Enabling Healthy Decisions | Category Archive

Discussing Oncology Prevention With Dr. Hawk From MD Anderson #WHCC12

April 26, 2012 by George Van Antwerp 0 Comments

Last week, I had a chance to sit down with Dr. Hawk right after his presentation at the World Health Care Congress (WHCC). Dr. Hawk is the Vice-President and Division Head for Cancer Prevention and Population Sciences at the University of Texas M. D. Anderson Cancer Center. He’s been there since late 2007 when he came from the National Cancer Institute.

My favorite point from talking to him was…

Cancer is a process not an event. Communication is critical.

In his presentation, he talked about several things:

The $227B total cancer cost in the US (2007).
The personalization of risk assessments and interventions.
The services of MD Anderson.
- Mortality reductions
- Wellness education
- Vaccinations and chemoprevention
The US Preventative Services Task Force.
The work that they’re doing direct with an employer (Shell).
The CEO Cancer Gold Standard.
The impact of aspirin on all-cause mortality.

So, after his formal presentation, we talked about several things.

One of the big focus areas for MD Anderson is prevention. As we know from research, many cancers are preventable. And, the promise of personalize medicine and genetic testing is beginning to help us understand these cancers and their treatments even more.
The three types of prevention:
1. Primary – this would include lifestyle changes such as diet and smoking which help prevent the disease
2. Secondary – this would include screening and detection to help slow the progression of the disease
3. Tertiary – this would include the focus on the patient (not the tumor) for treatment and helping them with quality of life
He talked about how cancer is really 200 different diseases to be understood and managed.
He gave a great analogy about how CVD (cardio-vascular disease) evolved and talked about how all the individual risk factors became asymptomatic diseases which have led to all the “know your number” campaigns around lipids and blood pressure.
We talked about cancer as a process which led us into the discussion about palliative care and shared decision making. He made another good analogy here about driving a car. We need to understand the value of wearing our seat belt and having insurance, but we have to make the final decision about whether to do that or not.
We talked about personalized medicine including genomics and epigenetics. We talked about how this impacts dosing and understanding of the tumor. (Interesting in a conversation with another person in this field this week they were telling me about how tumors and viruses change over time and those implications on genetic test results.) We also talked about SNPs and the complications in getting validation in studies due to sample sizes. We wrapped up this topic with discussions on coordinated registries and work that companies like 23andMe are doing.
Our final topic of discussion was around clinical practice algorithms and how evidence-based medicine (EBM) gets implemented. We talked about the use of guidelines and how those allow for monitoring the use of EBM standards. We also talked about the need for integrated EMRs that would allow for benchmarking and linking outcomes to use of guidelines.

This is a fascinating area. Cancer affects most of us either directly or through some family member or friend.

Books / Articles, Events, Healthcare, Leadership, Press, Research, Value Propositions

Interview With Laurel Pickering NEBGH At #WHCC12

April 17, 2012 by George Van Antwerp 0 Comments

Yesterday, I sat down with Laurel Pickering, MPH who is the President and CEO of the Northeast Business Group on Health. This was a great follow-up to the session she moderated with PEBTF and CalPERs and allowed me to validate my list of focus areas for employers. (Note: I did not use a tape recorder and have translated our dialogue into the discussion below so while it is based on my discussions with Laurel these should not be considered specific quotes.)

The first thing we discussed was the concept of ACOs (Accountable Care Organizations) and how employers think about them (or similar concepts). She talked about the fact that most employers don’t understand the ACO framework in specific. They may have heard something about the idea of a medical home or mention of the ACO, but they are more broadly focused on the conversion to an outcomes-based future. Initially, there are some leading edge employers and coalitions that you hear talking about these concepts at conferences, but in general, employers are going to look to their payors to lead this effort and think about how to embrace these new quality and payment frameworks.

We then talked about what are the issues that keep her up at night. In general, we focused on three things:

Reform – What is the future of healthcare reform and how will that impact employers?
Cost – How can we control costs both direct and indirect? And, what is the role of prevention in cost management?
Engagement – Even if we understand how to control costs, how do we engage consumers to take action? Is it through incentives, gamification, social media, mobile, or other tools?

We then talked about incentives and paying consumers (employees) for healthcare actions. She described three phases here:

Phase I: Payment for completing and HRA (which many companies have done for several years).
Phase II: Payment for completing specific screenings and participating in programs for which the patient is engaged (i.e., respond with the case manager calls you). (This seems to be a rapidly emerging standard with many employers.)
Phase III: Payment tied to achievement of different outcomes (weight loss, BMI, smoking cessation, blood sugar, blood pressure). (This is a lot further off and much more complicated, but it’s something that people are beginning to look at.)

We wrapped up with two topics – new technologies and ROI. In today’s environment, everyone is looking at mobile health and telemedicine. The question of course is how to get these tools used, paid for, and demonstrating the ROI. From a technology perspective, we talked mostly about the idea of the “digitally naive” (i.e., people under 16 today) for which technology is the norm. They’ve never experienced life without mobile phones and computers and Google. As this generation becomes patients, they won’t think twice about using technology as a way to see their physician and monitor their health.

From an ROI perspective, this has become a table stake to play. Everyone requires some case study for use. But, we had a great discussion about the flexibility of calculating ROI and how companies do look beyond just the simple avoided medical costs. They look at presenteeism. They look at satisfaction. They look at overall impact. This is a very important point as companies think about designing studies and monitoring their solutions.

Events, Healthcare, Leadership, Press

8 Common Employer Healthcare Themes #WHCC12

April 17, 2012 by George Van Antwerp 0 Comments

I had the opportunity to listen to some heads of HR a few weeks ago and then sit in on an employer session yesterday at the World Healthcare Congress here in DC. It was interesting the common themes that clearly were emerging from the presentations by PEBTF and CalPERs along with the event I was at before.

Incentives
Biometrics
Evidence-based medicine
Steerage of consumers to lower cost “Centers of Excellence”
Reference-based pricing to address unwarranted variation
Cost / transparency tools
Consumer engagement
Integrated care

Events, Healthcare, Leadership, Press

Some Facts On Palliative Care

March 23, 2012 by George Van Antwerp 1 Comment

In the book called Healthcare in 2020 by Steve Jacob, there is a chapter on End-of-Life Care. It provides some great data all sourced there (so not repeated here). I find this whole are of discussion especially around palliative care very interesting.

First, let’s define palliative care:

Palliative care (from Latin palliare, to cloak) is an area of healthcare that focuses on relieving and preventing the suffering of patients. Unlike hospice care, palliative medicine is appropriate for patients in all disease stages, including those undergoing treatment for curable illnesses and those living with chronic diseases, as well as patients who are nearing the end of life. Palliative medicine utilizes a multidisciplinary approach to patient care, relying on input from physicians, pharmacists, nurses, chaplains, social workers, psychologists, and other allied health professionals in formulating a plan of care to relieve suffering in all areas of a patient’s life. This multidisciplinary approach allows the palliative care team to address physical, emotional, spiritual, and social concerns that arise with advanced illness. (from Wikipedia)

The challenge of course is that most people don’t want to talk about dying, and physicians are taught to try everything to cure someone. After talking with a few people working in this area, the general scenario is where clinicians and other social workers are helping to enable to a patient to talk to their family and care team about their wishes. It’s not to make the decisions, but to give patients the tools to have an informed discussion.

Here were some of the interesting things from this chapter in the book:

Less that ¼ of physicians were familiar with the term in a survey
The American Society of Clinical Oncology has established a goal of integrating palliative care into its model of comprehensive cancer care by 2020.
A 2009 study of cancer patients found that palliative care improved patient satisfaction and eased pain, fatigue, nausea, insomnia, anxiety, and depression. And, increased appetite.
According to the Worldwide Palliative Care Alliance, more than 100M people worldwide would benefit annually from either palliative care or hospice…yet only 8% have access to it.
The average physician’s estimate of how long a patient will live was 530% too high.
Fewer than 40% of oncologists speak candidly with patients about end-of-life treatments.
Physicians equate suggesting hospice as “giving up”.
A 2008 published study showed that patient satisfaction was higher, more advance directives were completed, fewer ICU admissions were necessary, and medical costs were lower for patients in palliative care.
Patients with lung cancer that received palliative care lived 3 months longer than those with standard care (which compares to only getting 2-3 months of life from chemotherapy). [BTW – 1 in 5 cancer patients are still receiving chemotherapy in the last two weeks of life.]
A hospitalized palliative-care patient costs $279-$374 less per day.
In a Medicare study, patients who received palliative care cost $6,900 less during a hospital stay.

This seems like great data. Imagine that you can improve a patient’s experience in the last months of life and lower costs. To me, that’s a lot of what our healthcare system needs these days.

Books / Articles, Healthcare, Leadership, Marketing / Communications, Methodology, Research, Value Propositions

Took A New Job With inVentiv Medical Management

March 12, 2012 by George Van Antwerp 1 Comment

As some of you know, I’ve taken a new job. I just joined inVentiv Medical Management which is a company focused on reducing care costs and improving health outcomes quality for self-insuring employers, their employees and family members. One of the exciting new products that they launched before I came is called Accountable Care Solutions. Here’s a description from the press release:

Powered by a combination of clinical and financial algorithms and evidence-based decision-making rules, inVentiv Medical Management’s Accountable Care Solutions ensure that physician-ordered procedures are the best option from a treatment effectiveness and patient risk perspective. The new suite of solutions includes Comprehensive Oncology Care Management(TM), Comprehensive Cardiovascular Care Management(TM) and Comprehensive Kidney Care Management(TM). These Accountable Care Solutions offer customers – such as third-party administrators, employer groups and reinsurance carriers – best-in-class resources to effectively and efficiently enhance healthcare quality, while reducing overall costs of medical claims and improving patient outcomes.

Events, Healthcare, inVentiv Health, Leadership

My PCMA Presentation On Copay Cards

February 8, 2012 by George Van Antwerp 2 Comments

I’m giving my PCMA presentation in FL right now about copay cards. For those of you that can’t attend, here is my executive summary and a copy of some slides. (My actual slide deck was shorter for presentation but this gives more data to those of you looking online.)

I focused on three key points:

Copay cards are a direct threat to the PBM model. They can run against the idea of copay differentials and formulary tiers. Since they’re not allowed at mail order, they create a disconnect there. And, eventually, I believe they will be in conflict with rebates (i.e., why pay for both).
The cost numbers to the payer are huge ($32B according to Visante) although this is less than $1 per Rx over that 10 year time period. But, it’s concentrated on 3% of all scripts which makes it a big deal.
There should be a win-win IF they are concentrated on specialty medications with a link to improved adherence and health outcomes.

There doesn’t seem to be clear data (although another article says it is available) but the general data shows that availability and use of copay cards is growing rapidly.

Investing in copay cards seems to be based on four myths:

Cost is a large issue in non-adherence. It’s an issue but not the dominant issue.
Costs will influence physician choice. The reality is that they don’t know the costs and see this as a pharmacist issue.
Copay cards are a cost effective way to improve adherence. They get about a 10% improvement in MPR which sometimes produces a positive ROI. There are much lower cost ways to get a similar improvement.
Copay cards can delay conversion to generics. This is still in the air with the Pfizer Lipitor program, but if it works, it will be a lightning rod for PBMs and payers to focus on.

This topic’s not going away. For now, the easy PBM response is to close down the formulary, move more scripts to mail, and implement prior authorization programs. I would expect this will happen more often unless there is more transparency here around what’s happening and the benefits.

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

Rock Health Report on Digital Health

February 5, 2012 by George Van Antwerp 0 Comments

I saw this out on Slideshare, and I thought I would share it here.

Consumerism, Healthcare, Leadership, Research, Technology

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:

The focus on preventative care
The fact that some managed care organizations are changing (and others will too)
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:

Number of medications
Plan design (i.e., cost)
Gender
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

Walgreens Interview As Follow-up To Their White Paper

January 16, 2012 by George Van Antwerp 0 Comments

As anyone who follows the pharmacy industry knows (and now millions of consumers), Walgreens and Express Scripts have had an ongoing contract dispute since mid-2011. Most of us expected this to get resolved by the end of the year to minimize patient disruption, but it didn’t.

With that in mind, Walgreens has published several white papers to help articulate the results of their employer survey data and to help plans quantify the value of keeping Walgreens in the network. As this is a fascinating case study that will someday make a great Harvard case study, I reached out to Walgreens to get their thoughts on a few points.

Thanks to their PR team, I was able to get responses from Michael Polzin, their VP of Corporate Communications, to my questions.

Consumers are always resistant to change. After the initial disruption and assuming you eventually reach terms with Express Scripts, how will you get your consumers to return to Walgreens’ pharmacy? Is the retail pharmacy experience able to be significantly differentiated? How are you doing this today?

As we’ve previously stated, we are now moving on without being part of the Express Scripts network. While we are open to any fair and competitive offer from them, we also are fine with continuing to operate our business without Express Scripts.

We intend to retain patients affected by this situation over time by reaching out on both a consumer level and a business-to-business level. To date, more than 120 health plans, employers and other Express Scripts clients have informed us that they have either changed pharmacy benefit managers (PBMs) or taken steps consistent with their contracts to maintain access to Walgreens pharmacies in 2012. That represents 10 million of the 88 million Express Scripts prescriptions we filled last year. We’re also in active negotiations with many health plans and employers to provide access to Walgreens in their networks as soon as their contracts allow. In addition to those 10 million prescriptions already retained, we also expect to retain many Medicare Part D patients who previously were in an Express Scripts-managed Part D plan and moved to a different plan during last fall’s open enrollment period. We will get more detail on those numbers when CMS announces the results of the open enrollment period later this month.

On the consumer level, they are very receptive to looking at options to continue using Walgreens pharmacies whenever possible. They want to retain their choice of pharmacy and are exercising that ability as best they can. For example, we’ve had great response this month with our Prescription Savings Club (PSC) promotion. The PSC offers savings on more than 8,000 brand name and all generic medications. During the month of January, you can get an annual membership in this program for just $5 ($10 for a family). We have seen more than 250,000 patients sign up for the club just since Jan. 1, and we continue to have record sign-up days. The interest we’ve seen in the club has been extraordinary.

As for differentiating the retail pharmacy experience, that is exactly what we are doing through our new Well Experience store format, which has piloted so far in about 20 Chicago area stores and the entire Indianapolis market. The pharmacy, health and wellness area of these stores are truly a game changer. The pharmacist is more accessible by bringing them out from behind the pharmacy counter to a desk in front of the pharmacy. As a result, patient interactions are higher than our pharmacists have ever experienced. The format also allows for tighter integration between our Take Care Clinic nurse practitioners and pharmacists to create a real community health corner.

We’ve had many CEOs of major health plans and large employers tour these Well Experience stores, and their No. 1 comment is, “This is exactly what we need. How fast can you make this happen?”

The white papers are good summaries for the consultants. How are you taking your message to other constituents – consumers, MDs, Wall Street?

Our best ambassadors to consumers are our pharmacy staffs. They are the ones with the trusted relationship with our customers and are able to have individual, face-to-face conversations with them. They’ve done a tremendous job educating our patients, and that’s why we’re seeing so much interest in the PSC and have patients finding other ways to continue using Walgreens, such as using their spouse’s coverage, if available.

The same is true with physicians. Our pharmacy staff work with them every day and help them find the best options for their patients including generic alternatives that can be very competitive through the PSC card with a 90-day supply compared with the patient’s program under Express Scripts.

As for Wall Street, we’ve been quite active speaking at analyst conferences, addressing the issue on our earnings conference calls and at our recent annual shareholders meeting. The analysts also have found our white papers and other SEC filings to be helpful in understanding the situation.

Ultimately, payers/employers care about cost. If a PBM creates savings for them thru a limited network, can you summarize what they lose by not including Walgreens and how that transfers to hard dollar savings? Are Walgreens consumers more engaged with their health? Are they more satisfied with their healthcare?

Our research demonstrates the importance of Walgreens presence in a payers’ network in addition to the cost factor. A Walgreens proprietary survey conducted in December of 823 executives and managers who are key decision makers for pharmacy benefit decisions or provide input found that 82 percent of employers said that they would not exclude Walgreens for less than 5 percent savings on their total pharmacy spend. Sixty percent of employers would not exclude Walgreens for less than 10 percent savings, and 21 percent would not exclude Walgreens from their network regardless of the amount of savings. These findings on employer attitudes are consistent with recent research published by several leading equity research analysts. Clearly, employers value having Walgreens as a pharmacy option for their employees, but Express Scripts wants to take that choice away.

Now, add to that the small variation in costs among pharmacies. We believe that the vast majority of pharmacies, including Walgreens, receive reimbursements per prescription that fall within a narrow band, typically within less than 5 percent of one another. Therefore, excluding any pharmacy with our 20 percent market share from a 5 percent pricing band can only result in savings on the order of 1 percent or less. And that doesn’t take into consideration the additional savings Walgreens can provide through our leading generic dispensing rate or the 7 percent savings that payers can see by adding a 90-day refill option at our retail pharmacies.

It’s also important to point out that during negotiations, Walgreens offered to hold rates for a new contract flat and did not seek an increase in rates. The response from Express Scripts was to insist on being able to unilaterally define contract terms, such as what does and does not constitute a brand and generic drug. Express Scripts also proposed to slash Walgreens reimbursement rates to levels below the industry average cost to provide each prescription.

Walgreens is focused on helping payers with their total health care spend, not just the 10-12 percent of their health care costs that are spent on prescription drugs. While a patient with asthma can lower drug spend by not getting refills on their medication, the resulting emergency room visit that could result will be much more expensive overall for the payer. So we are focused on expanding the pharmacist’s role among health care providers to lower overall medical costs rather than focusing on drug spend alone.

Adherence is a big issue these days especially in Medicare where it is one of the key Star measures for PDP. One of the key value points in the paper is about adherence. How has Walgreens improved patient adherence and are you collaborating with payers to do this?

Walgreens pharmacies provide many medication adherence services, counseling and other assistance that lowers medical costs by improving outcomes. These include monthly adherence calls to inform patients about critical upcoming blood tests that are required to continue therapy; next-day home delivery for medications; assistance programs to help patients minimize risk resulting from economic circumstances that may negatively impact therapy compliance; and alerts for missed doses, at-risk patient behavior or serious adverse side effects that are communicated to a prescribing physician. We also offer 90-day supplies of medication, further promoting adherence. Walgreens pharmacists have consistently demonstrated increased adherence to chronic medicines for high-risk conditions for the populations that we serve. For example, for patients in one study who filled their statin and thyroid medications at community pharmacies and who consulted with a pharmacist, a significant improvement in first refill rates resulted (from 55.7 percent to 70.4 percent) after the adherence program was implemented.

While CVS has opted to own a PBM, Walgreens has sold their PBM. Has this experience with Express Scripts changed the way you interact and contract with PBMs? Do you think this will have broader implications on the industry?

I think it has helped us tremendously in terms of building closer relationships with other PBMs and payers. We’re moving forward with partners such as Catalyst Rx, Prime Therapeutics and SXC Health Solutions, and health plans such as Coventry and Humana. All of us see this as an opportunity to create a differentiated offering during the upcoming selling season.

Have any PBMs stepped up to work more strategically with you to create a differentiated offering to take advantage of this disruption during the 2012 selling season?

See answer above.

What’s next? As Walgreens looks to the future and focuses on creating new value, how are you embracing key changes in the industry around health reform and technology innovation?

See question 1 and our development of the Well Experience store and pharmacy format.

Healthcare, Leadership, Marketing / Communications, PBM / Pharmacy, Press

Speaking at the upcoming PCMA Event

January 14, 2012 by George Van Antwerp 0 Comments

I just got added to the agenda for the February PCMA event so look me up if you’ll be there. I’ve spoken on the topic of copay cards a few times for AIS in the past. Since then, there have been a few significant events:

The Pfizer Lipitor strategy and push around a copay card.
The PCMA study on the impact of copay cards.
CVS Caremark’s changes to their formulary of which some were attributed to the existence of copay cards.

As always, I welcome comments, articles, suggestions, or data to support this discussion. It is certainly one where there is limited data or facts. Thanks.

Books / Articles, Events, Healthcare, Leadership, PBM / Pharmacy, Research

“Twight” (Twitter Fight) Between $ESRX and $WAG

January 13, 2012 by George Van Antwerp 0 Comments

This is either a massive validation of the perceived value of Twitter or a crazy distraction, but either way, it’s interesting to those of us who study the industry and/or study marketing and communications.

As part of the ongoing dispute between Walgreens and Express Scripts, Twitter has become one of the latest tools. (see June post and September post) In an effort to sway public opinion and thereby pressure Express Scripts and its clients, Walgreens turned to bloggers and Twitter to push their messaging…but these were in some case paid comments which was surprising. They already have strong messaging in their IChooseWalgreens website and whitepapers on the Value of Walgreens. I also thought they were demonstrating some success in converting people to their discount program which was part of their overall growth strategy shared at their shareholders meeting.

After Walgreens (with almost 84,000 followers) created a promoted hashtag of #ILoveWalgreens, Express Scripts (with 1,645 followers) countered back with several Tweets about the dispute (see below). I guess the question is whether with millions affected and decisions made by the businesses and not consumers…does this forum matter? But, journalists and analysts follow them so it’s important to keep the messaging up. (Other articles on this are here, here, and here.)

Conveniently, I found this infographic on how Twitter is changing healthcare. At the same time, this is an interesting fight because it’s a blend of B2C and B2B crossing paths. More to come since I’m sure this fight is long from over.

Books / Articles, Consumerism, Healthcare, Infographic, Leadership, Marketing / Communications, PBM / Pharmacy, Politics, Social Media, Value Propositions

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

Only 2 of the top 25 “Companies for Leaders” from Healthcare

January 11, 2012 by George Van Antwerp 0 Comments

I don’t know about you but given the focus on healthcare and the percentage of our GDP that it consumes I had hoped this would be higher.

According to Fortune’s rankings (published 11/21/11), the top 5 companies were:

IBM
General Mills
P&G
Colgate-Palmolive
McDonald’s

Eli Lilly was ranked 12th, and UnitedHealth Group was ranked 20th.

Books / Articles, Healthcare, Leadership, Research

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

Interview with Per Lofberg (CVS Caremark) on the Future of the PBM

January 6, 2012 by George Van Antwerp 1 Comment

After sharing my forecasts about the PBM industry for 2012, I reached out to several people to get their perspective. One person for which I have a lot of respect is Per Lofberg. Per’s now the President of CVS Caremark’s PBM and has an impressive background at companies like Medco, BCG, and Generation Health. Everyone who’s ever worked for him has nothing but great things to say.

Given the change we all expect to see in the industry, I was glad that Per agreed to participate. Here are his answers to some of my questions:

1. 2012 is shaping up to be an exciting year in the PBM industry. Do you think this will finally be the year that limited retail networks take off?

Payers are always looking for new savings opportunities, and limited retail networks provide another avenue to increase savings without compromising access or quality. I have always believed it is quite possible to service large nationwide customers with retail networks that are smaller than the large 60,000 plus networks that are so common today. The current debate in the marketplace will only draw further attention to the topic of limited retail networks, which may result in more PBM clients, including clients who have not previously considered a limited network, engaging in a dialogue about this approach. As a result, I believe that during the 2013 selling season, benefit consultants will be quite focused during the RFP process on understanding the types of savings payers can realize with smaller networks. PBMs like CVS Caremark will need to be able to address this topic clearly with our clients and prospects so they can accurately weigh the benefits and impact of narrowing their network and consider how best to manage the natural disruption factor that will occur.

2. As the generic wave passes in the next few years, how do you expect PBMs to differentiate themselves going forward?

We can’t discount the importance of taking advantage of the large number of blockbuster drugs that will be going generic in the next few years. Being able to deliver strategies designed to drive generic utilization and work with clients to ensure that they appropriately move members to safe and cost-effective generic alternatives should become a best practice standard across the industry. Increasing GDRs will no longer be differentiators, but rather will be expected by clients as a basic PBM offering. As a result, during the generic tidal wave, PBMs need to sit tight, refine their standard formularies and perfect the implementation of programs that drive generic utilization.

As PBMs continue to drive GDR, those that are also successful at offering clinical solutions that support adherence, effectively manage the growing costs related to specialty pharmacy and helping clients manage the intersection of pharmacy and medical benefits to reduce waste and improve health are the ones that will stand out from the competition. Now and in the future, a best in class PBM is one that can accomplish all the basics that used to define differentiation (e.g., GDR, MDR) effortlessly, while bringing value to their clients through an integrated approach to managing the patient’s pharmacy care across the entire spectrum of care. The hallmark of a best in class PBM will be one that effectively addresses access, quality and cost for their clients.

Another consideration for PBMs will be around stricter formulary management strategies to counter increasing, and increasingly frequent, price hikes by pharmaceutical manufacturers. Brand manufacturers are using two basic strategies to protect their market share and we are seeing increased activity as generics erode the profitability of drug blockbusters. Unfortunately, these strategies – brand co-pay coupons and high and frequent price increases — ultimately raise costs and undermine the cost-controls used by employers and health plans to effectively manage their pharmacy spend. To help our clients manage pharmacy costs in this environment, PBMs will need to construct clinically appropriate formularies that provide our clients with options to manage sky-rocketing drug costs without compromising access or outcomes. CVS Caremark is combating price increases by pharmaceutical manufacturers by tightening what is offered on our recommended prescription formulary. As you know formularies are the list of approved drugs that an insurer or employer makes available to beneficiaries and, up until now, the formularies have been quite broad, including most FDA approved drugs, so that doctors and their patients have choice. However, physicians and pharmacists have long recognized that many drugs within a therapeutic class are essentially equivalent, and a “narrow” formulary can be comprehensive while also providing for substantial cost savings.

3. The role of the pharmacist continues to evolve with vaccines and their involvement in more patient management. Given your unique set of assets within the industry, how do you see CVS Caremark leveraging your POS resources to strengthen your focus on clinical outcomes and partner with clients?

As a pharmacy innovation company, we will continue to further develop our unique clinical offerings that leverage the pharmacist interaction and intervention in order to improve the health of our PBM members and drive costs savings for our clients. Our flagship products, Maintenance Choice and Pharmacy Advisor, developed to build on the member’s relationship with their pharmacist, are gaining increasing traction in the marketplace. These programs leverage the clinical expertise and insights of our PBM business along with the broad reach and face-to-face engagement in our retail business to deliver innovative solutions that are unmatched in the marketplace today.

Moving forward we will continue to build on this model by finding ways to further expand member access to these programs. For example, in 2012 we are expanding on our successful Pharmacy Advisor program, originally launched to increase adherence and close gaps in care for diabetes patients, to encompass patients with chronic cardiovascular conditions who are at risk of becoming non-adherent. We are also enhancing Maintenance Choice to make our integrated capability more broadly available to the CVS Caremark book of business and easier for members to use. In addition to enhancing our existing programs we are also continuing to innovate as a PBM by piloting new programs, including one we are piloting in 2012 that leverages pharmacist counseling to better coordinate drug treatment for patients recently discharged from hospitals in order to reduce rehospitalization rates and finding ways to fully integrate our Specialty Pharmacy business so clients and members get the full benefit of the entire CVS Caremark enterprise—PBM, CVS/pharmacy and MinuteClinic.

4. Medicare has pushed quality to the forefront with some of the new Star ratings. Additionally, some PBMs are looking at outcomes-based contracting with pharma. How do you see the marketplace engaging and leveraging pay-for-performance structures within the PBM industry?

Pay-for-performance based on outcomes is an extension of the guarantees that most PBMs negotiate with their clients today. These guarantees are in place to specify a level of service that clients should expect from their PBM with regards to such activities as response time on calls to the customer care center and performance for measurements such as a minimum GDR or MDR to be achieved within a specified time period. Adding in a level of clinical accountability is in line with how the PBM industry is evolving from one focused on channel/access and pure pharmacy cost savings through generics to one that encompasses health outcomes, adherence and the resulting overall health care cost savings associated with these measures. As PBMs get even better at implementing clinical programs and managing adherence across the spectrum of care, I would anticipate we will see more requests by our clients for contracts that either reward or penalize PBMs for their performance in these areas.

5. There is lots of talk about the value of carve-in versus carve-out pharmacy and the integration of medical, pharmacy, and ultimately lab data to provide improved management and identification of at-risk patients. Given your relationship with Aetna and ActiveHealth, how do you see CVS Caremark leveraging these assets even when they work in a carve-out relationship to help clients?

In our current partnerships with health plan clients, our main objective is to find ways to smoothly integrate our pharmacy management activities with the health plan’s focus on solid medical management. This integrated approach—one that balances traditional utilization management with programs to improve adherence, close gaps in care, improve outcomes and reduce negative health events – can deliver better results than a carve-out model that simply focuses on minimizing pharmacy spend. As I mentioned earlier when talking about how PBMs will differentiate their offerings in the future, a best in class PBM delivers on more than increasing GDR or moving members to mail order, it is about managing the whole patient and delivering results that address access, quality and cost. Being able to integrate a full view of the patient and their health works because it makes pharmacy care an integral component of overall health management for the member

[Thank you for reading. If you enjoy reading these posts, I would encourage you to sign up for e-mails from the blog every time new content is added. It's a convenient way to have the content delivered to your inbox for you to read and share. You can sign up in the right hand column of this site.]

Healthcare, Leadership, PBM / Pharmacy

Will Patient Reported Data Augment Claims Based Models?

January 3, 2012 by George Van Antwerp 0 Comments

On the one hand, it seems fairly obvious that patient reported data (use of OTCs, exercise, food intake) is important in understanding their healthcare. On the other hand, the historical bias has been to use historical claims to predict future costs. At a minimum, I think that studies around tools like PAM (Patient Activation Measure) have shown that patient reported information is important in understanding their literacy and attitudes on healthcare. This data is critical in designing effective healthcare engagement programs. [One of the reasons that Silverlink has stressed our focus on using data for segmentation and personalization for years.]

That’s why I found one of the latest studies by Kaiser to be really important. They used both claims data and patient reported data to evaluate inpatient admission rates and costs. And, as explained below, this data increased the predictive power of their model.

The research determined that self-reported information about being in poorer health was a key determinant in predicting higher inpatient admissions and for being in the top tier for costs. Higher admission rates and costs were associated with patients who self-reported:

Lower score for general self-rated health

Yes to “do you need help with one or more activities of daily living?”

Yes to “do you have a bothersome health condition?”

The addition of this self-reported information to a claims history model explained an additional 2.8 percent of variance in admissions and 4 percent in cost.

Books / Articles, Healthcare, Leadership, Marketing / Communications, Methodology, Research, 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

Does Duration Of Team Matter In Business As In Sports?

January 1, 2012 by George Van Antwerp 2 Comments

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

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

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

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

by visually via

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

RWJF Guest Post: Interprofessional Collaborative Care Will Be Key to Meeting Tomorrow’s Health Care Needs

December 21, 2011 by George Van Antwerp 0 Comments

Guest Post by Maryjoan Ladden, Ph.D., R.N., F.A.A.N., Robert Wood Johnson Foundation Senior Program Officer

Maryjoan Ladden, PhD, RN, FAAN, is a senior program officer at the Robert Wood Johnson Foundation. A nurse practitioner whose work has focused on improving health care quality and safety through health professional collaboration, her work at the Foundation addresses: faculty recruitment and education to increase the capacity of nursing programs; developing collaborative partnerships to address local nursing issues; creating the next generation of academic nurse leaders; and building senior executive leaders in nursing. She also is senior editor for the Foundation’s quarterly publication, Charting Nursing’s Future. (full bio here)

A little over a year ago, the Institute of Medicine’s landmark Future of Nursing: Leading Change, Advancing Health report put forward a series of recommendations for transforming the nation’s health care system. Among them was a call for a system in which “interprofessional collaboration and coordination are the norm.” That’s no simple assignment in a system that often operates in silos, from schooling through practice. But a number of innovators around the nation are already making headway.

Their work is the subject of a new policy brief from the Robert Wood Johnson Foundation, part of its Charting Nursing’s Future (CNF) series. The brief delves into what the IOM recommendation means for health care systems, offers case studies of several collaborative care models already in place, and examines the implications of the recommendation for how we train nurses and other health care professionals.

According to the brief, Implementing the IOM Future of Nursing Report–Part II: The Potential of Interprofessional Collaborative Care to Improve Safety and Quality, the “silo” approach must soon give way if we are to meet coming health care challenges. For example, chronic conditions are increasingly common—not surprising given an aging population. But the health care system is poorly structured to provide the sort of coordinated care and preventive services needed to give these patients quality care while reducing costs.

Some health care institutions are gearing up for the challenge.

In Boston, where Harvard Vanguard Medical Associates developed its Complex Chronic Care (CCC) program, primary care has become interprofessional, collaborative and noticeably more efficient. Each CCC patient is assigned a nurse practitioner (NP), a registered nurse with advanced education and clinical training. The NP consults with all the patient’s subspecialists and incorporates their guidance in a single plan of care. The NP then manages and coordinates that care, connecting patients to nutritionists, social workers, and other professionals as needed. The model is dynamic, allowing patients to meet more or less frequently with the NPs and their primary care physicians, who remain responsible for the patients’ overall care.
In New Jersey, the Camden Coalition of Health Care Providers is “revolutionizing health care delivery for Camden’s costliest patients,” according to the brief. These individuals, sometimes called super utilizers, typically rely on hospital emergency rooms for care. Not surprisingly, such patients account for an outsized share of local hospital costs, often with diagnoses that would have been more properly handled in a primary care setting. The Coalition developed its Care Management Project to reduce these unnecessary emergency room visits by treating patients where they reside, even when that means treating them on the street. A social worker, NP and bilingual medical assistant work as a team to help patients apply for government assistance, find temporary shelter, enroll in medical day programs and coordinate their primary and specialty care.

Training the Next Generation to Collaborate

Of course, the silo effect usually begins in school. In May 2011, six national education associations representing various health care professions formed the Interprofessional Education Collaborative (IPEC) and released a set of core competencies to help professional schools in crafting curricula that will prepare future clinicians to provide more collaborative, team-based care.

Such efforts are already under way at a number of institutions.

Maine’s University of New England has developed a common undergraduate curriculum for its health professions programs in nursing, dental hygiene, athletic training, applied exercise and science, and health, wellness and occupational studies. The curriculum includes shared learning in basic science prerequisites and four new courses aimed specifically at teaching interprofessional competencies.
In Nashville, Vanderbilt University is also pursuing an interprofessional education initiative that unites students from the medical and nursing schools with graduate students pursuing degrees in pharmacy and social work at nearby institutions. Students are assigned to interprofessional working-learning teams at ambulatory care facilities in the area.
The Veterans Health Administration (VHA) is piloting an interprofessional initiative, as well, focused on preparing medical residents and nursing graduate students for collaborative practice. As part of the initiative, five VHA facilities have been designated Centers of Excellence and received five-year grants from the U.S. Department of Veterans Affairs. Each VHA Center of Excellence is developing its own approach to preparing health professionals for patient-centered, team-based primary care.
In Aurora, Colorado, the University of Colorado built its new Anschutz Medical Campus with the explicit objective of creating an environment that promotes collaboration among its medical, nursing, pharmacy, dentistry and public health students. It features shared auditoriums and simulation labs, as well as student lounges and other dedicated spaces in which students from different professions can pursue common interests such as geriatrics in a collaborative fashion.

Such initiatives are clearly the wave of the future, if only because the pressures of caring for a larger, older and sicker population of patients in the years to come will drive efforts to identify efficiencies. In the words of Mary Wakefield, PhD, RN, head of the Health Resources and Services Administration, “As the health care community is looking for new strategies and new ways of organizing to optimize our efforts—teamwork is fundamental to the conversation.”

Sign up to receive future Charting Nursing’s Future policy briefs by email at www.rwjf.org/goto/cnf.

Books / Articles, Guest Post, Healthcare, Leadership, Methodology, Research, Value Propositions

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

Barrett Toan To Speak At PBMI Spring Conference

December 14, 2011 by George Van Antwerp 0 Comments

Barrett Toan who was the motivating force behind building Express Scripts has been gone for since 2006 when he stepped down as Chairman of the board. He is now the chairman of Sigma Aldrich here in St. Louis and active in other pursuits. I was excited yesterday when I heard from Brenda Motheral, the Executive Director at PBMI, that Barrett had agreed to speak at their conference (register here).

While I never got to work with Barrett as closely as I would have liked to, I was on several projects with him. I was always amazed by both his passion for the industry and the patient along with his ability to move from both the macro-vision to digging down into the details. It should be fascinating to hear his view on where the industry is today and all the changes that have happened.

And, that should add to the agenda they already have which includes Gilbert Welch, the author of Overdiagnosed, Kjel Johnson from Magellan, Stacy Dow from Whirlpool, and Dr. Troy Brennan from CVS Caremark.

The focus of the agenda this year is on specialty which is obviously front and center for all of us. The one concern that I have had in the past was around attendee mix. It always seemed like the PBMs talking to each other, but Brenda told me that so far ~75% of the registrants are plan sponsors and that the actual number of plan sponsors registered already exceeds last year. This would be a big and very positive change.

Brenda also mentioned several other key topics – 340B, MTM, eRx, generics, consumerism, OTC, and Rx and Dx integration. Of course, I’m sure there will be discussion from their survey which I reviewed earlier, and they will be releasing their new specialty survey at the event. I’m planning to attend, and I hope to see you there.

Events, Healthcare, Leadership, PBM / Pharmacy, Research

Cost and Outcomes Drive Better Use of Data

December 8, 2011 by George Van Antwerp 1 Comment

Overall, I would describe healthcare companies as trying to figure out how to drive the best outcomes at the lowest cost while maintaining a positive consumer experience. This isn’t easy. One area of opportunity that companies increasingly look at is how to use data to become smarter.

Can I build a predictive model of response curves? Who’s likely to respond? Who’s likely to take action?
Can I develop a segmentation model that works? How will I customize my communications after the segmentation?
Can I rank and prioritize my outreaches? Should I do that based on risk or based on potential value?

Ultimately, I think this is driving companies to be a lot smarter and to look at how they use both medical and pharmacy data. For example, I’ll point to both CVS Caremark and Prime Therapeutics in press releases from earlier this year.

“The ActiveHealth CareEngine offers evidence-based information that can be used to improve the health care of our members and enables us to take our programs to the next level by seamlessly incorporating medical data,” stated Troyen Brennan, EVP and chief medical officer of CVS Caremark. “This agreement will enhance our existing programs to identify issues related to gaps in care, potential drug-to-drug interactions and duplicative care — information that is important to bring to the attention of the member’s physician.” (article that this is sourced from)

Smart use of medical and pharmacy data is one of the most powerful tools we have to improve outcomes and increase value for our members and clients,” said David Lassen, PharmD, Chief Clinical Officer at Prime. “Through ongoing partnership with health plan clients, Prime is uniquely positioned to view the entire spectrum of patient care, and we can leverage that information to help manage cost and to improve outcomes. We are very excited to collaborate with Corticon on the development of this clinical platform.” (press release)

The next step will be to integrate PRO (patient reported outcomes) from sources like connected devices and PHR (personal health records) that might show blood pressure, workouts, calories, or other data points that could help companies determine when to intervene and how to add value to drive an outcome.

Additionally, another key is continued work in the outcomes-based contracting world and bonus areas such as Star Ratings where the financial value is tied in the short-term to outcomes. This creates a burning platform for smarter use of data and use of a broader set of data to understand and impact care.

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

Medicare Patients Save $1.5B on Rxs!!

December 6, 2011 by George Van Antwerp 0 Comments

Now, here’s a great story. This may be one of the best government success that I’ve heard about in what I think of as a collaboration of the government with multiple businesses. (Although I think this is a lot more of what HHS is doing these days under Todd Park’s guidance.)

According to USA Today this morning, more than 2.65M Medicare recipients have saved an average of $569 per person this year based on addressing the donut hole with a 50% discount on the brand drugs filled during this time. And, the average premium for 2012 is actually LOWER than the premium in 2011 (by $0.76 per month).

The other part of the article is about the potential value of preventative care and leveraging this as part of the Medicare benefit. The key here is engagement of the participants to help them understand and take action on their healthcare. The power of the consumer in driving healthcare costs and outcomes is significant which is a topic that I know was discussed by several people today at the mHealth event in DC.

Books / Articles, Consumerism, Healthcare, Leadership, Managed Care, PBM / Pharmacy, Research, Value Propositions

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

Text4Baby Learnings About Flu Shots And More

November 30, 2011 by George Van Antwerp 0 Comments

Here’s a slide presentation from the Text4Baby team that they presented yesterday. This has been one of the biggest SMS programs in the country and has gotten a lot of press. They did a survey of people about their plans to get flu shots and also share some other data and plans.

Books / Articles, Healthcare, Leadership, Marketing / Communications, PBM / Pharmacy, Press, Research, Technology

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

What’s A PAM Score?

November 25, 2011 by George Van Antwerp 0 Comments

PAM^TM is the Patient Activation Measure which was developed by Dr. Hibbard, Dr. Bill Mahoney, and colleagues. It helps you gauge how much people feel in charge of their healthcare. To find out more, you can go to InsigniaHealth’s website.

Given the focus on health engagement across the industry these days, I think this is an important tool to consider. It’s been used broadly and has been validated in a lot of published studies. The questions lead people to be assigned to one of four different activation levels.

You can collect and use the PAM score for segmentation, developing customized messaging, measuring program success, and/or identifying at risk populations.

A few other interesting points from one of their FAQ documents were:

Patients who are more activated are more likely to adopt positive behaviors regardless of plan design.
People with higher activation levels are more likely to choose consumer directed plans.
People with low activation often feel overwhelmed with the task of taking care of themselves.
You increase the level of success in by breaking down change into smaller steps where the consumer has a greater likelihood of success.

Books / Articles, Consumerism, Healthcare, Leadership, Managed Care, Marketing / Communications, Methodology, PBM / Pharmacy, Research, Silverlink

Which PBMs Have The Highest Mail Order Penetration?

November 25, 2011 by George Van Antwerp 0 Comments

I was looking at some data from earlier this year (Q1 – 2011) from the AIS quarterly survey of PBMs. I thought this was a nice summary of mail order penetration by PBM. As you can see, it identifies some areas of opportunity:

Will Express Scripts’ mail penetration go up with the potential acquisition of Medco? Or, will Medco’s go down?
Will anyone be able to match the Medco mail penetration?
Will Aetna’s mail penetration go up to the CVS Caremark penetration rate?
How will Prime Therapeutics, SXC, and CatalystRx increase their mail penetration?

Overall, the mail penetration of the industry has dropped to 16.3% which is the lowest it’s been since 2004 when it was 12.9% (according to AIS). [Note: These are based on adjusted Rxs.]