First, they didn’t use my name in the email. It just said “Hi ,”. Then, at no point in the pitch did they say anything about why they reached out to me. And finally, they then asked me to tweet specific pre-formatted tweets that they had created. If I wanted that, I would follow them and do a RT.

And to top it off, they don’t offer a way to follow-up to learn more. It was just shameless self-promotion. #Fail

Blogroll, General Thoughts, Healthcare, Press, Social Media, Technology, Value Propositions

The Value of the Family Dinner

January 12, 2012 by George Van Antwerp 0 Comments

Studies have shown that kids who eat dinner with their families do better in school, feel more socially connected to their parents, have better peer relationships, and are less likely to try drugs and alcohol.

Wow! That quote from Grace Freedman at eatdinner.org certainly makes a compelling case. The article in Spirit magazine (Jan 2012) goes on to say that according to a 2010 Pew Research poll only about half of families make dinner a daily ritual and roughly 20% eat together only occasionally or never.

It certainly is a challenge with long workdays, commutes, travel, and kid activities.

Books / Articles, General Thoughts, Research, Value Propositions

Does Duration Of Team Matter In Business As In Sports?

January 1, 2012 by George Van Antwerp 2 Comments

One thing that I often think about is the amount of change in the teams within rapidly growing companies (e.g., many PBMs). Does this have an effect on internal knowledge, productivity, and therefore success? It’s a great question. With that in mind, I found the infographic below very interesting.

At the same time, I looked back a few years to see how much change there has been in the management teams at each of the largest PBMs (Medco, Express Scripts, and CVS Caremark).  [Honestly, it was less change than I had expected, and I didn't look at average age since I'm not sure that's a great proxy in business while it may be in sports.]

  • At Express Scripts, 7 of the 10 people listed on the website have been there that entire time.  Most of them in their current roles. 
  • At CVS Caremark, 6 of the 10 people listed on the website have been there that entire time althought there has been more movement across roles. 
  • At Medco, 14 of the 16 people listed on the website have been with Medco that entire time and the two others might have also but their start date wasn’t listed in their bio. 

So maybe more change is needed?  Certainly with the changes in the market dynamics, there is always a need for bringing in a fresh perspective…at the same time, the PBM industry is complex and continuity given long-term contracts is important. 

 

by visually via

 

Books / Articles, General Thoughts, Healthcare, Infographic, Leadership, PBM / Pharmacy

Tiny Tower Retail Pharmacy Missed Branding Opportunity

November 3, 2011 by George Van Antwerp 0 Comments

Tiny Tower is a simple yet addictive game you can play on your iPhone or iPad.  My kids figured out the other day that you could re-name the floors.  For example, one of the floors is a pharmacy.

So, instead of saying “pharmacy” this could say Walgreens or CVS or Express Scripts.  What a missed opportunity.  I’ve talked about this before, but I think the pharmacy industry in general has missed integrating themselves into Hollywood and gaming.  When’s the last movie or TV show you saw where the primary actor was a pharmacist or worked at a PBM or even worked at a health insurance company (and was shown in a positive light)?

Here’s an easy branding opportunity.  It also seems like an easy revenue source for the Tiny Tower founders.  Why not have companies pay them to brand these?  Why not have people playing the game earn points to buy up from McDonalds to Red Robin?

General Thoughts, Marketing / Communications, PBM / Pharmacy, Social Media

Candy For Cash (or Toys)

October 31, 2011 by George Van Antwerp 0 Comments

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.

Events, General Thoughts, Healthcare

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

October 27, 2011 by George Van Antwerp 0 Comments

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?

 

General Thoughts, Healthcare, Marketing / Communications, Words Matter

Should Health Companies Be Brutally Honest With Consumers?

October 25, 2011 by George Van Antwerp 2 Comments

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.” 

General Thoughts, Healthcare, Marketing / Communications

Words Matter: Doodling – We Should Foster It

September 30, 2011 by George Van Antwerp 0 Comments

As someone who was trained as an architect, I understand the value of sketches in the design process and have always “doodled” as I try to conceptualize what people are describing with words.  With that in mind, I really enjoyed this TED video and think it’s a good message for all of us in the communications field.

Events, General Thoughts, Leadership, Marketing / Communications, Methodology, Research, Social Media, Value Propositions, Words Matter

Post ESRX/MHS Merger – How Many Big PBMs Are There?

September 20, 2011 by George Van Antwerp 0 Comments

This seems to be one of the critical questions in the evaluation of whether the merger should go through.  We’ve always talked about the Big 3 PBMs – Express Scripts, Medco, and CVS Caremark.  If that’s the market, then going from 3 to 2 seems like a huge deal.

But, I think the market has and is changing.

  • What about OptumRx (formerly Prescription Solutions)?  Once the lives formerly managed by Medco are insourced in 2013, this is going to be > $20B company (I believe) which is part of a huge company (United Healthcare).
  • What about Prime Therapeutics?  They manage over 14M members (I believe) and have been actively bringing in lots of new management from other PBMs as part of their growth strategy.
  • What about SXC and CatalystRx?  They both have shown their ability to win against the “Big 3″ and grow.
  • What about “captive PBMs” like Humana and CIGNA?  I think they would both want a bigger crack at the lives outside their insured book of business.
  • What about MedImpact?  They manage 35M lives today.
There are dozens of other PBMs that have shown success in the market – ReStat, WelldyneRx, Navitus.  I guess it also depends on whether you view the market as just PBMs or you look at it for drug spend in which case cash patients play into the mix and you look at what companies like Walgreens, Walmart, CVS, Target, and RiteAid do.  [One could hypothesize that in a >80% generic world that cash is really the dominant method since insurance discounts matter much less and the role of the PBM or PBA is more around claims coordination for utilization management and DUR.]
Ultimately, I think it boils down to whether size gets you unfair advantages in pricing and discounts (i.e., rebates, acquisition cost, network discounts).  I would suppose that Worker’s Compensation is an area to look at where there are dozens of smaller WC PBMs competing with Express Scripts – MyMatrixx, PMSI, CypressCare.  What’s their experience been?

Today’s session in DC will certainly be interesting.

[As noted before, I both own shares in some of the companies mentioned here and do business with others and/or seek to do business with the companies mentioned here.]

Events, General Thoughts, Healthcare, PBM / Pharmacy

Handling A Mistake: Chevy’s Versus Jilly’s Cupcakes

July 17, 2011 by George Van Antwerp 0 Comments

I think in healthcare we are finally all realizing that the customer experience matters (#CEM).  The question is how to standardize and optimize that experience in scale and on a personal level when the people delivering that experience are call center agents, receptionists, physicians, pharmacists, pharmacy technicians, etc.  It’s the people in the field not those sitting in the corner office.

And, since exchanges will make healthcare a more individual buying experience and satisfaction is tied to loyalty, this is something we all need to figure out sooner rather than later.

As a family, we recently had a few experiences that show the two extremes here:

  1. Chevy’s.  This is a Mexican restaurant we frequent.  We go there probably once a week to the point where we have a preferred waiter (who knows our order before we sit down) and know the server and the manager.  Service has been great for years, but it’s begun to go down.  One night, it took 3x as long to get our food with no explanation, and we had to leave without eating.  The next time, the hot plate of food had some oil jump off and burn my wife (to the point of them getting her burn spray and ice).

    This seems like a great opportunity for an intervention by the manager.  But no.  They didn’t do anything.  They still charged us for the meal including my wife who’s leaving with an ice bag.  Oh well…time to find a new restaurant.

  2.  Jilly’s Cupcakes.  Here’s a cupcake store and restaurant that we’ve never been to, but we saw that they recently won on Cupcake Wars.  We decided to book a small birthday party there to decorate custom cupcakes.  When we show up, they are surprised.  Apparently, their reservations person wasn’t very good and got fired so they’re dealing with us and another party of 25 that have showed up unexpectedly.  A key opportunity for success or failure.

    I thought the General Manager did great.  She stepped right up and came up with a plan for us.  We got to go behind the scenes and meet the cupcake making team.  We got to customize our own cupcakes and really enjoyed it.  It was probably more memorable that the original party would have been.  In this case, I’m willing to drive people to her store and will send her a personal note to thank her.

One of the big points here is that it’s easy to either lose a lot of credibility or build up some credibility.  But, customers are fickle.  Much like companies strive for Six Sigma from a process perspective we need to keep that in mind from a customer experience perspective.  It won’t always go perfect, but how do you enable your staff and train them to respond quickly to keep the consumer happy and engaged.

BPM / Process, Consumerism, General Thoughts, Healthcare

Enchantment Infographics (by Guy Kawasaki)

June 28, 2011 by George Van Antwerp 0 Comments

I’ve had the privilege to hear Guy Kawasaki speak and have read a lot of the stuff he’s written over the years.  I haven’t read the new book Enchantment, but these infographics might get me to go out and do that.

I’d love to think about similar graphics which blend his work and the work of David Shore on trust in healthcare…how to you engage and build trust as a healthcare entity!

Books / Articles, Business Tools, General Thoughts, Leadership, Marketing / Communications, Methodology

Your Refill Logic Has To Be Dynamic

May 15, 2011 by George Van Antwerp 0 Comments

I signed up for an auto-refill program recently.  It quickly made me realize how stockpiling happens.  (Stockpiling is where a patient ends up with a large supply of their medication over time…typically due to refilling too soon.)

Imagine the following:

  • I get a 90-day supply of a medication.
  • At day 75, I get a refill of the medication.  (I have 105 days left at this point.)
  • 75 days later, I get my next refill.  (I now have 120 days left at this point.)
  • 75 days later, I get my next refill.  (I now have 135 days left at this point.)
The problem here is what I would call “static refill logic”.  The auto-refill program is triggered to fill the drug 75 days after it was last filled.
What is needed is “dynamic refill logic” which calculated days supply on hand.  This isn’t easy, but it makes a lot of sense.  The risk (if I’m a mail pharmacy) is that without this, I get gaps-in-care and/or create a short-term retention issue.
Imagine the following:
  • You ask me to refill, but I have 30 days on hand so I say no.
  • Now I forget to refill on time and I have a choice – (a) skip my medication for a few days or (b) go back to retail.  Neither is ideal for the mail pharmacy.
BUT, all of this could have been fixed if the logic was dynamic and they called to confirm my refill when I had just a few weeks left (i.e., enough to be thinking about refilling but also enough to have time to get it shipped to me).
BPM / Process, Consumerism, General Thoughts, Healthcare, Marketing / Communications, Methodology, PBM / Pharmacy, Technology, Value Propositions

The Royal Wedding Symbolism For Healthcare

April 29, 2011 by George Van Antwerp 0 Comments

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

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

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

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

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

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

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

Consumerism, Events, General Thoughts, Healthcare, Leadership, Marketing / Communications

Could CVS Caremark Become A Kaiser?

April 20, 2011 by George Van Antwerp 0 Comments

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

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

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

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

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

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

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

General Thoughts, Healthcare, PBM / Pharmacy, Politics, Value Propositions

QR Codes – The Ultimate Opt-In Tool

April 14, 2011 by George Van Antwerp 0 Comments

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

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

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

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

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

Blogroll, Books / Articles, Consumerism, General Thoughts, Healthcare, Innovation, Marketing / Communications, Methodology, PBM / Pharmacy, Technology

Why I Quit Facebook

April 9, 2011 by George Van Antwerp 0 Comments

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

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

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

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

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

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

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

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

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

General Thoughts, Marketing / Communications, Social Media

Data: Should You Be Paranoid?

April 4, 2011 by George Van Antwerp 0 Comments

I think we all know or are quickly realizing that everything we do leaves a trail of breadcrumbs.  That trail is a series of data points which now can be aggregated to create a record of you.  What you do?  What you buy?  What ads you respond to?  Who your friends are?  The list goes on. 

The question of course is whether you should be paranoid and worried about it. This video below shows you the extreme scenario of how data could be abused.

In a more balanced view, Time Magazine had an article call Your Data, Yourself which just appeared on March 21, 2011.

Oddly, the more I learned about data mining, the less concerned I was. (Joel Stein, author of article)

The article talks about a variety of companies that collect and sell data:

  • Google Ad Preferences
  • Yahoo!
  • Alliance Data
  • EXelate
  • BlueKai
  • RapLeaf
  • Intellidyn

The author makes a key point…a lot of the things we get for free are free because people collect and sell our data.  Otherwise, these “free” business models wouldn’t exist.  Would you pay for all the content and other things you get today or do you just want to understand what happens to your data?

On the other hand, the author shows you how data put together adhoc can paint erroneous pictures of you.  Should you care?  Do you want to fix this?  Can you control it?

This is all important since there is some do-not-track legislation being discussed.  (See Joe Manna’s post on this for some additional perspective)  Several people bring up the good question…

While we say that we don’t like to know that our data is being used to target ads at us, do we really want to have to sort through all the irrelevant advertisements?

Of course, we all become a lot more sensitive around healthcare data.  But, somehow, I doubt many of us think about what happens when we use our work PC to research a condition (see article on 10 ways to monitor your employees).

The article also suggests some sites for protecting yourself:

Don’t expect this one to go away.  With issues like the data breach at Epsilon, people are concerned.  Additionally, as data gets co-mingled and your credit score is used to determine health programs (for example), there may be limits about what and how information is used.

Blogroll, Books / Articles, Consumerism, General Thoughts, Healthcare, Marketing / Communications, Methodology, Politics, Technology, Value Propositions

Likelihood Of Being Wealthy

March 24, 2011 by George Van Antwerp 1 Comment

I found this test in Money Magazine (Sept 2010) interesting especially when you dig into the research behind the questions and the scoring.

  1. Optimists do better financially than pessimists although extreme optimists don’t save as much money as moderate ones.
  2. A child born into the wealthiest 20% of families has a 55% chance of staying in that quartile.  A child born in the poorest fifth only has a 9% chance of reaching the top and one born in the middle a 13% chance.
  3. If you’re raised in a home your parents owned, your more likely to stay in school and buy your own place.
  4. If you have chronic conditions (diabetes, arthritis, Crohns), these are associated with less wealth.
  5. People with IQs over 130 (top 2%) early $6K-$18.5K more per year…but that doesn’t correlate with better savings.
  6. A college grad will earn $450K more in their lifetime than someone with only a high school education.  Getting a graduate degree adds another $120K.
  7. A 6-foot tall man earns $5,525 more per year than someone that’s 5′-5″.  “Hotties” (their word) are twice as likely to make an above average income as their homelier peers and slim people have a higher net worth than heavy ones.
  8. The more brothers and sisters you have the poorer you tend to be.
  9. Boomers who got and stayed married accumulated 93% more wealth than their unmarried counterparts.
  10. Kids drain wealth.
  11. Being too agreeable leads to lower earnings.
  12. Affluent people exercise more.
  13. Families that own businesses are more affluent.
  14. Although adreneline junkies earn more than their cautious counterparts they are also more likely to make poor investing decisions.
  15. 84% of millionaires shop for bargains.

So, this may be neither hear nor there, but I’m fascinated by tests like this as they are data that can be used to predict and segment people from a communication perspective.  Understanding their behavior within sub-segments is critical in understanding why they act or don’t act.

Books / Articles, General Thoughts, Research

Happy Fat Holiday!

March 17, 2011 by George Van Antwerp 0 Comments

Not to be a party popper since I love the holidays, and I ate my Corned Beef & Cabbage meal a few days ago (and hope to have another).  But, I pulled up a quick recipe to see the calories (700), the calories from fat (470), fat grams, etc. in such a meal (assuming you only eat one serving), and it got me wondering.

If we look at all our holidays – New Years, Valentine’s Day, St. Patrick’s Day, Fat Tuesday, Fourth of July, Easter, Christmas, Thanksgiving, etc., is there any wonder we have food issues?  A lot of our favorite memories are tied to holidays which are tied to food.  You take those experiences (which typically include some snacks and deserts), and you can eat a few days calories in one day.

Not that it’s bad if you burn off more calories than you take in, but it certainly embeds this food problem right into our culture.

Events, exercise, General Thoughts, Healthcare
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