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.

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.

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)

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

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.

Here’s the description of my presentation:

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.

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.

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?

“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.”