New CMO – Dr. Jan Berger June 23, 2009
Posted by George Van Antwerp in Healthcare, Leadership, PBM / Pharmacy, Silverlink.add a comment
I’ve had the chance to read Dr. Berger’s research over the years when she was at CVS Caremark. After having a chance to spend some time with her on a few topics, I am very excited that she is coming on board at Silverlink Communications as our Chief Medical Officer.
From the press release:
DR. JAN BERGER JOINS SILVERLINK AS CHIEF MEDICAL OFFICER
June 23, 2009
Burlington, MA – Silverlink Communications® Inc., the leader in healthcare consumer communications, today announced that Dr. Jan Berger, former Senior Vice President and Chief Clinical Officer for CVS Caremark, joins Silverlink as Chief Medical Officer. In her role, Dr. Berger will focus on setting the company’s overall vision and strategy for population health and clinical communications programs within the managed care, population health, and pharmacy benefit management space.
Dr. Berger brings more than 25 years of business and clinical expertise in healthcare, including more than 15 years as a medical director at both a health plan and a major regional hospital. She is actively involved in quality initiatives, participating in numerous committees for National Committee for Quality Assurance (NCQA); medication safety, participating in steering committees at National Quality Forum (NQF); and population health management through her Executive Board position at DMAA. She also serves on several influential editorial and healthcare company boards, including Editor in Chief of American Journal of Pharmacy Benefit. Her expertise expands Silverlink’s focus in population health and clinical outreach – specifically related to engaging and connecting with healthcare consumers in a variety of lifestyle management, disease management and preventive health activities.
“Jan is clearly one of the leading innovators in healthcare, with tremendous clinical acumen and an ongoing track record of business execution in programs that drive down healthcare costs and improve health outcomes,” said Stan Nowak, Silverlink’s co-founder and CEO. “We are extremely proud to have her join our executive team at a time when behavior change is critical to our national healthcare reform process.”
“Silverlink is at the forefront of using communications and analytics as strategic assets to help consumers make more effective healthcare decisions,” said Dr. Jan Berger. “With the consumer at the center of our healthcare cost equation, we have the opportunity to improve the health of our country and eliminate hundreds of billions of dollars that relate to preventable conditions. This is a complex but solvable problem and I’m passionate to be part of a team that is already making an impact.”
Gov’t Reduce HC Costs: Rx Decisions Say No June 23, 2009
Posted by George Van Antwerp in Blogroll, Healthcare, Leadership, PBM / Pharmacy, Politics, Value Propositions.add a comment
I have nothing against the pharmaceutical companies. We need medications. Development of medications costs money. There are lots of failures to find one that works. They deserve to make money.
That being said…they are smart and apparently the administration is inappropriately (IMHO) paying attention to what they suggest is right.
- For Medicare PDP, the plans can no longer require the member to pay more when they choose a brand drug which is available as a generic. WHY NOT? It’s the same drug. There may be a few exceptions called Narrow Therapeutic Index (NTI) drugs, but just make them exceptions. This was a bad decision which will cost us taxpayers money. (See prior posts – Potentially Ridiculous Decision and Uproar Over “Reference-Based”…)
- Now, they jump on the savings that are offered for members who hit the “donut hole” and stay on the brand medication. Why not just require MDs to give out samples? Of course this will effect behavior and drive brand utilization. Pharma is not stupid. This is another decision which will cost us taxpayers money.
On the one decision where they go against pharma – drug reimportation, they make a bad decision. Why import drugs? Why not implement a therapeutic MAC (maximum allowable cost)? This will definitely impact drug costs AND generic drugs (which make up almost 70% of the claims filled) are cheaper in the US.
This is the government that we want to manage the costs of our healthcare system when they can’t even make the logical decisions that anyone close the business could make. Come on!
[IMHO = In My Humble Opinion]
Introverts versus Extraverts June 2, 2009
Posted by George Van Antwerp in Books / Articles, Leadership.1 comment so far
I thought this was a nice summary in the American Way magazine (5/1/09). It also talks about Jennifer Kahnweiler’s book “The Introverted Leader: Building on Your Quiet Strength“.
I think understanding this about your team and peers is critical. It’s also important just to understand that recepients of your messaging may analyze the information very differently. From a quick scan on Google, I found that 25% of the overall population is considered introverted.
CVS Caremark TrendsRx Report 2009 May 5, 2009
Posted by George Van Antwerp in Books / Articles, Consumerism, Healthcare, Innovation, Leadership, Marketing / Communications, PBM / Pharmacy, Research, Silverlink, Technology, Value Propositions.1 comment so far
This is one of my favorite times of year. After working on the Drug Trend Report at Express Scripts for several years, I love to get all the trend reports from the PBMs and read them. The first one that I have had a chance to review is the one from CVS Caremark. I found it an easy to read document with good case studies and a mix of strategy and tactics.
Here are some of my highlights and observations:
- 3 out of 4 clients cited “reducing health care costs” as their primary measure of PBM success…AND 2 out of 3 prioritized “plan participant behavior change” as the way to reach that goal. [Maybe the plan design bigot is finally dead.]
- With pharmacy spend approaching $1,000 PMPY, I found their chart on potential cost reduction a simple way of pointing people to things they should think about.
- A 10% improvement in diabetes adherence can save $2,000 in annual health care costs. [I assume this is based on improving MPR and would definitely like to learn more on how the health care costs are quantified.]
- They layout three objectives – improve use of lower cost drugs, improve adherence, and get people to take better care of their health. [Similar to the concept I laid out in my white paper of needing to be broader than just Rx benefit management.]
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They talk about two of their solutions:
- Consumer Engagement Engine (CEE) which is very similar to what Silverlink does and provides business logic for targeting the right member at the right time with the right message.
- Proactive Pharmacy Care is their “medical neighborhood” concept to stitch together their entities – Mail Order, CVS retail, Specialty, MinuteClinic, and their disease management company.
- Consumer Engagement Engine (CEE) which is very similar to what Silverlink does and provides business logic for targeting the right member at the right time with the right message.
- Their trend was 3.9% PMPM in 2008 (or 2.8% excluding specialty drugs).
- Medicare Part D utilization was up 4.1% compared to 0.8% for the rest of their BOB (book of business).
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Their GDR (generic dispensing rate) averaged 65.1% for 2008 and was 66.3% in December 2008.
- Best in class employers = 68.2%
- Best in class health plans = 73.4%
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As they remind you, a 1% increase in GDR is roughly equal to a 1% reduction in pharmacy spend.
- [What I would like to see is improvements in GDR from new drugs coming to market in 2008 versus improvements that came from clients implementing plan design.]
- They say [which I preach all the time} – "proactive consumer engagement improves results and lowers the risk of disruption. For best results, provide personalized actionable information at a range of touchpoints."
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I saw a few interesting things in one of the case studies they share about their "Generous Generics" program. [Does that name get used with consumers? What's their reaction to it?]
- $0 generic copay at mail [that should drive volume]
- 10% coinsurance penalty for not shifting to mail after the second fill [similar in concept (I believe) to the Medco "retail buy-up" concept]
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Top Ten Therapeutic categories (53% of spend):
- Antihyperlipidemics
- Ulcer drugs
- Antidiabetics
- Antidepressants
- Antiasthmatics
- Antihypertensives
- Analgesics, Anti-inflamatory
- Anticonvulsants
- Analgesics, Opioid
- Endocrine and Metabolic Agents
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They state that the population of diagnosed diabetics is growing by roughly 1M a year.
- Executive Summary, Economic Costs of Diabetes in US in 2007, American Diabetes Association, March 2008
- Executive Summary, Economic Costs of Diabetes in US in 2007, American Diabetes Association, March 2008
- They state that a generic for Lipitor is now expected in Q4 2011 [which I think is about a year later than originally expected]
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They show some data from their Maintenance Choice program which I think has a lot of opportunity.
- This is where you can get a 90-day Rx from either mail or a CVS store for the same copay. [The key here is for them to understand member profitability and for CVS Caremark to understand how to drive consumers to the preferred channel.]
- [I would really need to understand their profitability by channel because if I read the chart in here right, it would appear that given the choice 45% of those at mail would choose 90-day at retail…a scary concept for mail order pharmacy.]
- They give a case on Maintenance Choice which leaves me looking for a key fact. They state that a recent implementation has a goal of 70% of the client’s day’s supply will go through the preferred network (CVS) or mail and that 20% of it goes through mail today. [What percentage goes through CVS today? If it's a client in Boston, that one scenario. If it's a client in Chicago, that would be another feat.]
- Specialty pharmacy trend was 13.5%.
- They say that pharmacogenomic testing is being used more frequently for specialty drugs. [I would love to know more…how often? For what drugs? Has it improved outcomes? Are their clients covering it? How are they playing in this space?]
- They talk about adherence which continues to be one of the hottest areas in the Rx arena today. They give stats showing 15-48% improvement across different metrics and up to $142 in cost avoidance in one case. [Are these again control groups? What was the cost / benefit analysis or ROI? Is this improvement in average MPR (Medication Possession Ratio) or improvement in the % of people with an MPR of >80%?]
- They talk about 88% of heart failure patients maintaining optimal prescription adherence compared to a norm of less than 50%. [My questions here (which isn't apparent) is whether this was an opt-in program so the 88% is for engaged and active participants or whether it was across all targeted members.]
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They provide a quick list of factors that will impact drug trend:
-
Driving costs:
- Aging
- Obesity
- Diabetes
- Specialty pipeline
- More aggressive treatment guidelines and earlier diagnosis [which hopefully would lower total healthcare costs]
- DTC advertising
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Reducing costs:
- Economy – reduced utilization and improved GDR
- Increased availability of generics
- FDA safety reform
- Lackluster non-specialty drug pipeline
- Utilization and formulary management
- Consumer price transparency
-
Express Scripts Outcomes Conference Begins April 21, 2009
Posted by George Van Antwerp in Blogroll, Books / Articles, Consumerism, Events, Healthcare, Innovation, Leadership, Marketing / Communications, PBM / Pharmacy, Research, Value Propositions.add a comment
As with each annual Outcomes conference, Express Scripts (ESRX) has released their annual trend numbers. Here are a few of the highlights from the press release:
- Overall pharmacy trend = 3.0% (down from 5.5% in 2007)
- Estimate consumers and employers are paying $42B too much in 13 therapy classes by not optimizing generics.
- On average, a generic drug is over $90 cheaper than a brand name drug.
- Generic drug usage increased by 7.5 percent, while utilization of brand name medications decreased 11 percent.
- 67.3 percent of all prescriptions that Express Scripts filled were for generic drugs by the end of 2008. [I didn't like the comparison which was an average across the 12 months ending in Sept 2008 from IMS of 63.7%...not apples to apples.]
- In 2009, at least 20 branded drugs are expected to become available generically.
- Over the next five years, more than $66 billion worth of branded drugs are expected to lose patent exclusivity.
“Using generic drugs that are safe and effective can help lower costs while still driving value for patients and employers,” said Steven Miller, MD, senior vice president and chief medical officer at Express Scripts. “Our results indicate that cost control is achievable through careful management of appropriate use of drugs and delivery channels, without shifting costs to consumers. Although the trend is the lowest it has been in over a decade, significant opportunity to lower spending still exists.”
“Finding ways to reduce spending without compromising health outcomes is the top priority for healthcare reform, as the Obama administration recognizes,” said Alan Garber, MD, PhD, Henry J. Kaiser Professor and director of the Center for Health Policy at Stanford University. “We have long used financial incentives to try to eliminate waste. Now we’re finding that tools that build upon the insights of behavioral economics and psychology can have powerful, positive effects.”
“In today’s economy, we are not only tracking wasteful spending across the country but developing strategies to reduce it,” said George Paz, chief executive officer at Express Scripts. “By applying the principles of behavioral economics we are helping consumers make better and more cost-effective healthcare decisions. We understand we cannot eliminate waste alone and we are committed to working alongside likeminded organizations, such as the Federal Coordinating Council for Comparative Effectiveness Research, to continue to identify strategies to improve our healthcare system.”
“Studies have repeatedly shown that people work much harder to avoid losses than to pursue gains,” said Bob Nease, PhD, the company’s chief scientist. “This suggests that a ’stop wasting money’ message is more effective than a message focused on potential savings. In addition, by applying evidence-based segmentation, we have practical insight into which members are likely to be most sensitive to loss aversion. One size does not fit all.”
The $40B HealthCare Opportunity Around Retention April 18, 2009
Posted by George Van Antwerp in Books / Articles, Consumerism, Healthcare, Leadership, Managed Care, Marketing / Communications, Research, Value Propositions.1 comment so far
It’s obvious to anyone close to it, but harder to align the goals to take advantage of it. With people “aging-out” from group plans to Medicare and people leaving their employer coverage to go to the individual market, managed care has a huge opportunity to retain that business by providing them a transition path. According to McKinsey (and from what we see), that’s generally not happening.
A few facts from their report:
- 68 percent of all members aged 60 to 64 have never been approached by their current insurers to discuss retirement options.
- more than 80 percent of respondents aged 60 to 64 said they would consider purchasing an individual product from their current carrier if they left their jobs or retired.
- Only 33 percent of 60- to 64-year-olds thought that their insurers offered Medicare products, for example, when in fact almost all major carriers do.
It’s also a simple economic problem. They are less expensive to retain and convert while their a member than once they are on the open market. You may even save on broker fees. Developing a data driven approach to create timely and personalized communications along with a service to transition them should be a priority.
Upcoming Book By George Halvorson From Kaiser April 16, 2009
Posted by George Van Antwerp in Events, Healthcare, Innovation, Leadership, Managed Care, Research, Value Propositions.2 comments
I had the privledge of previewing George Halvorson’s new book “Health Care Will Not Reform Itself” this week. My book cover quote would go something like this:
“Opinions supported by facts all wrapped up in a narrative. It’s like a fireside chat with one of the greatest leaders in healthcare.”
I won’t pull things from the book yet, but I found it a logical follow-up to his other book “Health Care Reform Now! A Prescription For Change“. He talks about the need for bold goals and a clear set of metrics to drive change. He talks about why healthcare costs go up and the fact that we need universal coverage. And, he also hits on what seems to be the key theme of the day – reducing costs while improving outcomes.
While I was at the WHCC09, I got to sit down with George Halvorson and talk about healthcare for an hour. It was a great privledge that I enjoyed a lot, and I could have talked for hours. We hit on a bunch of topics so let me share some of them.
- We talked about him writing books. I was commenting on how much I like his writing style and was intrigued to learn that he said some professors don’t like using his books because they’re “too easy to read”.
- We had a fascinating discussion around leadership and diversity and how he has created a very diverse leadership team at Kaiser. I was also impressed to hear that one member of team does an international fellowship each year where they spend time abroad learning about how healthcare is delivered and managed in other countries. [very progressive]
- We talked about how healthcare was going to change. He spent a lot of time on the need to create aggressive goals especially around the 10-20% of things that drive 80% of the costs. For example, he asked why we don’t try to reduce asthma attacks or congestive heart failure by 90%. And, he pointed out the fact that we don’t have a common set of goals that allows enterprises to reverse engineer the process and identify points of variance. Without that process analysis and a specific goal, it is hard to drive improvements.
“We need to change our expectations of what is possible.”
- We talked a little bit about where innovation will come from. He talked about how Deming, a statistician, revolutionized manufacturing as a lead into the point that innovation will likely come from outside the industry. [I think this is interesting as I have seen more and more executives at healthcare companies that are coming from outside of healthcare. I also think things like the X-Prize may attract others to try their ideas.]
- He gave some great examples of how Kaiser has deployed their 30 black belts. The one I quickly jotted down had to do with how nurses change shifts. This shift change is where all the information was exchanged about different patients and when accidents sometimes happened. By changing the process, they dropped the accident rate and reduced the communication time from 40 minutes per shift to 12 minutes per shift.
- We also talked about HIT (Healthcare Information Technology) and the need not only to drive utilization but to mandate system integration. This tied in with an earlier conversation where we spoke about coordinated care versus uncoordinated care and the need to create a “virtual Kaiser”. I think there is a lot to learn from the Kaiser model and some of the things they are doing with technology to drive care. [I was pleasantly surprised that he believes physicians will embrace technology as a tool to help them standardize care. I think that is critical path to successfully reducing costs while improving outcomes.]
- I couldn’t jot down all the statistics fast enough, but he talked about how they were testing different “panel systems” in different geographies to see what the best process and technology solution would be. They had had some great results. [One fact he shared that jumped out at me was that 25% of people over 65 that break a bone die within a year.]
- The last thing we talked about was probably the most insightful to me. Given the amount of money spent in the last months of people’s lives, I was interested in his global perspective on whether that was a cultural issue. He said that he thinks it is mostly that the care system in the US lacks honesty or the ability to be brutally honest. We talked about one scenario where people who do nothing live an average of 140 days and those that get invasive surgery live an average of 100 days…but they are hoping to be that 1 in a 1,000 that live an extra year. [Is it worth all that pain, surgery, and medicine for the last few months?] We also talked about the new $100,000 breast surgery drug which extends the patient’s life on average for 1 month. [Again, is that an appropriate use of money? Would we spend it if it came out of our pockets?]
When the book comes out, I will try to pull out some of the key points, but I would recommend you pick it up and read it for yourself. I think you will really enjoy it.
$2.3T on Healthcare and 47M Uninsured – National Disgrace March 21, 2009
Posted by George Van Antwerp in Books / Articles, Healthcare, Leadership, Managed Care, Marketing / Communications, Politics, Research, Value Propositions.add a comment
Kaiser Permanente recently launched a series of advertisements that drive this message around health disparities home. It is (or should be) a concern for most of us. Health outcomes and especially preventative care is driven by health literacy, our attitudes towards health, and our access to the healthcare system. We should all be working with our families, our communities, and our country to try to make this better.
I am a firm believer that one of the best ways to start to manage cost is to find a viable strategy to get universal coverage. The costs of emergency care and absenteeism all get passed on to us in one way or another. And, as the government is the dominant payor of healthcare (Medicare, Medicaid), long term costs are a significant issue for our economy. If there is a systemic way of improving it, we should seek that out.
So, a cause that is both moral and economical…what more do you need?
Today, more than 50 percent of Americans and 75 percent of Californians without health care coverage are people of color. Uninsured men, women, and children are far more likely to get sick and forego care simply because they lack coverage. This is a national disgrace. We spend 2.3 trillion dollars on care in this country. Securing health care coverage for every American is the next great civil rights issue of our time. We can and should achieve universal coverage.
Some of the facts highlighted on their new website about disparities include:
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Disparities in health and health care impact everyone. African Americans, American Indians, Alaska Natives, Asians, Pacific Islanders, and Hispanics are most affected.
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27% of adults report having no usual source of care. African-American (28%), Hispanic (51%), and Asian (23%) adults are all more likely to report not having a usual doctor.
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Uninsured adults are disproportionately, young, and minorities; 82% are between 19-49 years of age, and 41% identified themselves as black, Hispanic, or other.
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American Indian and Alaskan Native death rates from sudden infant death syndrome are the highest of any population groups.
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Asian Americans have the highest tuberculosis case rates of any racial and ethnic population.
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During 1996-2000, Native Hawaiians were 2.5 times more likely to be diagnosed with diabetes than non-Hispanic white residents of Hawaii of similar age.
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In 2005, African Americans accounted for 18,121 (49%) of the estimated 37,331 new HIV/AIDS diagnoses in a national poll which encompassed 33 states.
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21.9% of U.S. children live in poverty, far and away the worst in the industrialized world. Comparable figures for the Nordic countries are 4.2% and less.
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Adults who have not finished high school are almost two times more likely than college graduates to be obese.
To learn more about the topic, you can go to their community of information.
Buyology: Best Book of 2009 February 25, 2009
Posted by George Van Antwerp in Books / Articles, Business Tools, Consumerism, Innovation, Leadership, Marketing / Communications, Research.1 comment so far
I am finally getting around to writing this up. I mentioned the book – Buyology – a few weeks ago. It is definitely the best book I have read this year. It is by Martin Lindstrom and is all about neuromarketing.
For those of you that don’t think it’s relevant to healthcare, think again. Healthcare is all about compelling individuals to take action and become responsible for their health. That is about understanding how they interpret information and what drives them.
Here are some of my notes from the book:
- One of the processes used was fMRI (functional Magnetic Resonance Imaging) which measures the amount of oxygenated blood throughout the brain. Scientists can see what part of the brain is working at any given time.
- The other process used was SST (steady-state typography) which tracks rapid brain waves in real time.
- One of his first studies looked at the effect of cigarette warning labels and found that they not only failed to deter smoking but activated the nucleas accumbens.
- What people say on surveys and in focus groups does not reliably affect how they behave. [although it is often the best we have]
- Brand matters…He re-conducted the Pepsi Challenge and showed that if people knew what they were drinking they preferred Coke to Pepsi. When they didn’t know, 50% of people liked Coke. When they knew, 75% of people liked Coke.
- He showed that consumers have no memory of brands that don’t play an integral part in the storyline of a program. Just putting something in the movie, TV show, or video game isn’t enough to get you mindshare. AND, those successful placements also weaken our ability to remember other brands.
“Our irrational minds, flooded with cultural biases rooted in our tradition, upbringing, and a whole lot of other subconscious factors, assert a powerful but hidden influence over the choices we make.”
- In the Smiling Study that he references, they revealed that people are far more positive and have a better attitude toward the business when the person they are dealing with is smiling. [Maybe a key thing for avatars and real agents as they talk to people over the computer and/or phone.]
- Our mirror neutrons allow us to get pleasure just by observing or reading about people doing something that would give us pleasure – e.g., opening a present with a new Wii in it. [You can go to www.unbox.it.com or www.unboxing.com to enjoy this.]
- Logos are dead. They showed that images that are associated with smoking (for example) were far more potent in creating a reaction in the brain than the logo.
- “Secret Ingredients” matter…he shared several examples of how things sold differently when there were non-existent things listed on the label.
- When people viewed images associated with strong brands – iPod, Harley-Davidson, Ferrari – their brains registered the same activity as when they saw religious images.
- They studied and showed that odor can activate the same brain response as the sight of the product. He talked about an interesting study that showed that “feminine scents” such as vanilla were sprayed in women’s clothing sections, sales of female apparel actually doubled.
- Sex, extreme beauty, or a celebrity in an advertisement can hijack attention away from the information in the advertisement.
“I predict that soon, more and more companies (at least those who can afford it) will be trading in their pencils for SST caps. That traditional market research – questionnaires, surveys, focus groups, and so on – will gradually take on a smaller and smaller role, and neuromarketing will become the primary tool companies use to predict the success or failure of their products.”
Some interesting facts:
- 300 million people, including 60% of male doctors, in China smoke.
- 8 out of 10 new product launches fail within 3 months.
- In 2005, 156,000 new products debuted globally (or one product every 3 minutes).
- In 1965, a typical consumer could recall 34% of advertisements from TV. In 1990, that number dropped to 8%. In 2007, consumers could only remember 2.21 advertisements from all advertisements they had ever seen. [Talk about saturation.]
- We walk almost 10 faster than we do a decade ago. 3.5 mph
- A study in Denmark showed that people talked 20% faster than they did a decade ago.
- And, if you don’t believe that culture matters…In Asian cultures, four is an unlucky number and one researcher found that heart attacks among US residents of Chinese descent spiked as much as 13% on the fourth day of each month.
- Children that experience social difficulties in school are more likely to be preoccupied with collecting.
- Both J&J and Play-Doh have lost their original fragrances and haven’t been able to replicate it.
- When classical music was piped over loudspeakers in the London Underground, robberies, assaults, and vandalism dropped by over 25%.
Some of the interesting companies mentioned:
I thought he had a great story about a rock. If I gave it to you for your birthday, you’d be offended until I told it was from the Berlin Wall. And then when I told you it was from the moon, you would be even more impressed.
For more information, there is also a neuroscience blog.
Trickle Down Healthcare February 24, 2009
Posted by George Van Antwerp in General Thoughts, Healthcare, Leadership, exercise.add a comment
Many of us know the term “trickle-down economics” which is generally associated with Ronald Reagan. (Obviously not a concept bought into by the current administration.) I was thinking about this today from the concept of workplace culture around healthcare.
I have not seen any research to this point, but it would seem to make sense that companies where the senior executive team is focused on exercising – running, triathalons, tennis, etc. – would generally be healthier companies. As we have seen multiple times, peer pressure works. So, does it work from a top-down perspective also?
I know one healthcare company where they were refining what was served at the cafeteria and what was in the vending machines. Obviously, there are ways to control diet through what the company “encourages”. Do they have bowls of fruit or bowls of chocolate?
Personalized Medicine Webinar February 19, 2009
Posted by George Van Antwerp in Books / Articles, Consumerism, Events, Healthcare, Innovation, Leadership, Managed Care, PBM / Pharmacy, Research, Technology, Value Propositions.add a comment
I don’t have anything to do with this, but it sounds pretty interesting. Medco and Regence are talking. Here is the teaser. (Click here for more info and registration.)
Personalized medicine is moving rapidly. The FDA in December considered requests to require genetic testing for the colon cancer drugs Vectibix and Erbitux. Approval of such labeling changes could pave the way for a slew of other personalized therapies and diagnostics now waiting in the wings. Stakeholders anticipate significant clinical and financial savings. Recently approved genetic testing for the blood thinner warfarin, for instance, is projected to avoid 85,000 serious bleeding events annually and save roughly $1.1 billion a year!
On the other hand, questions remain whether the model actually provides a favorable return on investment (ROI). A new study finds that genetic testing for warfarin does not appear to be cost-effective in certain patients. And health plans and PBMs are trying to sort out which of the numerous diagnostic tests on the market actually provide clinical utility and improved results. One large health plan, for example, says its costs for diagnostic testing are growing at nearly 20% a year.
So where does all of this leave Rx payers in February 2009?
Ix for Rx Management February 19, 2009
Posted by George Van Antwerp in Consumerism, Healthcare, Leadership, Managed Care, Marketing / Communications, PBM / Pharmacy, Value Propositions, Weblogs.add a comment
Josh Seidman from the Center for Information Therapy today announced on their blog that the center is going to begin focusing on “Ix for Rx Management” that will look at adherence along with other critical issues. As I talk about all the time, finding the right way to deliver information to people in a way that they can accept it and act upon it is critical. Given that we use more and more medications, this is a critical area where the center’s leadership can help build awareness of the problems.
“Although awareness certainly is an important precursor, it may be the easiest step in the pathway that takes the average consumer along the road to information consumption, then knowledge accumulation, and ultimately leading to behavior change. We know there’s a large body of research that tells us that, in order to be successful, our Ix initiatives need to “meet people where they are.” More specifically, we need to target the information to the individual’s particular moment in care and tailor it to their particular needs and circumstances.”
Seeing Significant Improvements With BPO February 18, 2009
Posted by George Van Antwerp in Books / Articles, Healthcare, Innovation, Leadership, Managed Care, Marketing / Communications, Methodology, PBM / Pharmacy, Silverlink, Technology, Value Propositions.add a comment
Business Process Outsourcing (BPO) or as I will sometimes call it CPO (Communications Process Outsourcing) is something we are definitely seeing a growing demand for in the market. It blends technology, services, process management, consulting, and analytics.
Both IDC and Gartner have now talked about this in recent reports.
According to Janice Young, IDC program director, Payer IT Strategies, “we expect to see an increasing interest and likely investment in BPO in 2009 and 2010 for healthcare payers. Our recent results from our January 2009 healthcare payer survey of IT spending indicate that 45% of healthcare payers expect BPO investments to increase this year.” These trends are highlighted in IDC’s U.S. Healthcare Payer 2009 Top 10 Predictions (January 2009).
Gartner research vice president, Joanne Galimi, reported on BPO services within health plans in a recent report entitled Healthcare Insurer Business Process Outsourcing Trends (January 2009). “Although things look gloomy for the larger economy, the potential for BPO to address immediate business pressures and long-term recovery goals for the health plans will be unprecedented,” says Galimi.
When I first came to Silverlink as a consultant in early 2007, this was exactly my vision. I always talked about the “one throat to choke” model. When you are in an operations role, it is always so difficult to coordinate modes, vendors, discrete data sources, and ultimately to get a holistic view of the member (or patient). This is what I wanted to help build and is exactly what we have done.
Fortunately, we are now in a position where we can talk about how this service model has grown and how offering turnkey services for clients has driven results. I love to focus on outcomes so this is exciting. Here are a few from the press release we put out this morning:
- Over a 300% improvement in retail-to-mail conversions for a large pharmacy benefit manager (PBM),
- 54% increase in participation for a pharmacy program, representing between $150 and $175 per year per prescription in consumer savings,
- 400% improvement in yield in a COB program, translating to over $20 million in cost savings to a major U.S. health plan, and
- Up to an 82% increase in transfer rates for population health engagement for disease management, lifestyle management and treatment decision support programs.
7 e-Patient Conclusions January 29, 2009
Posted by George Van Antwerp in Books / Articles, Consumerism, Healthcare, Innovation, Leadership, Marketing / Communications, Research, Technology, Value Propositions, Weblogs.2 comments
Thanks to e-patient Dave’s reminder on the e-Patient blog…
Here are 7 conclusions from the white paper that came out last year on this topic. Very important in diffusing some of the myths around the role of social networking in healthcare and the use of the Internet for information.
1. e-patients have become valuable contributors, and providers should recognize them as such.
“When clinicians acknowledge and support their patients’ role in self-management … they exhibit fewer symptoms, demonstrate better outcomes, and require less professional care.”2. The art of empowering patients is trickier than we thought.
“We now know that empowering patients requires a change in their level of engagement, and in the absence of such changes, clinician-provided [information] has few, if any, positive effects.”3. We have underestimated patients’ ability to provide useful online resources.
Fabulous story of the “best of the best” web sites for mental health, as determined by a doctor in that field, without knowing who runs them. Of the sixteen sites, it turned out that 10 were produced by patients, 5 by professionals, and 1 by a bunch of artists and researchers at Xerox PARC!4. We have overestimated the hazards of imperfect online health information.
This one’s an eye-opener: in four years of looking for “death by googling,” even with a fifty-euro bounty for each reported death(!), researchers found only one possible case.* “[But] the Institute of Medicine estimates the number of hospital deaths due to medical errors at 44,000 to 98,000 annually” … [and other researchers suggest more than twice as many]
* We can only conclude, tentatively, that adopting the traditional passive patient role … may be considerably more dangerous than attempting to learn about one’s medical condition on the Internet.” (emphasis added)5. Whenever possible, healthcare should take place on the patient’s turf. (Don’t create a new platform they have to visit – take yourself wherever they’re already meeting online.)
6. Clinicians can no longer go it alone.
* Another eye-popper: “Over the past century, medical information has increased exponentially … but the capacity of the human brain has not. As Donald Lindberge, director of the National Library of Medicine, explains ‘If I read and memorized two medical journal articles every night, by the end of a year I’d be 400 years behind.”
* In contrast, when you or I have a desperate medical condition, we have all the time in the world to go deep and do every bit of research we can get our hands on. Think about that. What you expect of your doctor may shift – same for your interest in “participatory medicine.”7. The most effective way to improve healthcare is to make it more collaborative.
“We cannot simply replace the old physician-centered model with a new patient-centered model… We must develop a new collaborative model that draws on the strengths of both systems. In the chapters that follow, we offer more suggestions on how we might accomplish this.”
Walgreen’s President On Recession Impact January 8, 2009
Posted by George Van Antwerp in Books / Articles, Healthcare, Leadership, PBM / Pharmacy.add a comment
In case you didn’t see it, Gregory Wasson (President and COO) from Walgreens did an interview with The New York Times on how the economy is impacting them and answered a few other questions about their strategy.
Q. How is the slowdown affecting purchases of prescription drugs and health and beauty aids?
A. We certainly are seeing a slowdown in prescription drugs. In this economy, patients are not seeing their doctors as frequently. There may be some cases they are skipping doses of medications to control costs. As far as over-the-counter items, we see consumers definitely looking for value. We’re also seeing a big increase in private label product. The consumer is willing to buy down.
To read the rest of the interview…click here.
100 Smart Choices – Optum Health December 31, 2008
Posted by George Van Antwerp in Books / Articles, Consumerism, Healthcare, Leadership, Marketing / Communications, Research.add a comment
Optum Health, a part of United Healthcare, has released a book called 100 Smart Choices. It lays out tips, advice, and tools to help you take control of your health. Since 87.5% of health care costs are due to individual choices, this is a big deal.
We don’t need to create the most medicated generation, we need to find a way to eat better, exercise more, have less stress, and act preventatively.
“Individuals can feel healthier and happier, avoid unnecessary trips to the emergency room or a doctor’s office, and cut their health care expenses by tapping the information in this book,” said Dr. Michael Rosen, national medical director for OptumHealth Care Solutions and consultant on the book. “As we developed the book, we made sure that all of the content was consistent with evidence-based guidelines and assisted members in making informed health care decisions.”
Need A Brady Bunch Show About Health Plans December 26, 2008
Posted by George Van Antwerp in General Thoughts, Healthcare, Leadership, Managed Care, Marketing / Communications.add a comment
This is a thought that I have had multiple times. Think about what The Brady Bunch did for architecture. Subconsciously or consciously, I believe it created a positive impression about architecture in the minds of millions of people growing up. I don’t think this was something that architectural associations thought up, but it would have been a good idea.
So, why doesn’t AHIP, the organization that represents the health insurance plans, come up with a way to fund or collaborate with hollywood to create a web story, a sitcom, or a movie in which the hero is an executive at a health plan. By day they are running the company and by night they are moonlighting at a free clinic helping improve health.
Maybe I am crazy, but I really believe this positive imagery would help the industry. In it’s place, the only thing we have are negative images from the movie Sicko or from stories about people being denied care or from our first hand experience with our benefit costs going up. This may not matter as the health industry changes, but I think it will be a long-time before we every really move to a single-payor system or something that radically eliminates the current structure.
Viral Marketing in Health: Humana Steps Up December 24, 2008
Posted by George Van Antwerp in Consumerism, Healthcare, Innovation, Leadership, Managed Care, Marketing / Communications, Software, Technology, Weblogs.1 comment so far
I talked about Humana’s innovation group a few days ago. They have done it again with two new games. One is on HumanaGames.com and the other is a Facebook application.
The Freewheelin Cycle Challenge is an online bicycle-racing videogame that matches you and a quirky virtual opponent. To make it to the finish line first, players energize their bicyclist and pick up speed by capturing nutritious snacks, such as nuts and oranges. They lose energy, however, by rolling over holiday junk food, including candy canes, cookies and other sugary snacks.
“The Battle of the Bulge” is an application that will be available at Facebook.com beginning Dec. 24. To participate, users go to “The Battle of the Bulge” Facebook page and answer a few questions about their lifestyle, including exercise and eating habits. Based on the responses, users are assigned a virtual waistline, affectionately called a “bellytar.” The goal of the game is to maintain an ideal weight.
But it won’t be easy. Other “friends of flab” can “fling fat” your way, making your bellytar’s pants literally bulge at the seams. In a worst-case scenario, you could be headed toward an online heart attack. To shape up, simply answer questions about exercise correctly and watch your bellytar shrink before your very eyes. Then answer questions about nutrition correctly to fling some fat of your own.
I find these to both be great examples of viral marketing which Seth Godin does a good job of explaining on his blog. Obviously, there is a long-term objective here which is driving healthy behaviors and positioning Humana as a leading edge company. They also hope to learn about human behavior and understand how tools like these can affect healthcare.
And We Have Two Winners?? December 19, 2008
Posted by George Van Antwerp in Healthcare, Leadership, Marketing / Communications, PBM / Pharmacy, Research.1 comment so far
In looking at recent investor decks from both Medco and Express Scripts, I was surprised to find almost identical charts each claiming victory on drug trend management. Here are the two charts…you can judge for yourself.
(Express Script’s from Credit Suisse Healthcare Conference 11/13/08)
(Medco’s from 2008 Analyst Day 11/21/08)
Humana is “Crumpling It Up” December 12, 2008
Posted by George Van Antwerp in Consumerism, Healthcare, Innovation, Leadership, Managed Care, Technology, Weblogs.2 comments
I have given it away in the title, but would you have looked at the webpage below and imagined this was from Humana.
You can go to their website CrumpleItUp to learn a little more about what they are doing with bikes called freewheelin and what they are doing around games and health.
They have a fascinating group there in Louisville that works on innovative ideas. A lot of them don’t drive the core business of health insurance but they are related to improving the health of the general public or looking at interesting ways to use technology.
They have recently added a blog about this that you can see here. Additionally, I had a chance to meet with Grant Harrison from this group at the WHCC and also hear him speak as part of a panel on innovation. I was very impressed with him and a few of the other people in the group.
As John talked about over at Chilmark Research, it is refreshing to see someone focusing on this type of innovation. When I talked about innovation with a reporter recently, I suggested that Humana would be one of the first groups that they should interview.
5 Myths of Health Care December 8, 2008
Posted by George Van Antwerp in Healthcare, Leadership, Managed Care, Weblogs.add a comment
Charlie Baker, the CEO of Harvard Pilgrim, has a post on his blog about the Five Myths of Healthcare. It’s worth a read as is his blog.
1) America has the best healthcare in the world.
2) Somebody else is paying for your health insurance.
3) We would save a lot if we could cut the administrative waste of private insurance.
4) Health care reform is going to cost a bundle.
5) Americans aren’t ready for an overhaul of the health care system.
Want Senator Daschle To Come To Your HC Party December 6, 2008
Posted by George Van Antwerp in Consumerism, Healthcare, Innovation, Leadership, Politics.add a comment
Obama’s team is leveraging the power of the people to solicit input. You can go to their site www.change.gov to provide input.
He is specifically asking for groups to meet on healthcare and document their thoughts. Senator Daschle will attend at least one of these events personally.
It worked to get him elected so it will be interesting to see what they get and how they leverage this.
Who’s Responsible For Healthcare Costs? November 26, 2008
Posted by George Van Antwerp in Consumerism, Events, Healthcare, Leadership, Managed Care, Value Propositions.1 comment so far
I was recently at the AHIP Business Forum Chicago and was in a session where Amy Holmes, CNN Political Analyst and Peter Beinart, Editor-at-Large of The New Republic held a discussion on Decision 2008 and What it Means for the Future of Health Care. They are two of the sharpest people I have seen speak in a while and they hosted a very engaging discussion on the issues and what the Obama win means for healthcare from both sides of the political spectrum. (They also had a very entertaining “He Said, She Said” style that captivated the audience.)
The big changes they felt were bound to happen were cuts in Medicare and an expansion of the SCHIP program, and there were others that they said would be debated including being able to sell insurance across state lines, the government offering coverage, individual coverage mandates and coverage for pre-existing conditions. But the biggest part of the discussion was around healthcare costs. Costs that are out of control, who pays for services, and where will the money come from. While at an aggregate level talking about healthcare’s spiraling costs is simple, it is not the heart of the issue.
Isn’t the issue about how as an industry we get individuals to change their behaviors?
The most powerful force for changing the economics of healthcare is the healthcare consumer. If the consumer changes behavior (even small changes) there are billion dollar impacts in cost. Our research shows that if a plan the size of Aetna is able to improve adherence by 1% they could save $238M! According to the Journal of Occupational and Environmental Medicine (JOEM), 70% of all healthcare expenses are lifestyle related. This is not a new number but it translates to $1.4 trillion in healthcare costs that could be controlled simply by modifying healthcare behaviors.
So if our lifestyles are “killing us” and destroying a system meant to improve our quality/length of life, why are we not talking about that at the national level as THE core issue? How can we as industry professionals develop solutions that support consumers and facilitate the changes they need to make?
I was excited to see in the third Presidential debate that both candidates addressed responsibility being in the hands of the individual. Next steps: Let’s see some discussion on programs and policies that truly look to impact healthcare consumer behaviors.
(This is a guest post from Chuck Eberl, VP of Marketing, at Silverlink Communications.)
Example of Misalignment April 4, 2008
Posted by George Van Antwerp in Books / Articles, Healthcare, Leadership, Managed Care, PBM / Pharmacy.add a comment
One of the points in George Halvorson’s book Health Care Reform Now! is about misalignment of incentives. Providers are not paid for better outcomes. They are paid per activity (i.e., to keep people coming back). It’s a key point which deserves a much longer discussion. That being said, I couldn’t help but think of this when reading yesterday’s WSJ article “Flu Economy Takes Unexpected Turn“. A few quotes that it mentions include:
- CEO of Walgreens at shareholder meeting – “If attendees of the meeting needed to cough, he joked, they should leave the room and ‘go to a movie theater or on a bus’ to spread their germs. ‘We’re really hoping for a very strong flu season’.”
- “Unfortunately, people have not been getting sick at a rate that we would all like yet.” P&G CEO
- “On the pediatric side, young kids coming into the hospital, that’s a nice margin for us, as well.” CFO of LifePoint Hospitals
Now, the easy discussion here would be to criticize these executives for being insensitive, but that’s not the problem. The problem is that we have incented our healthcare system so that people make money when people are sick. To my earlier post, this doesn’t mean people shouldn’t make money, but it means we should find a way to incent them to make people better. We have decades of benchmark data (somewhere).
Convergence: The White Space Between Ford and Starbucks April 2, 2008
Posted by George Van Antwerp in Books / Articles, Consumerism, Healthcare, Leadership, Managed Care, Marketing / Communications, Research, Technology, Value Propositions, Weblogs.1 comment so far
I recently read a great book called Microtrends. If you haven’t seen it, I highly recommend it for its interesting analysis of trends and the way it makes you think. For example, it talks about how people are drinking more water and more caffeine drinks. It talks about how people have much shorter attention spans yet there is a rise in knitting and books are getting longer. It talks about obesity and young vegans. It plays on the power to see small trends (i.e., 1% of the population) and how they can impact the overall framework. (You can read my detailed notes here.)
One of the frameworks that the authors use is to compare the world as moving from a Ford economy (one choice) to a Starbucks economy (personalization). As healthcare typically lags other industries, I think we this analogy works to show where healthcare was and where we are going over time. Historically (at least in the modern era), we had one choice for healthcare coverage which was offered through our employer. Over time, that has changed to where most people have more than one option for healthcare coverage from their employer. And now, more and more people are losing coverage and the fastest growing segment is individual health insurance.
We have evolved to personal healthcare, but we aren’t yet to personalized healthcare which I think will be largely driven by genomics and some radical change to our healthcare system. Unfortunately, I think we are stuck somewhere in between right now where to personalize your healthcare you need to go to a series of providers or tools which aren’t integrated. There are a few scenarios out there where there is some integration of medical, pharmacy, lab, and other data (Kaiser jumps to mind). But, even in an integrated environment, they haven’t yet fully digitized the offering and created a seamless patient experience (to the best of my knowledge).
As George Halvorson says in his latest book, Health Care Reform Now!, “We have an expensive plethora of uncoordinated, unlinked, economically segregated, operationally limited Microsystems, each performing in ways that too often create suboptimal performance both for the overall health care infrastructure and for individual patients.”
In a likely scenario, you have the following for a sick patient who is actively managing their health:
- A primary care physician and their staff to interact with
- A specialist and their staff to interact with
- A pharmacist (or likely multiple pharmacists)
- A specialty pharmacy and their nurse
- A managed care company (and possibly Medicare) which offers a member portal and tools
- A PBM which offers a member portal and tools
- A disease management company and their health coach
- Health portals or information sites (e.g., WebMD, RevolutionHealth)
- A gym and potentially a trainer
- A series of vitamins and OTCs that no one has visibility to (other than maybe their grocery frequent buyer card program)
- One or more disease specific communities that they participate in (i.e., some of the Health 2.0 companies)
- Blogs and news feeds they subscribe to for information on their disease
The reality is that they have to go out and build a series of interactions to create this semi-personalized offering with no hope of the data being integrated, getting consistent messages, or any true learnings being generated. Each party has a 1:1 relationship with them (best case) and knows a piece of the puzzle. Without an integrated infrastructure, aligned incentives, and a mechanism to engage each patient according to their preferences, we have a very difficult challenge (as an industry) and each patient bears the brunt of this.
Until we can create physical or virtual convergence (i.e., integration of data and tools into one framework), we won’t be able to move from buying coffee at one store and skim milk at another store and our muffin at another store to a Starbucks world where we have one interface to select and personalize our healthcare experience. I wish I had the answer. Unfortunately, as more and more people are talking about, it seems like we have to make a radical change to be successful. Evolution from the status quo will likely not work. Much like GE had a program in the dotcom days called DestroyYourBusiness.com where they encouraged their leadership to figure out how to develop a new model, that is what healthcare needs with the support to initiate the skunkworks organization which might eventually become the norm.
Facebook Application To Drive Blood Donations March 27, 2008
Posted by George Van Antwerp in Consumerism, Healthcare, Innovation, Leadership, Marketing / Communications, Technology, Value Propositions, Weblogs.1 comment so far
I must admit I am pretty conservative so it was with some reluctance that I finally joined Facebook. After the Health 2.0 conference formed a group out there, I decided to join earlier this week. First, my brother reached out to me. Then, a roommate of mine from college who I hadn’t talked to in almost 20 years contacted me.
Then, I became mildly interested. So, I spent a few hours early this morning playing around. But, I was most interested to find a post on Vijay’s Consumer Focused Healthcare blog about a non-profit using Facebook as a way to drive blood donations. Will it work? I don’t know, but it is a worthy cause and an interesting use of social technology.
When a patient is in need of blood that isn’t available, it becomes a life and death situation. Historically the Red Cross will make efforts to alert the public during a shortage. But there may be a better way – leverage the social networks to get the word out. If shortages of a certain type of blood occur in a certain zip code, having a database of willing donors in that zip code to contact may be the most efficient way to solve the problem quickly.
That’s where Takes All Types (TAT), a non-profit organization, comes in. Users install their just-released Facebook application, tell it their location and blood type, and say how often they are willing to be contacted to donate blood (maximum is every 57 days). If a shortage occurs, they’ll contact you via the methods that you authorize (Facebook, email, text message, etc.)
Health Transformation 2.0: Follow-up March 27, 2008
Posted by George Van Antwerp in Books / Articles, Consumerism, Healthcare, Innovation, Leadership, Managed Care, Marketing / Communications, PBM / Pharmacy, Technology, Value Propositions.add a comment
The other day, I provided a few comments on this book (manifesto) that I picked up, and I reached out to the author. He got back to me last night and was kind enough to provide the PDF of the publication.
In his words:
“These are simply my thoughts and thoughts inspired by a community of friends. It’s written as a kind of manifesto with the hope to inspire more good minds to tackle a very major challenge facing our society.”
I would encourage you to reach out to him if interested. (E-mail Scott Danielson – author)
Here is the book for you to view. I hope you will enjoy the hard work his community put in both in terms of content and graphic design.
Don’t forget to sign up for e-mail updates or put the blog in your reader. Thanks.
Health Transformation 2.0 March 24, 2008
Posted by George Van Antwerp in Books / Articles, Consumerism, Healthcare, Innovation, Leadership, Managed Care, Marketing / Communications, PBM / Pharmacy, Technology, Value Propositions.add a comment
I grabbed this little book off the table at Health 2.0. I am finally getting around to flipping through it (rather than sleeping).
I can’t figure out if it’s associated with a company. If yes, they have done a great job of disguising it. [For what purpose, I don't know.] It is very well laid out with great graphics and is called:
Health Transformation 2.0
Can A Better Healthcare Operating System Make Us Healthier?
The author’s name (Scott Danielson) and e-mail are in the cover so I have shot him a note to see if I could add it here as a flash or some other visual. Here are a few of the comments from the book:
- Healthcare 2.0 uses emerging technologies to transform an archaic, disease-treating system into a progressive health-enhancing one.
- In the past 4 years, healthcare costs have doubled. Are we twice as healthy?
- Today, we have the ability to create a set of tools, a healthcare operating system that will help people find and manage information, research and control costs, and get and/or stay healthy.
- Connected. Helpful. Secure. Organized. Informed.
- Personal + Health + Power = Personalized Health Empowerment
