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NYT Article On ACOs Replacing Health Insurers

February 4, 2012 by George Van Antwerp 2 Comments

I think it’s a bold (maybe foolish) prediction that is made in the NY Times article saying that ACOs (Accountable Care Organizations) will be the end of health insurers.  We don’t even know that ACOs will work yet.  You can even see some debate on this topic in this blog post on Why ACOs Won’t Work.

But, I’m not an ACO expert so let me focus on what I found interesting in the NYT article.  It points out a few things:

  1. The focus on preventative care
  2. The fact that some managed care organizations are changing (and others will too)
  3. The fact that “ACOs” (in whatever form they take) will need a platform

This is what I find interesting.

I think the concept of an ACO (or Patient Centered Medical Home) where care becomes localized and there is greater focus on prevention and wellness not just sick-care is great.  We should all want that to happen in some form.

But, in all cases, this changes the data needs and role of the physician.  They need to be empowered with new information and tools.  How do they manage their panel of diabetics?  Will some database track them and monitor their screenings and blood sugar?

When the field of medicine is constantly changing with new drugs and new studies, how will physicians have the best practices pulled into their practice?  They won’t want to wait the 16 years it takes for things to work their way through the system.  They’ll actually want to embrace the best solutions and see more comparative effectiveness information.

I see a huge opportunity here for someone to create an ACO “platform” that embeds business rules, tele-monitoring, consumer engagement, and reporting into a way to create the “i-physician” (informed physician) of the future.

Books / Articles, Healthcare, Innovation, Leadership, Managed Care, Research, Technology

Uping The RxAnte: An Adherence Predictive Model

January 30, 2012 by George Van Antwerp 0 Comments

Those of you that have heard me speak know that I look at this topic of predicting adherence both from an area of fascination along with the eye of a skeptic.  While I love the concept of predicting someone’s adherence and therefore determining how to best support them from an intervention approach, I also believe that the general predictors are pretty straightforward:

  1. Number of medications
  2. Plan design (i.e., cost)
  3. Gender
  4. Health literacy and engagement (see PAM score research)

And, this is a hot topic (see post on FICO adherence score).  You can see my prior posts on some different studies, on the Merck Estimator, and some notes from the NEHI event on this topic.  It generated a good dialogue on Kevin MD’s blog when I talked about paying MD for adherence.

I had a chance to talk with Josh Benner the CEO of RxAnte the other day.  It sounds very interesting, and they have an impressive team assembled.  In general, they’re focused on:

  • Predictive modeling
  • Decision rules
  • Monitoring and managing claims to track adherence
  • Evaluating effectiveness of interventions
  • And creating a learning system

There are definitely some correlations to the work we do at Silverlink Communications around adherence.  We’re helping clients determine a communication strategy that might include call center agents, direct mail, automated calls, e-mail, SMS, mobile, or web solutions.  We’re looking at segmentation and prioritization.  We’re looking at past behavior and messaging.  The goal is how to best spend resources to drive health outcomes from primary adherence to sustaining adherence.  This is a challenge, and we all need to build upon the work that each other is doing to improve in this area.  We have a huge problem globally with adherence.

Blogroll, Books / Articles, Healthcare, Innovation, Leadership, Managed Care, Marketing / Communications, Methodology, PBM / Pharmacy, Research, Silverlink, Technology

Pharmacy Needs A Neuromarketing Study

January 23, 2012 by George Van Antwerp 0 Comments

I was reading this article in Fast Company about neuromarketing with a focus on the CEO of NeuroFocus. Companies like PepsiCo, Intel, CBS, ESPN, and eBay have used them and many others are trying work in this area. But, I’ve never heard of a healthcare company doing anything in this space. I’ve talked about this before in my article about the book Buyology. It’s fascinating, and the mobile tool that NeuroFocus has created could create new ways of capturing data.

One interesting example he talked about was the expression of a person on a poster (for example). If the expression is too easy to decipher, we simply move on…BUT if it’s hard to decipher, it causes us to pause and think.

He also talks about always putting images on the left hand side of the screen and words on the right. (Seems applicable to direct mail and maybe my next slide presentation.)

Another example is that the brain loves curves not sharp edges.

Given the shifting pharmacy marketplace, I would think this is a study that the industry needs. The PBMs should better understand what the consumer thinks about when they hear the word mail order. Manufacturers should understand the reaction to brand names or copay cards. The retailers should think about how brand equity plays into choice. There are endless opportunities here. (A business opportunity perhaps!)

(They Have Hacked Your Brain by Adam Penenberg)

Books / Articles, Healthcare, Innovation, Marketing / Communications, PBM / Pharmacy, Research

United HealthGroup At CES – Two Videos

January 13, 2012 by George Van Antwerp 0 Comments

This is Dr. Crounse from Microsoft talking about worldwide healthcare and using technology.

This is Dr. Reed Tuckson from United Healthcare talking about creating cost effective healthcare leveraging technology.

Healthcare, Innovation, Leadership, Managed Care, Technology, Value Propositions

Mouthguards For Non-Contact Sports

January 9, 2012 by George Van Antwerp 0 Comments

I wore a mouthguard when I played lacrosse, but I’m not sure I could see myself putting in a mouthguard for running or playing tennis or golf.  Under Armour is pushing a series of mouthguards for any sport now (see brochure).  But, from a purely academic perspective, it’s interesting.

The material says that:

  • It improves airflow.
  • It reduces stress.
  • It improves strength.
  • It reduces lactic build-up.
  • It improves response time.
  • It reduces cortisol production.

It just makes me think that you’ll create this casual athlete with:

  • A mouthguard.
  • Nose strips to improve breathing.
  • Dark compression socks pulled up to the knee (perhaps with no bottom to allow for barefoot running).
  • Compression arm sleeves.
  • Heart rate monitor with GPS.
  • Googles to protect the eyes.
  • Magnetic band for strength and balance.

You get my point.  All of these things offer either some type of protection and some improvement in results, but it can go too far (IMHO).  Although on the flipside, the competitor inside me is anxious to try them out.

Books / Articles, exercise, Healthcare, Innovation, Leadership, Marketing / Communications, Value Propositions

Presenting at PBMI in February

January 6, 2012 by George Van Antwerp 0 Comments

I am excited about the opportunity to present at PBMI in February.  I hope many of you will be there.  If you want to meet up, send me a quick note at gvanantwerp at mac dot com.  Thanks.

Here’s the description of my presentation:

The PBM industry continues to consolidate through mergers and acquisitions.  At the same time, new PBMs and niche PBMs continue to grow.  While the majority of the green space is gone, there is increasing focus on the individual market through exchanges and the Managed Medicaid market.  But, this maturing of the market has forced PBMs to look at more organic growth opportunities also.  How do you retain business?  How do you innovate?  How can you increase profitability per member?  With a few large market dynamics playing out in 2012, we’ll begin to look at what the future might hold and what we can learn from the past.  It is an interesting time for all PBMs, pharmacies, and manufacturers as they embrace the role of pharmacy in improving overall health outcomes.   
Events, Healthcare, Innovation, Leadership, PBM / Pharmacy, Press, Silverlink, Value Propositions

Should You Be An “Imovator”?

January 2, 2012 by George Van Antwerp 0 Comments

Innovation has been a hot buzz word for the past few years.  The question is always whether to be on the bleeding edge (i.e., an innovator) or a fast follower.  I like the word “imovator” from a July 10th, 2010 Time article on the two business books – Different versus Copycats. 

Many people will tell you that we’ve tried that before or list all the reasons why something won’t work.  It’s never easy to be innovative.  At the same time, you don’t want to be innovative without a purpose.  There has to be a business value to justify the time and investment. 

One easy way to do this is to monitor your competition and simply make what they do better and less expensive.  This fast follower strategy has worked for many people.  They let the competition come up with an idea than execute on it better without having all the upfront investment. 

One of the examples in the article was Walmart.  Sam Walton didn’t invent the discount store, but he certainly figured out how to do it better and scale it.  So, as you think about 2012, what are your strategies for innovation and imovation? 

I personally find focusing on the whitespace between different products to create opportunities.  Look at how consumers use your products.  Look at the choices in the market.  There are often niches which can be grown to create opportunities.  The key is identifying those and creating something that is sustainable in terms of differentiation.

Books / Articles, Healthcare, Innovation, Leadership

Using the Local Pharmacist to Moderate the P2P Discussion

December 15, 2011 by George Van Antwerp 1 Comment

P2P or Peer-to-Peer healthcare is a common discussion topic these days. Patients want to go online and learn from others with their condition on sites like Inspire.com or PatientsLikeMe.com. The government has been one of the early adopters.

“The social media sites we have created show that the government can interact in a meaningful way with the public. We don’t just push information out; we strive to make the content relevant so people can act on it, share it with family or friends and ultimately change their behavior.” Amy Burnett, CDC (Tapping Into The Power By Getting Personal, Robin Robinson, PharmaVOICE, May 2011)

The question is how can traditional companies – pharmaceutical manufacturers, disease management companies, providers, managed care companies, pharmacies, and PBMs – interact in these discussions. On the one hand, they have a broad depth of experience and data to share. On the other hand, they can’t just jump in and drive their agenda. They have to add value to the conversation, demonstrate that they care, and add value.

Much like the idea that you can purchase things online and return them to the physical store, I think these virtual discussions need to eventually be tied to a physical experience for many patients. One group that I think could play significantly in this is local pharmacists. Imagine that a chain or an association created a social media team. That team could monitor and interact with patients especially in key conditions such as some of the specialty drug areas. As relevant, this could be linked back to a local store where a pharmacist could spend time consulting with the patient. I think this would be a great way to drive the retail specialty business and increase consumer brand awareness.

“The potential use of social media as a bellwether for identifying trends, informational gaps, support tools, even improved communications between providers, allied health professionals, and others could pave the way for a more collaborative approach to population mapping and patient care.” Michael Parks, Vox Media (Social Media: Paving The Way, Robin Robinson, PharmaVOICE, May 2011)

The CDC has even created a toolkit for people to use.

Books / Articles, Consumerism, Healthcare, Innovation, Leadership, Marketing / Communications, PBM / Pharmacy, Social Media, Technology

What’s Your Digital Strategy?

December 6, 2011 by George Van Antwerp 0 Comments

Do you have a digital strategy?  Even if you don’t call it out that way, you certainly have digital as part of your overall member and physician strategy these days. 

Hopefully, you start with a few basics like:

  • What do I want to accomplish?
  • How do I measure success?
  • Who am I targeting?
  • What does my target group do online and what tools do they use (and for what)?
  • What is my competition doing?  (and what do companies outside my vertical that I want to emulate do)

Once you know those things, you can start looking at different areas of focus.  The key ones that jump to mind for me are:

  • Search engine optimization
  • Brand monitoring (e.g., Radian6)
  • Content creation (blogging, Twitter, Facebook, Google+, LinkedIn)
  • Moderation and involvement with social networking (e.g., PatientsLikeMe, DiabetesMine)
  • Tele-monitoring / telemedicine
  • Electronic prescribing / EMR / PHR
  • Digital couponing / incentives
  • Gamification
  • Mobile applications
  • SMS
  • QR codes
  • Augmented reality

But, I’m sure there are others…suggestions on what I’m missing?

Healthcare, Innovation, Leadership, Marketing / Communications, Methodology, PBM / Pharmacy, Social Media, Technology

IDC On Personalized Medicine

November 30, 2011 by George Van Antwerp 0 Comments

I was reading the IDC Health Insights newsletter this morning where they had an article by Dr. Alan S. Louie on personalized medicine.  While this was a hot topic in the PBM world 12-18 months ago, I’ve heard much less about it lately.  I thought it made sense to share one paragraph from his article here.  I hope that his predictions for delivery of this evidence-based approach to care come true and can be delivered in a cost-effective way to consumers with physician buy-in and understanding about how and when to use this information.

“I believe that the FDA is likely to be significantly marginalized as a major player in the transformation to a more personalized care scenario. While still rigorous in their role as gatekeeper to ensure that drugs are safe and effective, the ability to apply growing genomics, EMR, and CDSS data and knowledge to routine medical treatment is likely to be executed outside of FDA purview. If the FDA decides to lay down the heavy hand and demand that all testing be FDA approved, then all bets are off and medical innovation will be delayed by at least 10 years or more. With payers, clinical laboratories, and others (e.g., PBMs) all buying genomics testing capabilities, it becomes increasingly possible to deliver the latest genomics insights to the point of care and amortized over large patient populations, recognizing that what are probabilities for the individual become real outcomes for portions of patient populations. Net improvements in patient outcomes become real and avoidances of treatment with little or no likelihood of success reduce both wasted efforts and unnecessary adverse drug exposure.”

Books / Articles, Healthcare, Innovation, Methodology, PBM / Pharmacy, Research, Value Propositions

Slideshare: 2012 Digital Trends For Healthcare Marketing

November 26, 2011 by George Van Antwerp 0 Comments

Good deck that I found on Slideshare.net.

Books / Articles, Healthcare, Innovation, Leadership, Managed Care, Marketing / Communications, Methodology, PBM / Pharmacy, Research, Technology

Will Pfizer Strategy On Lipitor Become The Norm?

November 23, 2011 by George Van Antwerp 0 Comments

Remember Twisted Sister’s song – We’re Not Going To Take It Anymore?

That’ seems like a good summary of the Pfizer response to the typical market dynamics around patent expiration.

Here’s a summary of what they’re doing:

  1. Pfizer is striking deals with PBMs to offer them brand Lipitor at a lower cost (net of rebate) than the generic drugs which are coming to market during the exclusivity period.
  2. Pfizer is continuing to offer their $4 coupon for brand Lipitor direct-to-consumers.
  3. Pfizer is continuing to advertise Lipitor and talking about “if Lipitor has been working for you, stay with it”.
  4. Pfizer is partnering with Diplomat Pharmacy to sell Lipitor directly to the consumer through mail order.
  5. Pfizer is offering pharmacies additional services around adherence for helping keep patients on Lipitor.

Here’s some key questions on implications:

  1. If I’m the authorized generic, how do I feel? I thought I had a deal by which I was bringing a drug to market and making some money during the exclusivity period. Will this change the way that authorized generic deals get structured?
  2. If I’m the generic manufacturer that has the 180-day exclusivity, how do I feel? I’ve just lost a lot of my opportunity. Will this change the economics of generic manufacturers? I believe most of their profit is made during the exclusivity period.
  3. Will other brand manufacturers follow suit on other patent expirations?
  4. Will the PBM response to couponing intensify with their push into couponing when there is a multi-source generic available?
  5. Will this serve as a bridge until they can get OTC Lipitor approved? And, will that ever happen?
  6. How does this affect retailers who make more money on the generics and won’t see the increased rebate dollars?
  7. For PBM clients that get rebate dollars shared with them, these deals with Pfizer are probably a win (i.e., lower cost). What about those clients that don’t? How are they being made whole? What about clients of clients (i.e., employers who contract with a TPA or MCO who gets the rebates but doesn’t share them)?
  8. How hard does it become to transition patients off Lipitor when Pfizer stops offering the increased rebates or lower cost?

This could be a game changing moment in the industry. We’ve seen lots of shifts, and I would add this as a new phase in the industry.

  • 1.0 = Traditional focus on MDs and heavy use of people to detail physicians.
  • 2.0 = Shift to DTC advertising still supported with detail reps.
  • 3.0 = Increased power of PBMs and focus on rebating and formulary positioning.
  • 4.0 = Rise of generics and shift to specialty.
  • 5.0 = DTC couponing and broader disease centric strategies.
  • 6.0 = New business models??
Healthcare, Innovation, Marketing / Communications, PBM / Pharmacy

Reprint: Getting Aligned For Consumer Engagement

November 17, 2011 by George Van Antwerp 0 Comments

(This just appeared in the publication by Frost  & Sullivan and McKesson called “Mastering the Art and Science of Patient Adherence“.  It was written by me so I’m sharing it here also for those of you that don’t get that publication.)

According to the 15th Annual NBGH/Towers Watson Health Survey, employees’ poor health habits are the number one issue for maintaining affordable benefits. Since studies have shown that 50-to-70 percent of healthcare costs are attributed to consumer choices and adherence is one of those issues, the topic of how to engage consumers isn’t going away.

The challenge is getting the healthcare industry to use analytics and technology tools when engaging the consumer in a way that works for each individual and builds on their proven success in other industries. Healthcare has an enormous amount of consumer data ranging from demographics to claims and behavior data. Consequently, there is great opportunity to use this data to engage consumers in their health to improve clinical outcomes. While on the one hand, it’s like motivating consumers to buy a good, the reality is that healthcare is both personal and local which complicates the standard segmentation models.

This is a dynamic time where people are experimenting with different strategies for engagement. For instance, in medication adherence, people are trying everything from teaming those who have chronic conditions with community pharmacists to make sure they are taking their medications correctly to technology that monitors when the pill actually enters your body. But, there are still fundamental gaps in the process which can be addressed using interactive technology to complement the pharmacist interventions.

Consumer engagement in healthcare is increasingly moving to new channels with 59 percent of adults in the U.S. looking for health information online and 9 percent using mobile health applications according to Pew Research Center. Additionally, there is more and more participation in social media or peer-to-peer healthcare applications. Modes like SMS, which companies are starting to leverage in programs like Text4Baby or the diabetes reminder program recently launched by Aetna, are gaining popularity. Companies like Walgreens have also begun exploring the use of SMS and Quick Response (QR) codes for medication refills.

At the end of the day, consumers want preference-based marketing where they can elect how to best engage them, but that doesn’t mean that’s the most likely channel to get them to take action.They want you to learn from their past responses to improve your future outreach, but they are also skeptic about how their data is used. You have to put yourself in their shoes to create the optimal consumer experience. You have to deliver the right message to the right consumer at the right time using the right sequence and combination of channels.This is not easy.

So, if you’re going to optimize your resources and build the best consumer experience, you need an approach which is dynamic and personalizes each experience. For example, we found that creating the right sequence and timing around direct mail and automated calls improved results by as much as 100 percent in a pharmacy program. Or, in another case, at Silverlink Communications, we found that using a male voice in an automated call to Latinos got an 89 percent better engagement rate around colonoscopies. We also know that using a peer pressure message does not work in motivating seniors to take action in both a retail-to-mail program and a cancer screening program, but does work for those younger than 55-years-old?

You have to make simple messaging relevant to them—why should I get a vaccination, why is medication adherence important, how can you address my barriers? Only an ongoing test and learn approach to consumer insights will suffice, and those that figure this out will become critical in the ongoing fight for mindshare and trust. But, this isn’t a stand-alone opportunity. We have to partner with providers to improve engagement, adherence, and ultimately outcomes in different forms. We have to offer them a platform for engagement that is built upon consumer insights and provides a unique consumer experience to them based on their disease, their demographic attributes, and their plan design. All of these factor into their behavior and are important in “nudging” them towards healthcare engagement and ultimately, better health.

Books / Articles, Consumerism, Healthcare, Innovation, Leadership, Managed Care, Marketing / Communications, Methodology, PBM / Pharmacy, Press, Research, Silverlink, Social Media, Technology, Value Propositions

Sustained Patient Engagement Around Hypertension: Silverlink and Aetna

November 15, 2011 by George Van Antwerp 0 Comments

At Silverlink, we had a great opportunity to work with one of our clients and publicize it. This morning, Aetna released a joint press release with us about our hypertension program.

As companies continue to look at new ways to use technology to engage patients around chronic diseases, solutions like this offer companies a unique way to blend multiple channels into an overall consumer experience that improves engagement and outcomes.

From the press release:

The program also achieved high levels of engagement, with nearly 60 percent of participants continuing to actively monitor their blood pressure by using a free blood pressure monitor and submitting readings on a monthly basis. The frequency of participants’ cholesterol (low-density lipoprotein (LDL) cholesterol) screening also improved 5 percent.

“By helping our Medicare members manage their high blood pressure, we are hoping to help prevent heart disease, strokes and even deaths,” says Randall Krakauer, MD, FACP, FACR, Aetna’s national Medicare medical director. “Our nurse case managers work closely with our members and do a tremendous job providing them with the information, tools and support they need to help them control and improve various chronic conditions, including hypertension. The results of our program with Silverlink demonstrate that an automated program can further support and engage members in managing their own health conditions.”

Books / Articles, Consumerism, Healthcare, Innovation, Leadership, Managed Care, Marketing / Communications, Press, Research, Silverlink, Technology, Value Propositions

Retail Pharmacy Mobile Applications

November 10, 2011 by George Van Antwerp 0 Comments

I’ve talked before about some of the mobile PBM efforts, but what about the retail pharmacies. You should expect that the chains will have different mobile strategies than the grocery stores or the big box retailers. And, it will be interesting to see how the independents might collaborate on a shared platform.

Here’s a few things already out there:
- Walmart new shopping application and Walmart’s page on mobile
- CVS retail application
- Walgreens has a mobile pharmacy app
- Target also has a mobile pharmacy application

So what should or could pharmacies offer consumers in terms of mobile applications:
- A refill application is a minimum
- Education or drug information is another basic
- There are certainly some geographic options such as a store locator or clinic locator
- There are options for location based check-in using Foursquare
- Scheduling MTM consultations or vaccinations are a reasonable option
- What about promoting saving thru 90-day retail or generics?
- As retail pharmacies are in the specialty business, there could be opportunities to promote this channel and offer support.
- Telemonitoring is another option (e.g., FaceTime)
- Use of QR code is another part as is augmenting the shopping experience with augmented reality
- Of course, couponing will be part of the solution, but what I’d like is someone who would download my shopping receipts (from multiple companies) and provide me with relevant savings.
- Should it include Rx coupons? Unlike the PBMs, retailers want traffic and if coupons increase adherence then why not.
- There are other options like photos and integration with social networks and tools.

I think one of the key “killer apps” is secure rules based messaging. Imagine using data to identify when you need a vaccination or identifying a potential drug-food issue or having age based triggers. These could be sent directly to the consumer in a secure environment. Of course, we’re only at about 10% adoption and the key question is whether these are the key consumer that everyone wants to attract. Are they the high utilizers? Do they buy other goods?

More to come here. This is a rapidly evolving space.

Consumerism, Healthcare, Innovation, Marketing / Communications, PBM / Pharmacy, Social Media, Technology, Value Propositions
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The Augmented Reality Prescription Bottle

November 9, 2011 by George Van Antwerp 0 Comments

I was watching a YouTube video on Starbucks’ augmented reality cup which got me thinking. Why not do the same with the prescription bottle?

What a great way to engage the tech savvy consumer.

Perhaps you could provide a plain language summary of information about the medication. You could give a list of side effects. Or show how to take the medication.

Perhaps it could have an embedded survey that you complete weekly.

And, it seems like an easy opportunity for someone to offer an augmented reality applications for all medications. Hold up the phone to a pill and get information on it. (maybe a little harder)

I think there is a lot more here as companies like Lamar continue to evolve.

Healthcare, Innovation, Marketing / Communications, PBM / Pharmacy, Technology
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My Eight PBM Predictions For 2012

November 3, 2011 by George Van Antwerp 0 Comments

I recently heard one of the key CEOs in the PBM industry say that his crystal ball for 2012 was fuzzy, and he wasn’t sure what was going to happen.  (Not particularly reassuring.)  That being said…it’s an exciting time, and I’m going to take my pass at predictions anyways.

  1. The proposed Express Scripts acquisition of Medco will take place although they will be required to sell off some specialty assets.  This will create a new specialty player and will also trigger further consolidation and acquisitions.  You will also see many of the Medco people go to new healthcare companies throughout the industry to drive change.
  2. The contract dispute between Express Scripts and Walgreens will get resolved shortly after 1/1/12, but it will serve as the trigger for limited networks as multiple clients will keep Walgreens out of the network since they’ve addressed most of the disruption and achieved savings.  But, you will also see several companies quickly add Walgreens back into their network.
  3. Star Ratings will trigger a bigger focus on adherence across the industry and begin to create outcomes-based performance measures that the commercial business starts to see in their PBM contracts linking payment to performance.
  4. Lipitor will be a disruptive item throughout the year with aggressive Pfizer rebating, the overhang from it potentially going OTC, and the pricing of the initial generic.
  5. Innovation will finally begin to shift to the specialty space with this being the primary area of concern from a trend management and clinical perspective.  Clients will expect innovative ways of engaging patients and improving outcomes which will push closer links between pharma and PBMs around key drugs and complex conditions.  The focus on specialty spend in medical will continue, but the increasing percentage of infusion drugs will challenge this and push specialty to look for more ways of engaging with the physician.
  6. The “retailing of healthcare” through storefronts will manifest itself in different ways in pharmacy with greater focus on specialty at retail, pharmacists as part of the ACO/PCMH concept, MTM, and ultimately through exchange based partnerships with large payers.
  7. Integration of medical, pharmacy, and lab data will be a huge focus on PBMs create targeting algorithms and databases for segmentation, targeting, and ultimately engaging consumers around specific health behaviors.
  8. Telemedicine in the form of telemonitoring will link into the retail pharmacy clinic strategy as they extend their pharmacy relationship from an event based relationship to an ongoing monitoring relationship around key conditions like diabetes.

Two things that I expect to continue to be areas of focus will be the development and execution of a mobile strategy and continued exploration in the area of personalized medicine and genomics.

The one outlier which I’m not sure of yet is Medicaid pharmacy.  It’s been a hot topic lately, but I’m still unsure of whether that will radically change in 2012 or not.

[Interested in sharing your opinions on 2012 in a formal way?  I'm going to reach out to several companies and ask their thought leaders or executives to do an "interview" with me about their predictions for 2012.  Let me know if you'd like to participate.]

[And, don't forget that you can sign up to have these posts e-mailed to you whenever I write them by signing up for my e-mail list on the right side of the blog.  Thanks for reading.]

Healthcare, Innovation, Leadership, Marketing / Communications, PBM / Pharmacy, Research, Value Propositions

Why Don’t Physicians Use More Information Therapy

November 1, 2011 by George Van Antwerp 0 Comments

My PCP is very good about giving me information to read every time I visit him.  (Never mind that it sits in a pile on my desk.)  But, I believe this is under-utilized in today’s information rich society.

I was reading an article this morning from PharmaVOICE about physicians not using certain medications or treatments because they didn’t have the time to spend with patients explaining them.  Therefore, they default to the “easier” solution which requires less explaining.  Is this prevalent?  I don’t know.

The article talked about a survey from Sermo and Aetna Health which revealed that almost 2/3rds of the 1,000 MDs surveyed felt that “the current health care environment is detrimental to the delivery of care”.  And, less than 1/5th felt that “they could make clinical decisions based on the what was best for the patient, rather than on what the payers are willing to cover”.  Pretty scary and sad.

Imagine if the physician was using an electronic interface during the encounter.  They could pre-create several information packets around certain diseases, drugs, and/or treatments.  When the patient was diagnosed and a treatment plan agreed to, they could e-mail the package to the patient.  It might include written information, links to websites, YouTube videos, or other assets.  I would imagine this could be very powerful and address the common gaps that exist between what the physician says and the patient hears.

[The article was "Is the Business of Health Care Getting in the Way of Providing Good Health Care? by Ken Ribotsky in PharmaVOICE from October 2011.]

Books / Articles, Healthcare, Innovation, Leadership, Marketing / Communications, Methodology, PBM / Pharmacy, Technology

Will Drought Eventually Push Us To Drink Toilet Water?

October 4, 2011 by George Van Antwerp 0 Comments

Not a hot topic! But, I think we all have seen the issues in Texas and other areas of the US this year around lack of water. Water is rapidly becoming a critical resource with McKinsey estimating that by 2030, the global water supplies will meet just 60% of demand. Basically, water supplies don’t go up while demand does due to population and new uses for land.

There is an interesting article called Droughtbusters by Anita Hamilton. One of the more disgusting but yet practical solutions in there is recycling toilet water which is being done in Namibia. I won’t pull you through the technology, but if Orange County, CA can begin treating sewage water and pouring it into its underground aquifiers than it’s not that far fetched.

To read more about water scarcity, you could go to http://thewaterproject.org/.

Books / Articles, Healthcare, Innovation

Here Come The Pharmacy Co-Branded MA/PDP Plans

October 3, 2011 by George Van Antwerp 0 Comments

In the past few days, I’ve seen two new announcements:

  1. Aetna partnering with CVS to launch a co-branded Medicare plan
  2. Coventry partnering with Walmart, Walgreens, and Target

I think we’re all familiar with the success that Humana has had in their Medicare offering with Walmart.

I think one could also say that the PBMs (i.e., mail order) getting into the Medicare business was also an effort to co-brand Medicare offerings between payers and pharmacies.

I wonder if we’ll see an NCPA offering.  I would think in certain regions that that would play well.

 

Books / Articles, Healthcare, Innovation, Leadership, Managed Care, Marketing / Communications, PBM / Pharmacy

Ambient Paper For Adherence

September 24, 2011 by George Van Antwerp 0 Comments

We’ve all heard of GlowCaps which is a great idea of using sound and color and communications to remind people to fill their medications.

One idea I’ve thought about for several years is the idea of “intelligent paper”.  Imagine a refrigerator magnet or prescription label or some other piece of information printed on paper that changed color with time.  As it got closer to time to refill your medication, it would turn yellow.  When it was time to refill, it would turn red.

It should be easy.  If you blend this with the QR code that Walgreens uses for refills, you have a captive reminder and reorder system that could be embedded within the label for less cost.  I haven’t totally solved the issue, but it’s one that I think is feasible to accomplish and sell as a low-cost reminder vehicle.

Healthcare, Innovation, Marketing / Communications, PBM / Pharmacy, Technology

Pharmacy Adherence (Waste) And The Need for MD-RPh Collaboration

September 22, 2011 by George Van Antwerp 0 Comments

I spent the day today at the NEHI adherence event in DC. I pulled out a few of my takeaways below, but while I was riding on the plane to get here, a few things were running thru my head:

  • The focus on budget and the estimates that adherence costs us $290B a year here in the US.  (or as one person pointed out that’s $1.2T in a presidential term)
  • The recent report estimating that chronic conditions could cost us $47T worldwide over the 20 years which is leading to the UN talking about healthcare for only the second time ever.
  • The discussion by George Paz from Express Scripts the other day about how PBMs drive value by eliminating waste (see Drug Trend Report). A large piece of waste is adherence and certainly one of the forecasted benefits of the combined Express Scipts and Medco entity is the intersection of Consumerology with the Therapeutic Resource Centers (TRCs).
  • The ongoing dialogue around motivational interviewing, commercial MTM, and blending face to face interventions with technology to “nudge” behaviors.
  • The huge opportunity which I believe exists in leveraging technologies like Surescripts to create data exchanges with physicians around MPR and barriers.
  • The exciting fact that the new STAR measures for Medicare include more adherence metrics that are weighed more heavily than some of the operational metrics.

Fortunately, these were a lot of the topics that were discussed.  Here some of the discussion topics:

  • The fact that there’s no “easy button” for adherence.
  • How adherence is a foundational building block for quality.
  • The role of HIT in sharing data bi-directionally across the care team.
  • Upcoming evidence around VBID.
  • The role of the pharmacist and need for them to collaborate more with the physician to discuss and manage adherence.
  • The fact that the adherence solution has to be multi-factorial.
  • The need to optimize the drug regiment and individualize care (aka patient-centered care).
  • The role of the caregiver.
  • Opportunities around PCMH, readmissions, MTM, and eRx.
  • The need for patient engagement.
  • The need for the patient to believe in the therapy and that it will make them better.
  • Good discussion on the role of the PCMH (patient-centered medical home) versus the pharmacy as the foundation for adherence.
  • Discussion on whether physicians could address adherence if time wasn’t an issue.  Do they have the training and skills?
  • Social media as an emerging factor.
  • Reaching the consumer when they have time and are receptive to information.
  • Helping prepare the consumer for the encounter (i.e., checklist or list of questions).
  • What happens when the patient waits in line and then is rushed themselves in the encounter.
  • The role of technology in complementing the physician and patient.
  • How to share data across team members.
  • The need for ROI data on interventions.
  • The value of having a Dx on the Rx.
  • The need to vary incentives and not keep doing the same thing.
  • If prevention is long-term and adherence is short-term, should the physician focus more on adherence and less on screening and other preventative measures.
  • The need for – sufficient accountability, information, and skills.
  • Adherence as a solution that needs to be localized.
  • Patient centered or disease centered solutions.
  • The governments role in improving adherence via policy and funding demonstration projects through CMS.
  • STAR ratings and the bonus payments as an incentive to motivate research and programs in this area.

Overall, it was a good discussion with a very engaged panel and audience.  We didn’t come to any answers, but you certainly got to think about the topic, identify some projects that should be done, and identify some research questions. 

I look forward to pulling out a few of the topics in more depth.  They align well with the communications platform and intervention strategies that Silverlink provides for our clients around adherence.

Healthcare, Innovation, Leadership, Marketing / Communications, Methodology, PBM / Pharmacy, Research, Silverlink, Value Propositions

New Walgreens Pharmacy Layout

September 19, 2011 by George Van Antwerp 1 Comment

I was in a Walgreens last week in Chicago.  Maybe it’s just a newer store than my local store in St. Louis, but I thought the pharmacy looked very different.  I captured a few shots with my camera phone.  As you can see below:

1. There is an automated check-in option for refills. 

2. There is a pharmacist in front of the counter not just behind.  (And people were actively coming in and talking with him.)  The clinic also seemed to have a person on the floor roaving around interacting rather than sitting behind a podium. 

4. There was a sitting space with what appeared to be a meeting room.

5. Overall, there was a lot more signage and videos which made it a very lively and bright place to be. 

 

This seems like a different engagement strategy.  I’m surprised no one is talking about it.  The only thing I could find was a mention of a “training store” and 40 locations and the following mention in an article about Express Scripts and Walgreens:

As part of its plan to expand its healthcare offerings and reduce costs, Walgreen is working on pilot stores with new technology and a health guide on staff to help patrons more easily fill prescriptions, speak to pharmacists and see nurse practitioners at its in-store Take Care clinics. The first such store, in the village of Oak Park, Illinois, opened in November. Walgreen plans to have 20 stores in Chicago and other nearby towns by October.  (source)

It sounds like there are just a few stores so I must have got lucky to stumble into this one.  I had heard rumors of some re-design, but I hadn’t seen anything out there on the Internet.  Interesting.  I’d love to see a study to understand satisfaction, engagement rates, retention, etc. associated with this footprint versus the older store pharmacy layout.

Consumerism, Healthcare, Innovation, Marketing / Communications, PBM / Pharmacy

Is Your Adherence Program Leveraging Segmentation?

September 19, 2011 by George Van Antwerp 0 Comments

I was just finalizing a new marketing piece with our marketing team on Silverlink’s adherence services.  I love this picture because it drives home the point of understanding the consumer.

If you don’t understand the factors that drive behavior and leverage those attributes in segmentation and personalization of your adherence program, you may be leaving opportunities on the table.

Healthcare, Innovation, Marketing / Communications, Methodology, PBM / Pharmacy, Silverlink

Primary Adherence – Technology, Kaiser Study, and EHRs

September 13, 2011 by George Van Antwerp 0 Comments

I think we all know that primary adherence is a real issue.  Depending on what you read, you see that anywhere from 20-30% (or more) of patients don’t start therapy.  They are prescribed a drug, but they never fill it.  This is due to lots of reasons:

  • They get a sample.
  • The drug costs too much leading to abandonment.
  • They don’t feel like they need the prescription.
  • They feel better.
  • The doctor tells them only to fill it if something else doesn’t work.

These issues vary based on whether it’s an acute drug or a maintenance drug.  It also varys by drug class. 

I’ve always been surprised that pharmaceutical manufacturers focus so much on ongoing refills leading to improved MPR rather than focusing on primary adherence which would grow their market significantly.  One of the big reasons for this has been visibility.  Without electronic prescriptions and mapping those to claims data, it was hard to identify who had a prescription and didn’t fill it.  You could do something with data out of the PPMS (Physician Practice Management System) or through more complicated processes to get data out of their notes, but it wasn’t easy. 

So, this new study by Kaiser caught my attention. 

If you are a diabetic, have high cholesterol, or high blood pressure and you receive medical care at an integrated healthcare system that has electronic health records (EHRs) linked to its own pharmacy, then you are more likely to collect your new prescriptions than people who receive care in a non-integrated system, a Kaiser Permanente study shows.

That’s a strong sell for an integrated model, but perhaps more realistically for the use of EHRs.  You can also see some of the data from Surescripts around this topic of electronic prescriptions and adherence. 

This creates a great opportunity for pharmacies, PBMs, payers, and pharmaceutical manufacturers to leverage technology to improve primary adherence.  By identifying people who don’t fill a prescription they receive, companies can help determine which of those are intentional and which of those should be addressed.  This should help address the overall costs attributed to non-adherence and be a business driver for all these entities. 

[Note: If you're interested in working on primary adherence, let me know.  We have several approaches for this at Silverlink.]

Books / Articles, Healthcare, Innovation, Marketing / Communications, Methodology, PBM / Pharmacy, Research, Silverlink, Technology

$47 Per Rx Guarantee From Prime Therapeutics

September 1, 2011 by George Van Antwerp 0 Comments

I think this is a good, bold move.  Prime Therapeutics has launched four new programs.  The most aggressive is called Reliance and guarantees your net spend per Rx at $47.  The easy way to do this would be to exclude specialty drugs and basically offer a generics-only formulary.  My quick read from their drug trend report and press release is that it includes specialty drugs.  It also includes a lot of utilization management programs, suggestions on plan design, encouragement for mail order, and other features.  I’ll be interested to see the adoption of the program or whether it’s just a great program to encourage clients to consider new, more aggressive plan designs.

“Our Reliance plan keeps costs predictable for plan sponsors,” said Michael Showalter, Prime Chief Marketing Officer. “The goal is to make pharmacy benefits easy, understandable and affordable. Through Reliance, there will be no surprises, allowing organizations to better plan for and manage their pharmacy costs and reduce overall health care costs, while providing excellent benefits. We provide a single number demonstrating the true cost of care – $47. We are the only PBM to back that up with a price guarantee and complete price transparency.”

Books / Articles, Healthcare, Innovation, Leadership, Marketing / Communications, PBM / Pharmacy, Value Propositions

Increasing Preferred Pharmacy Usage (3 of 3)

August 25, 2011 by George Van Antwerp 1 Comment

This is the third of three posts on new ideas for increasing usage:
  1. Driving preferred pharmacy usage from the employer site
  2. Using social media
  3. Borrowing from other industries

The idea in all of these was to look at new ways that builds on the standard approach that we work with many clients on today.  And, if you believe that the Express Scripts / Walgreens dispute won’t get resolved, we’re going to see a lot of people using limited or preferred networks very soon.  This is also something that Adam Fein talked about in highlighting some of the progress Wal-Mart is making in this area.

So what are some examples of things we could borrow from other industries?

Referral Program:  Why not offer incentives for people who refer their friends and family into the pharmacy? Wouldn’t this play into the social network or peer-to-peer trends out there?

Satisfaction Surveys:  Why isn’t there more monitoring of the customer satisfaction to look for improvement opportunities?  [Note: I know there is some, but I think it's under-utilized as a tool.]

Tiered Service Levels:  Frequent travelers get different levels of customer service.  Why don’t high utilizers with lots of co-morbidities and Rxs get a better level of service?

Points:  Why aren’t there more incentive systems and “points” that are used to reward consumers based on share-of-wallet or other metrics?  [I think there may be some legal issues here.]

Online Order Tracking:  Why can’t I watch my prescription being filled and track it around the system online?

Pharmacy Ratings:  Why isn’t there a consumer and business system that ranks pharmacies based on wait time, friendliness of staff, error rates, generic fill rates, overall satisfaction, or other metrics that can then be pushed to the consumers?

Incentives / Coupons: Certainly these have been tried and there are limits here especially in government funded benefits, but it’s still few and far between.

MD Programs: Physicians can certainly influence this decision.  Why isn’t there more effort to differentiate a pharmacy (mail, retail, specialty) by building relationships with high prescribers?

Check-in / Preferences: Why don’t the forms in the physician’s office (or applications) have you select a preferred pharmacy or have a pop-up with a preferred pharmacy in it to drive you there?

Credit: For some people, it’s an issue to front the money for the 90-day supply.  Why haven’t the mail order pharmacies partnered with a credit card company to allow for installment payment?

If you’re going to “win” at this game, you have to think differently.  You have to test and learn.  You have to capture insights from your customers and translate them into product offerings.  It’s not easy.

Consumerism, Healthcare, Innovation, Leadership, Marketing / Communications, Methodology, PBM / Pharmacy

Increasing Preferred Pharmacy Usage (1 of 3)

August 22, 2011 by George Van Antwerp 0 Comments

For my purposes, I’m going to define a preferred pharmacy as one of the following:

This is the first of three posts on new ideas for increasing usage:
  1. Driving preferred pharmacy usage from the employer site
  2. Using social media
  3. Borrowing from other industries
For today’s post, I’m going to focus on how a PBM (or retailer) could work with an employer to drive use of a preferred pharmacy.  There are the obvious ways:
  1. Plan design
  2. Incentives
  3. Interventions (letters, calls)
  4. Reminders on the intranet
But, let’s look at a little history of what’s been tried first outside the obvious:
  1. On-site collection boxes
  2. Kiosks
  3. On-site pharmacy
It’s my understanding that Medco used to (or maybe still does) have “drop boxes” at their large employer sites in the HR department for people to drop off prescriptions for mail order.  The employee would drop them off and then they would be FedEx’d to Medco each night.  It’s a nice convenience feature and if promoted probably serves as a good constant reminder.
Another attempt was made by Duane Reade in NY to put kiosks at employer sites and hospitals to capture new prescriptions and allow them to be couriered over to the consumer from their central fill.  It was a good idea, but it didn’t scale well and had limited upside outside NY.
I spent about a year looking at how to blend the Duane Reade model with Redbox to allow for kiosks that could leverage telemedicine and dispense the top 100 SKUs.  A few models of that concept have continued to grow (although slowly).  Instymeds now has 200 deployments (after almost a decade).  I’ve heard about a few others continuing to try also.
You then began to see a spike in on-site clinics where you could see a physician or another medical professional and get a prescription filled.  Again, this works like some of these others in high density areas where there is a population using lots of chronic medications and with the same PBM/insurer.
Now, with technology, is there an easier way?
Why not have a QR Code posted in your HR department or in the physician’s office or on the back of your ID card or some other place.  When the patient gets their new Rx, they can scan in the code and it can do any of the following:
  • Show them a message about considering mail order
  • Trigger an SMS asking someone to call them
  • Send an e-mail requesting a call back about the closest preferred pharmacy
  • Send them a map of the closest in-network pharmacy
  • Link them to a YouTube video on getting started with mail order
  • Or, in the Worker’s Compensation area, it could create a virtual card for the network
We all know that mobile apps in the pharmacy space are “all the rage” although adoption is surely in the 5-10% range (best case).  So, will this make a difference?  Perhaps not today, but it’s a low-cost way of learning about how consumers (especially those working in large, high-tech environments) might engage.  Right now, most companies are in a learning mode.
Books / Articles, Healthcare, Innovation, Marketing / Communications, Methodology, PBM / Pharmacy, Technology

Engaging The Un-Engaged

August 17, 2011 by George Van Antwerp 0 Comments

 

One of the hot topics in a lot of healthcare conversations these days is engagement.  There’s the “easy” engagement for the e-patients that are actively involved in their healthcare.  Then there’s the much harder engagement of those that aren’t engaged.  And, finally, there’s the issue of chronic engagement.  I can easily get someone to engage a few times with an incentive or some other “trick”, but how do I get them to stay engaged over time.  It’s not easy.

This is one of the topics that will be discussed at the upcoming Forum 11 in San Francisco.  If you’re coming, look me up.  I’m presenting on Friday.

Events, Healthcare, Innovation, Leadership, Managed Care, Marketing / Communications, Methodology, PBM / Pharmacy, Press, Research, Silverlink, Value Propositions

How To Use A Robot For Patient Support

August 15, 2011 by George Van Antwerp 0 Comments

While it’s unlikely that we’re going to get much empathy from robots in the near future, VGo Communications is definitely making the idea of tele-presence more believable.  What intrigued me when I first saw this was the ability for remote caregivers to participate in events.  For example, I could imagine my parents going to a physician’s visit in Detroit.  If I was able to log-in and join them using a VGo robot, it would be great.  It’s unlikely I would fly from St. Louis to Detroit to join them.

Now, cost would be an issue here, but I’m guessing someone can come up with a model that allows providers or hospitals to buy multiple robots and allow a remote, web-based log-in process.  (After some training by the user on controlling the robot.)

If we look at studies like the one presented by Kaiser years ago (see below), we know that there’s a huge gap between what the physician says and should say.  For example, this shows that only 34% of the time did the physician tell the patient the duration of therapy.  This play into what I’ve talked about before which is the gap between what the physician says and the patient hears and the questions that come up after the fact versus what questions come to mind during the office encounter.  Could a tele-presence by a third-party help that?  It’s an interesting concept.

Healthcare, Innovation, Marketing / Communications, Research, Technology
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