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.

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

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?

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.

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?

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.” 

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.

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.]

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.

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!