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International Differences In Wellness Programs

I was looking for a statistic today on wellness programs when I came across this 2010 survey on global wellness from Buck Consultants.  I found the geographic differences really interesting, and I thought I’d share a few of the charts here.

Intl Drivers of Wellness strategy Buck

Top wellness programs by region buck

Wellness Program Objectives - Buck

If you want to see their 2012 report on what’s next for wellness, you can go here.

Fail Fast To Succeed Sooner – The Big Company Challenge

I was reading an article this morning about asking the question “are you afraid to fail?”  It’s an article about innovation which reminded me of one of my favorite quotes from David Kelley at IDEO.

Fail Faster

It also reminded me of another article from 2006 in Business Week about How Failure Breeds Success which was when I left Express Scripts to pursue several entrepreneurial opportunities.

Stefan H. Thomke, a professor at Harvard Business School and author of Experimentation Matters, says that when he talks to business groups, “I try to be provocative and say: ‘Failure is not a bad thing.’ I always have lots of people staring at me, [thinking] ‘Have you lost your mind?’ That’s O.K. It gets their attention. [Failure] is so important to the experimental process.”

BW Failure Cover

It also got me thinking about success rates in companies.  We all hear so much about the success of entrepreneurs and these 20 year old billionaires.  Is that reality?  Here’s a few stats from an article in the WSJ and a study by the Census Bureau.

  • 80% of companies make it to year one
  • 60% of companies make it to year three
  • 50% of companies make it to year five
  • 35% of companies make it to year ten

Sounds pretty depressing.  What about the fact that according to the WSJ article, only 5% of them achieve the projected ROI and 30-40% of them liquidate all their assets returning nothing.

“People are embarrassed to talk about their failures, but the truth is that if you don’t have a lot of failures, then you’re just not doing it right, because that means that you’re not investing in risky ventures.  I believe failure is an option for entrepreneurs and if you don’t believe that, then you can bang your head against the wall trying to make it work.” (David Cowan – Bessemer Venture Partners in WSJ article)

Just watch the show Shark Tank sometime.  There are amazing entrepreneurs with interesting ideas who have sacrificed so much to try to make it work.  I always try to tell people that it’s not just about passion and hard work otherwise people would succeed all the time.  Some things you do learn from Shark Tank along with the book The Art of the Start is how to frame and present your ideas.

So, why is this so important?  We’re on the the verge of huge transformation in the healthcare industry.  I think Oliver Wyman did a good job of discussing this in a whitepaper last year.  You can read article after article about mHealth, telemedicine, and remote monitoring.  (I’ll point you to Rock Health or The Center For Connected Health as two starting points.)

Of course innovation has been the buzz for several years now.  I think Jim Collins does a good job of teeing up this issue in discussing churn in the Fortune 500 list.  With the technology and VC crowd, the more recent term for business model innovation is “pivot“.  I think you’ve seen a lot more Chief Innovation Officers and innovation labs in healthcare companies these days.

I came across an interesting blend of technology consulting, investing, and innovation last night in the BCG Digital Ventures group.  In watching part of a YouTube video by their CEO, I think he does a great job summarizing how consulting maps to the investment paradigm.

  • Innovation is like seed capital
  • Product development is like venture capital
  • Commercialization is like growth capital

Interestingly, I probably get 1-2 calls a week from people in big companies that really want to get out of the big company and come work in the exciting start-up space.  I always tell them that the grass always looks greener on the other side of the fence so be careful.  It can be great, but it can be really tough.  It’s just a different type of risk and not everyone can take the emotional and potentially financial risk.  On the flipside, I also get people that look at the different entrepreneurial things I’ve done and say “why?”  They want to know why I didn’t just stay in a F500 company.  Sometimes, I think of this 8 years as a boomerang where I’ll end up back in a F500 company, but I’ll be a much more valuable product development, strategy, and innovation executive.  [This idea of boomeranging was one that Gensler introduced me to years ago in architecture where they encouraged people to work at different companies and come back if relevant.]

Depending on the day, I also think about what I’ve learned since I’ve never had one of those huge exits that everyone talks about.  I’m not cashing in on all my options to make money.  I’ve summarized many of those learnings on the blog, but here’s a few that I’ll call out.

  1. Firepond was my first venture into this space.  It was a 20-year company that General Atlantic had invested in to turn around as a product configurator in the CRM space.
    • Learned about CRM (customer relationship management) technology.
    • Learned about how to develop, structure, and manage alliances.
    • Learned the importance and how to structure offshore deals.
    • Learned about global sales and embedding technology into different solutions.
    • Learned about evaluating and buying companies.
  2. CentralScript was my second venture I started it from an idea I tried to sell at Express Scripts (and later was suggested to them by Clayton Christensen).
    • Learned about writing a business plan and financial modeling and projections.
    • Learned about the legal structure of businesses.
    • Learned about raising money and how to work with and evaluate angels and VCs.
    • Learned about building a team and structuring contracts with them.
    • Learned about selling and evaluating partners.
  3. Talisen Technologies was my third venture which was another turnaround where I worked with a friend of mine who had raise some private equity to do a technology services consulting roll-up.
    • Learned about Business Process Management technology.
    • Learned about how to build support companies around a technology platform.  (The opposite of Firepond where I was the technology company.)
    • Learned about the difficulties of transforming an existing company and evaluating new companies.
    • Learned about how to use blogging and create exposure using social media.
  4. Silverlink was my fourth venture (and most successful experience) and first real start-up where it wasn’t trying to turnaround an existing asset but building off what the founders had built.
    • Learned about how to present to and work with the Board of Directors.
    • Learned about managing a sales force.
    • Learned about product development, training, documentation, and product lifecycle.
    • Learned about sales and marketing and being responsible for growth and a team.
    • Learned about account management.
    • Learned the value of using thought leadership, social media, and the press to drive awareness and pipeline.
    • Learned how to develop competitive analysis and differentiation.
    • Leraned about pricing and analytics.
  5. inVentiv Medical Management is my current venture which is part of a broader entity, but it’s still the same concept which is a 20-year old company that we’re transforming into a new platform and new business model.
    • Still in-progress so more to come…

So, I wrote all this to make the point that innovation is difficult.  You have to take some risks.  Like the article said upfront, you have to believe you can fail.  You have to have a plan for what to do if you do fail.  Big companies should provide a safety net to people to fail fast.  I think I’ve learned a ton that I wouldn’t have learned staying in the big company.  At the right time, that will be a huge asset as I look to help drive the transformation and pivoting of a larger entity!

A Few Corporate Wellness Tips

While Al Lewis has become the industry antagonist (in a good way), he makes a lot of great points that anyone working in the industry should understand and consider.

If you haven’t read some of Al’s articles, let me point you to a few:

His writing reminds me of some of the things my former boss pointed out several years ago about the disease management industry.

In one of his posts, he makes several points that I wanted to discuss here:

  1. You should use a source like the US Preventative Services Task Force (USPSTF) as the evidence-based reference for appropriate screenings – frequency, age, gender.  Of course, I agree with this.  We need some common source that we all can use that’s based on best practices and evidence.
  2. He argues that you should stop weighing people.  I’d argue that knowing your numbers is important.  As a country and a world, we’re seeing massive growth rates in obesity which is linked to numerous diseases.  We need people to be more conscious of this risk factor especially in our sedentary work environments – see sitting disease infographic.
  3. His third point is about targeting and nudging the right population versus over-sampling everyone.  I couldn’t agree more.  This should be what the Big Data push in healthcare gets us.  How to build predictive algorithms to identify people with multiple risk factors.  How to identify people with gaps-in-care.  How to figure out what someone needs to take an action.  I always say there are 3 factors to consider:
    • Is there value in the intervention?
    • What channel / method is going to get the consumer’s attention?
    • What information is going to get the consumer to take an action?

To follow-up on my points above, here’s some information on obesity and it’s link to other diseases.

The CDC says that obesity is linked to:

  • Coronary heart disease, stroke, and high blood pressure.
  • Type 2 diabetes.
  • Cancers, such as endometrial, breast, and colon cancer.
  • High total cholesterol or high levels of triglycerides.
  • Liver and gallbladder disease.
  • Sleep apnea and respiratory problems.
  • Degeneration of cartilage and underlying bone within a joint (osteoarthritis).
  • Reproductive health complications such as infertility.
  • Mental health conditions.

And, for a fun video by Mayo Clinic on Knowing Your Numbers watch this:

The Boston Physician Dilemna

I often wonder why so many healthcare companies are in the Boston area.  These two set of statistics from the Merritt Hawkins study on physician appointment wait times paint an interesting picture.

First, you have the fact that Boston has the highest ratio of physicians per 100,000 people.  Almost double the US average.

Screen Shot 2014-02-01 at 6.51.20 AM

On the other hand, it takes you the longest time to get access to a physician.

Image

 

I’m a simple person.  This doesn’t seem to make sense.  I could say that lots of them are working in academia or in companies and not actually seeing patients.  I’m sure that explains some of it, but I can’t imagine all of it.

It’s also interesting that Boston also rises to the top of the list in terms of Medicare acceptance.

Medicare acceptance rates by city

New Harris Interactive Data Supports Focus On Hospitals And Retailers

As I’ve discussed before, trust is critical in engaging consumers.  The question always is “Who does the consumer trust in healthcare?”  We certainly know that individuals like physicians, nurses, and pharmacists are trusted, but they often aren’t the ones doing the big campaigns to engage consumers.  It’s the pharma manufacturers, the hospitals, the PBMs, the payers, the retail pharmacies, and other entities.  In my presentation at the CBI conference, I hypothesized that this is why retail pharmacy should (could) take a bigger role in the future.

The new survey from Harris Interactive reinforces that.  Of course, 42% of people don’t believe any companies, but with some healthcare companies being barely trusted more than tobacco companies, consumer engagement isn’t easy.

Harris Interactive - Trusted Industries 2013

The additional bad news from the survey is that people think more regulation is necessary in healthcare.

Harris Interactive - Regulated Industries 2013

 

Are Sports Good For Kids?

This was an interesting question that I was thinking about this morning.

I could take this several directions:

  • I could look at the benefits of exercise from sports (assuming the kids actually got enough exercise in practice – see older blog post).
  • I could look at the benefits of working in a team which I see from team sports.
  • I could look at the recovery benefits of losing and coming back which is very important in business and life. (how do you handle adversity)
  • I could look at the dangers of sports.
  • I could look at concussions in football and the discussion of helmets for soccer.
  • I could look at the negative impacts of parents on their kids relative to sports.
    • Fighting at sport events.
    • Pushing their kids too far.  (below are some things I’ve heard and seen)
      • Just keep running even if you throw up.  You’ll be fine.
      • If you have to pee, just pee in your swim suit.  You can’t be distracted during the meet.
      • If you do that again, we’re going to get up at 5 in the morning and go to the gym and practice it 100x before school.
      • You need to work harder so you can be in the Olympics at 16.
      • This is our college plan.  They have to be the best at this sport.
      • I pulled them out of school so they could practice more.  (The kid was 7.)

But, I saw an article about the time that kids start school, and it got me thinking about sleep and sports and the impact on kids.

Let’s start with some established facts:

sleep guidelines

Now, let’s assume most grade schools start around 8:00.  (My kid’s school starts at 7:30.)  That means that they likely have to get up by 7:00 at the latest.  So, they should be in bed by 9:00 PM on average probably earlier for most kids and families where people are catching the bus or driving to school.

If their sports are starting practice or games after 6:00 PM, how likely is it that they’re home, calmed down, with their homework finished, and in bed by 9:00 PM?  Even if they are, how many parents are getting their kids to bed by 9:00?

“Sleep may be the most important, though overlooked, contributor to your children’s development and health. The reality is that children can survive without exercise and on little food (though I don’t recommend either), but all children need sleep. It’s often unnoticed because you don’t usually see your children sleeping and its benefits are not readily apparent (though its costs usually are).

The influence of sleep on children is profound. Quality sleep has been found to be associated with improved attention, reduced stress, greater emotional control, better mood, improved memory, greater ability to learn and return information, better grades, improved mental health, lower risk of obesity and other health problems, and longer life.” (From a good article on kid’s sleep in the Huffington Post)

So, just to be clear…I think kids should be in sports.  I just think we (as parents) need to be more concerned about making sure we don’t sacrifice our kid’s sleep on a regular basis for them to play sports and lead them into health issues and school issues.  The tradeoff isn’t worth it.  (IMHO)

Three Recent Specialty Pharmacy Reports

Last week, I noticed three recent reports that have come out about specialty pharmacy.  I haven’t had a chance to really dig in to them , but I thought I’d pull out a few of the PR highlights and share the report links here.

The first report is from the Center for Healthcare Supply Chain Research and Health Strategies Group — “Specialty Pharmacy: Implications of Alternative Distribution Models” — which looks at how providers are using buy-and-bill and white bagging.

Karen J. Ribler, Executive Vice President and COO of the Center, notes, “Distributing specialty pharmaceuticals is complex; curbing costs is just one of the many facets of providing patient-centered healthcare. Site-of-care and day-of administration dosage requirements revealed themselves as determining factors for supporting the use of one method over another. A critical look at unintended consequences leads to our conclusion that Buy and Bill is, for the time being, the preferred model for practitioners of medium to large oncology clinics, but that could change as specialty treatments evolve.”

CVS Caremark just released their report Specialty Trend Management – Where To Go Next.  In there, they say:

Infusions are increasingly being done in a hospital setting where the costs for both the drug and its administration can be the highest of all potential sites of care.  For example, costs for a standard dose of a drug for rheumatoid arthritis can vary from $3,259 for the drug and $148 for administration when infused at the patient’s home to $5,393 for the drug and $425 for the administration when infused as an outpatient procedure at a hospital. In fact, the hospital setting is typically the least cost-effective site of care for infusions. (source)

As I’ve been doing lots of work lately in identifying and segmenting the population for Population Health Management, I found this chart interesting:

Image

http://lab.express-scripts.com/prescription-drug-trends/specialty-drug-spending-to-jump-67-by-2015/

And, last month, Prime Therapeutics released a report on Specialty Pharmacy which I blogged about.

Trajectory Modeling On Adherence By CVS

No one who works with consumers or who studies adherence should too surprised that people are different in how they fill their medications. I think companies are finally getting a better handle on longitudinal member records and ways of studying those patterns to determine how and when to intervene.

Our past behavior is always a great place to learn from about our future behavior but at the same time, people view different drugs and conditions differently. For example, I might be very likely to take my pain medication everyday since it’s a symptomatic condition versus my cholesterol medication since it’s an asymptotic condition. I also may take a different approach yo medications that have significant side effects.

At the same time, these data is well known so the quest for the “best” segmentation approach and behavior change model continues.

With that in mind, I finally got a chance to look at some research from September that researchers at CVS Caremark and Brigham and Women’s Hospital published in the journal Medical Care. They used trajectory modeling to follow statin users for 15 months and came up with six groups:

  • Brief gap in medication use or filled irregularly during the first nine months, but improved during the last six months (11.4 percent)
  • Slowly declining adherence throughout the 15 month period (11.3 percent)
  • Used statins only occasionally across the 15 month study period (15 percent)
  • Rapid decline in statin use after initiation (19.3 percent)
  • Virtually no fills after their initial fill (23.4 percent

They also identified some characteristics associated with adherence:

  • Higher adherence was seen with patients who were older, had higher incomes and held a high school diploma.
  • The highest adherence rates were associated with Medicare Part D clients and people who live in New England.
  • Those with the lowest adherence rates tended to be generally younger, male and less likely to have an initial prescription that provided them with more than a 30-day supply of medication.

Troyen A. Brennan, MD, MPH, Executive Vice President and Chief Medical Officer of CVS Caremark:


“The use of trajectory models could help us more accurately identify patients at risk for medication nonadherence so we can develop and implement targeted interventions to help them stay on their medications for chronic health conditions.”

Aetna’s Metabolic Syndrome Innovation Program

I’ve been closely following Aetna’s innovation for the past few years (see post on CarePass and Healthagen).  I had the chance last week to speak with Adam Scott who is the Managing Director of the Aetna Innovation Labs.

Here’s Adam’s bio:

Adam Scott is a Managing Director within Aetna’s Innovation Labs, a group developing novel clinical, platform, and engagement solutions for the next generation of healthcare.  Mr. Scott specializes in clinical innovation, with a focus on oncology, genetics, and metabolic syndrome, as well as “big data” analysis.  His work is aimed at conceptualizing and developing products and services that better predict illness, enable evidence-based care and lengthen healthy lives.  Prior to joining Aetna, Mr. Scott’s 15-year healthcare career has included management roles in consulting, hospital administration, and most recently health information technology.  Mr. Scott holds a bachelor’s degree from Washington University in St. Louis and a Masters in Business Administration from Northwestern University’s Kellogg School of Management.  Mr. Scott resides with his family in Needham, MA, where he actively serves as a director on community boards.

This is one of my favorite topics – Metabolic Syndrome (although yes…I still hate the term).

Definition of Metabolic Syndrome from the NIH:

Metabolic (met-ah-BOL-ik) syndrome is the name for a group of risk factors that raises your risk for heart disease and other health problems, such as diabetesand stroke.

The term “metabolic” refers to the biochemical processes involved in the body’s normal functioning. Risk factors are traits, conditions, or habits that increase your chance of developing a disease.

The Aetna Innovation Labs are focused on bringing concepts to scale and staying 2-3 years ahead of the market.  They are looking to rapidly pilot ideas with a focus on collecting evidence.  In general, Adam described their work as focused on clinical, platform, and engagement ideas.  They are trying to collaborate with cutting edge companies that they think they can help to scale quickly.  It’s pretty exciting!

As stated in their press release about this new effort:

“During the course of the last year, Aetna Innovation Labs has successfully piloted an analysis of Metabolic Syndrome and the creation of predictive models for Metabolic Syndrome. This prior work showed significantly increased risk of both diabetes and heart disease for those living with Metabolic Syndrome,” said Michael Palmer, vice president of Innovation at Aetna. “With this new pilot program with Newtopia, we are aiming to help members address Metabolic Syndrome through specific actions, before more serious chronic conditions arise, like diabetes and heart disease.”

Aetna selected Newtopia for this effort for their unique approach toward achieving a healthy weight with an integrative and personalized focus on nutrition, exercise, and behavioral well-being. Newtopia’s program begins with a “genetic reveal,” leveraging a saliva-based genetic test to stratify participants with respect to three genes associated with obesity, appetite, and behavior. Based on the results of this test and an online assessment, Newtopia matches each participant to a plan and coach trained to focus on the member’s specific genetic, personality and motivation profile. Through online coaching sessions, Newtopia will help members achieve results related to maintaining a healthy weight and Metabolic Syndrome risk-reduction, which will be measured by changes from a pre- and post-program biometric screening.

“Newtopia’s mission is to inspire individuals to make the lifestyle choices that can help them build healthy lives,” said Jeffrey Ruby, Founder and CEO of Newtopia.

If you’ve been following the story, this builds upon their project with GNS to develop a predictive algorithm to identify people at risk for Metabolic Syndrome.  As you may or may not know, there are 5 first factors for Metabolic Syndrome (text from NIH):

The five conditions described below are metabolic risk factors. You can have any one of these risk factors by itself, but they tend to occur together. You must have at least three metabolic risk factors to be diagnosed with metabolic syndrome.

  • A large waistline. This also is called abdominal obesity or “having an apple shape.” Excess fat in the stomach area is a greater risk factor for heart disease than excess fat in other parts of the body, such as on the hips.

  • A high triglyceride level (or you’re on medicine to treat high triglycerides). Triglycerides are a type of fat found in the blood.

  • A low HDL cholesterol level (or you’re on medicine to treat low HDL cholesterol). HDL sometimes is called “good” cholesterol. This is because it helps remove cholesterol from your arteries. A low HDL cholesterol level raises your risk for heart disease.

  • High blood pressure (or you’re on medicine to treat high blood pressure). Blood pressure is the force of blood pushing against the walls of your arteries as your heart pumps blood. If this pressure rises and stays high over time, it can damage your heart and lead to plaque buildup.

  • High fasting blood sugar (or you’re on medicine to treat high blood sugar). Mildly high blood sugar may be an early sign of diabetes.

So, what exactly are they doing now.  That was the focus of my discussion with Adam.

  1. They are running data through the GNS predictive model.
  2. They are inviting people to participate in the program.  (initially focusing on 500 Aetna employees for the pilot)
  3. The employees that choose to participate then get a 3 SNP (snip) test done focused on the genes that are associated with body fat, appetite, and eating behavior.  (Maybe they should get a few of us bloggers into the pilot – hint.)  This is done through Newtopia, and the program is GINA compliant since the genetic data is never received by Aetna or the employer.
  4. The genetic analysis puts the consumer into one of eight categories.
  5. Based on the category, the consumer is matched with a personal coach who is going to help them with a care plan, an exercise plan, and a nutrition plan.  The coaching also includes a lifestyle assessment to identify the best ways to engage them and is supported by mobile and web technology.
    newtopia
  6. The Newtopia coaches are then using the Pebble technology to track activity and upload that into a portal and into their system.

We then talked about several of the other activities that are important for this to be successful:

  • Use of Motivational Interviewing or other evidence-based approaches for engagement.  In this case, Newtopia is providing the coaching using a proprietary approach based on the genetic data.
  • Providing offline support.  In this case, Aetna has partnered with Duke to provide the Metabolic Health in Small Bytes program which he described as a virtual coaching program.

Metabolic Health in Small Bytes uses a virtual classroom technology, where participants can interact with each other and the instructor. All of the program instructors have completed a program outlined by lead program developer Ruth Wolever, PhD from Duke Diet and Fitness Center and Duke Integrative Medicine. Using mindfulness techniques from the program, participants learn practices they can use to combat the root causes of obesity. The program’s goal is to help participants better understand their emotional state, enhance their knowledge of how to improve exercise and nutrition, and access internal motivation to do so. (source)

We also talked about employer feedback and willingness to adopt solutions like this.  From my conversations, I think employers are hesitant to go down this path.  Metabolic Syndrome affects about 23.7% of the population.  That is a large group of consumers to engage, and pending final ROI analysis will likely scare some employers off.

Adam told me that they’ve talked with 30 of their large clients, consultants, and mid-market clients.  While we didn’t get into specifics, we talked about all the reasons they should do this:

  • People with Metabolic Syndrome are 1.6x more expensive
  • People with Metabolic Syndrome are 5x more likely to get diabetes
  • Absenteeism
  • Presenteeism

This ties well with my argument that wellness programs aren’t just about ROI.

Obviously, one of the next steps will be figuring out how this integrates into their other existing programs to address the overall consumer experience so that it’s not just another cool (but disconnected) program.  And, of course, to demonstrate the effectiveness of the program to get clients and consumers to participate.

Two quotes I’ll leave you with on why this is difficult (but yet exciting to try to solve):

“The harsh reality is that scientists know as much about curing obesity as they do about curing the common cold: not much. But at least they admit their limitations in treating the cold. Many doctors seem to think the cure for obesity exists, but obese patients just don’t comply. Doctors often have less respect for obese patients, believing if they would just diet and exercise they’d be slim and healthy.” (source)

Thirty percent of those in the “overweight” class believed they were actually normal size, while 70% of those classified as obese felt they were simply overweight. Among the heaviest group, the morbidly obese, almost 60% pegged themselves as obese, while another 39% considered themselves merely overweight. (source)

10 Healthcare Projects I’d Like To Solve

I always tend to see the glass half full so when I see a problem then I often want to rush in and try to fix it. With that said, here are 10 things that I’ve thought about that I’d like to fix or see as big opportunities:

1. The healthcare experience. While this is the third leg of the Triple Aim, it often seems like the one that is so hard for healthcare companies to get. The system is so fragmented that the patient often is forgotten.

2. Device integration. While devices are better and integration is possible, there is still a huge lift to integrate my data into the typical clinical workflow. This is only going to get much worse with ubiquitous use of sensors and will be the limiting factor in the growth of the Quantified Self movement. (See my post on FitBit)

3. Intelligent phones. This is something that people carry everywhere. They often live life through the phone sometimes missing out on reality. The phone has tons of data as I’ve described before. We have to figure out how to tap into this in a less disruptive way.

4. Consumer preferences. I’m a big believer in preference-based marketing. But the question is how do I disclose my preferences, to whom, and are my preferences really the best way to get me to engage. What would be ideal is if we could find a way to scale down fMRI technology and allow us to disclose this information to key companies so they could get us to take actions that were in our best interest. (see old post on Buyology)

5. Benefits selection. I’ve picked the wrong benefits a few times. This drives me crazy. As I mentioned the other day, the technology to help with this exists and all the data which sits in EMRs and PHRs should allow us to fix this problem.

6. The role of retail pharmacy. This is one of my favorite topics. With more retail pharmacies than McDonalds and a huge problem of access, pharmacies could be the key turning point in influencing change in this country.

7. Caregiver empowerment. Anyone who cares for an adult and/or child knows how hard it is to be a caregiver and take care of their own needs. This becomes even harder with the people being geographically apart. With all the sensors and remote technology out there, I see this being a hot space in the next decade.

8. The smart house. As an architect, I’ve always dreamed of helping create the intelligent house where it knows what food you have. It manages your heat and light. It tracks your movements and could call for help if you fall. I see this being an opportunity to empower seniors to live at home longer.

9. Helping the disenfranchised. For years, we’ve all seen data showing that income can affect health. The question is how will we fix this. Coverage for all is certainly a critical step but that won’t fix it. We have a huge health literacy issue also. Ultimately, public health needs a program like we had to get people to wear seat belts. We need yo own our fate and change it before we end up like the humans in the movie Wall-e.

10. A Hispanic healthcare company in the US. With 16% of the US that speak Spanish, I’m shocked that I haven’t seen someone come out with a health and wellness company that is Hispanic centric in terms of the approach to improving care, engaging consumers, and providing support.

So, what would you like to solve?

Retail Pharmacy As The Digital Medical Home

I’m excited to deliver my presentation on the topic about the retail pharmacy as the digital medical home tomorrow at the intersection of three CBI conferences – Point of Care Summit, Retail Strategy Summit, and Strategic Distribution Planning for Specialty Products.  As always, I’m sharing my slides below via SlideShare, and I’ll set up some tweets to give you the cliff note version.

The key here IMHO is that retailers are best positioned to take advantage of this, but the key points are:

  1. Why retail pharmacy?
    • Retail pharmacies have trust from consumers.
    • Easily accessible.
    • Pharmacy is the most used benefit.
  2. What’s the challenge?
    • Successfully engaging the consumer.
    • Integration with the provider so there are process oriented care gaps.
    • Data.
  3. What needs to happen?
    • Focus on the golden moments for engagement.
    • Systemic model for engagement – e.g., Prochaska.
    • Tools and skills to motivate the consumer – e.g., Motivational Interviewing, Incentives.

OMG – Prescription Coupons Could Cost Consumers More

Talk about an article that seems a few years late to the party…

Anyways, I was reading a link from the PCMA today about an article on philly.com about copay cards.  It stresses several points:

  • The cards are typically only for 90-days.
  • The cards get people started on brand drugs not generics.
  • People are less likely to switch to generics after they use the brand.
  • This costs people more money over time.

I’ve talked about copay cards many times and presented on this topic at the PCMA conference a few years ago.

Let me give some quick thoughts here.

  1. The cards may typically be for only 90-days, but most people that drop off therapy or titrate to other strengths do so in the first 90-days so perhaps this is saving some money.
  2. Of course, it’s for brand drugs not generics.  That’s the business model we’ve created in this country where generics are priced at pennies so there is no marketing to support those products.  It’s the PBMs and pharmacies that do the marketing for generics since they are the ones making money here.
  3. I think it’s a fair generalization that people are less likely to switch, but this is the problem.  If the drugs are the same (per the FDA), why is this an issue?  Is it an educational issue.  Or, is there really a difference?
  4. I’m not sure the consumer cost is the issue.  That’s marketing 101.  Don’t most consumers understand this issue that sales and coupons drive you to build loyalty often to higher priced products.  I think the debate here needs to stay on the payer who pays 70-80% of the drug costs.  They are the ones who really have an issue here since they don’t control the decision made in the market.

This one doesn’t seem to be going away, but I’m not seeing any net new information.

Diet Soda Versus Regular Soda – Ongoing Confusion

I view this as one more example of how the average consumer gets confused by all the information out there.

images

Should I focus on calories?

Should I focus on the ingredients?

Should I just drink water?  (of course)

Now, “new” research shows that the artificial sweeteners in the Diet drink can actually fool your body making it worse for you over time.  This isn’t completely new if you look at this blog from a few years ago.

But, we often wonder about why consumers don’t take responsibility for their actions and then get upset when more aggressive measures have to be taken.  (See the recent Penn State uproar.)

Consumers don’t know who or what to trust.

Should I drink alcohol?  Is it good for me in moderation?

How much exercise is needed?  New research shows that it can’t all be done at once.

Only 15% Of Workers Leave The Office Every Day

Have you noticed that you eat lunch more at your desk every day?  I certainly have.

With 7 hours of meetings (at least) every day plus 300+ emails every day, we’re busy.  I’d argue that most companies these days are busier than they were historically.  At the same time, everyone is focused on wellness and healthier choices.  When sleep, diet, exercise, and stress are all related to health, it’s hard to separate those from the workplace.

That being said, I wasn’t too surprised by this recent poll I saw which highlights this.

Exercise at work

Did You Know? Chronic Kidney Disease (#CKD) From The National Kidney Foundation

I was reading a document from the National Kidney Foundation (NKF) the other day.  Some of the facts jumped out at me.  I thought I’d share them.

  • 83,000 people are on the waiting list for a kidney transplant
  • 1 person dies every 2 hours while waiting for a kidney transplant
  • 26M Americans (1 in 9 adults) have chronic kidney disease (CKD) and most don’t know it
  • 367,000 people depend on dialysis for survival

It also reinforced some things that many people may know:

  • Once kidneys fail, patients need a transplant of dialysis to survive
  • People with diabetes, high blood pressure, or a family history of these conditions are at risk for CKD
  • African Americans, Hispanics, Asians, Native Americans, and the elderly are at increased risk

You can also find more information about CKD from the CDC.

There was an article this week in the NY Times about this silent killer.  Here’s a paragraph from there.

Only 1 percent of participants with no lifestyle-related risk factors developed protein in their urine, an early indicator of kidney damage, while 13 percent of those with three unhealthy factors developed the condition, known medically as proteinuria. Obesity alone doubled a person’s risk of developing kidney disease; an unhealthy diet raised the risk even when weight and other lifestyle factors were taken into account.

CarePass, Another Aetna Innovation – What’s Your Healthy?

Have you seen the new “What’s Your Healthy?” campaign?  Here’s a few shots.

BTW – My healthy is keeping up with my kids in sports and moving down a belt notch.

Image

Image

As many of you know, I consider Walgreens and Aetna to be two of the most innovative healthcare companies today (out of the big, established players).  [And, full disclosure, I own stock in both.]  I’ve talked about Walgreens (see Walgreens post on innovation) several times along with Aetna (see Healthagen post).

That being said, the new campaign along with the press caught my attention.  I was glad that I was able to get some time with Martha Wofford who is the VP and head of CarePass.

“We want to make it easier for everyone to engage in their health and hopefully shift from thinking about health care to taking care of their health,” said Martha L. Wofford, vice president and head of CarePass from Aetna. “CarePass helps consumers connect different pieces of health data to create a fuller, more personalized picture of their health.”

I spent some time talking with Martha and team about their initiative.  Here’s some highlights that stuck out to me.

  • There use of goals was really easy and intuitive.  If you log-in to the CarePass site and get started, you have 3 options or you can create your own (see below).  We spent some time talking about the importance of making these relevant to the individual not focusing on “healthcare goals” like adherence or lowering you blood sugar.  Most of us don’t think that way.  As they described them, they picked “motivation centric goals”.
    Aetna Carepass goals
  • I was also really interested in how they picked which apps to recommend.  There are so many out there, and many of you know that I’ve been fascinated by the concept of curating apps or prescribing apps to people.  They had a nice, simple process:
    • Which apps are most popular?
    • Does the app have “breadth”?  (i.e., national applicability)
    • They also spent more time pre-screening apps which collect PHI to understand them before listing them on the site.
    • They’re using the consumers goals to recommend apps to them.
  • The other big question I had is why do this.  It certain helps build the Aetna brand over time, but there’s not direct path to revenue (that I see).  They described their efforts as “supporting the healthcare journey” through connected data.  Ultimately, it’s about making Aetna a preferred consumer brand which may be very relevant in the individual market and exchange world in the not too distant future.
  • I like the idea of companies being “app agnostic” as I call it.  Walgreens is doing this.  Aetna is doing this.  I plan on doing this in my day job.  This allows the consumer to pick the app that works for them and as long as the data is normalized (or can be normalized) and the app provides some type of open API (application programming interface) it’s much easier to integrate with.
  • We talked a little about what’s next.  Metabolic syndrome is something they brought up.  This is something that Aetna’s been talking about in several forums for a while now.  They launched a new offering earlier this year.  (I still hate the term metabolic syndrome from a consumer perspective, but it seems to be sticking in the healthcare community.)
  • We also talked about new goals to come around smoking cessation, medication, and stress.
  • Another discussion I have with lots of people is how this data gets used.  (see a good article about what’s next for QuantifiedSelf)  I personally really want to see my data pushed to the care management team to monitor and send me information.  (Eat this not that type of suggestions)  Martha talked about how the data belongs to the member and they have to choose to push it to the coach.  She also talked about how they’re integrating with their PHR (Personal Health Record) first and then looking at others.  (see old interview with ActiveHealth)

In summary, CarePass is a nice additional to your #QuantifiedSelf toolkit.  As you can see from the screenshots below, the GUI (graphic user interface) is simple.  It’s well designed.  Integration with your apps is easy.  It provides you with goals and motivation.  They help you navigate the app world.  And, it helps you bring together data from multiple sources.  Once it can pull in all my Rx, medical and lab data along with my HRA data and my device data, it will be really cool!  But, I know that I’m a minority in that effort.  I’m really intrigued by the lifestyle questions they ask and wonder how those will ultimately personalize my experience.

Carepass lifestyle questions Carepass dashboard

So, what apps do they share?  Here’s a screenshot, but you really should log-in and try the site and see the full list.  It’s simple and worth the effort.

Carepass apps

As an added bonus, I’m adding a presentation I gave with Aetna at the Care Continuum Alliance two years ago.  I was searching for my past interviews with Aetna people and found this online so I added it to SlideShare and put it here.

Prescribing An App vs. An Rx – Why Are People Surprised?

A staggering 90 percent of chronic patients in the US would accept a mobile app prescription from their physician, as opposed to only 66 percent willing to accept a prescription of medication, according to a recent survey from health communications firm Digitas Health.  (source)

Is this surprising to anyone?

I don’t think it should be…and here’s why:

  1. In general, most apps don’t cost anything while prescriptions generally do.
  2. I don’t know of any apps with side effects.
  3. It’s unlikely that your app will have a negative interaction with another app (like a drug-drug interaction).  It may give you conflicting information, but that’s about it.
  4. You don’t have to wait to get your app.  You can probably download it while you’re at the physician’s office.  A prescription can take time to get either waiting in line, waiting for it to get filled, or sending it in through the mail.
  5. You don’t have to refill your app.  You may have to update it every once in a while, but it tells you when and all you have to do is press a button.

Of course, most (all) apps won’t have the same likelihood as Rxs in improving your health.  Of course, Rxs only work if people take them…which they don’t.

Still surprised?

Should You Care That Obesity Is Now A Disease?

The AMA has opened an interesting discussion in the past few days with their decision to recognize obesity as a disease.  On the one hand, we all know obesity is a problem that’s impacting our overall health and productivity across the world.  On the flip side, will this actually change anything?

Key discussion points:

  • What is a disease?
  • Is BMI a good metric to use?  If not, what should be used to measure obesity – waist?
  • How do you treat it?

Here’s a few quotes from some articles:

“Right now, physicians will treat high blood pressure, diabetes, give patients medications and say, ‘Oh you also need to lose weight,’” Khaitan told FoxNews.com. “I think (this) gives the physicians a little more credibility in pushing patients to address obesity and become healthier. It’s recognized as a disease…not just something that (because) you have poor lifestyle habits, this is your problem.”  (Fox News)

Obesity is not just a health risk but a disease. Estimates of the genetic contribution to weight gain in susceptible families range from 25—40% with a greater heritability for abdominal fat distribution of 50%1>2.  Obviously there is a major environmental effect but this genetic susceptibility alone removes this condition from a social stigma to the disease category.  (British Medical Bulletin 1997)

“The American Medical Association’s recognition that obesity is a disease carries a lot of clout,” says Samuel Klein, director of the Center for Human Nutrition at Washington University School of Medicine in St. Louis. “The most important aspect of the AMA decision is that the AMA is a respected representative of American medicine. Their opinion can influence policy makers who are in a position to do more to support interventions and research to prevent and treat obesity.”  (USA Today)

Telling all obese people that they have a disease could end up reducing their sense of control over their ability to change their diet and exercise patterns. As experience with addictions has shown, giving people the sense that they suffer from a disease that is out of their control can become self-defeating. So the disease label should be used sparingly: just as not all drinking is alcoholism, not all overeating is pathological. (Time)

Here’s a few facts from the Obesity Action Coalition:

  • In the United States, it is estimated that 93 million Americans are affected by obesity.
  • Individuals affected by obesity are at a higher risk for impaired mobility and experience a negative social stigma commonly associated with obesity.
  • Socioeconomic status plays a significant role in obesity. Low-income minority populations tend to experience obesity at higher rate and are more likely to be overweight.
  • In 2001, the states with the top five percentages for obesity were Mississippi, West Virginia, Michigan, Kentucky and Indiana.
  • Almost 112,000 annual deaths are attributable to obesity.
  • In the United States, 40 percent of adults do not participate in any leisure-time physical activity.

Here’s also a few things you might not realize about obesity from Yale:

  • Finding 1: Obesity can raise some cancer risks
  • Finding 2: Obesity is tied to heart attacks in younger adults
  • Finding 3: Obesity can ruin your day
  • Finding 4: Obesity speeds up girls’ puberty
  • Finding 5: Obesity is a cause of diabetes in kids
  • Finding 6: Obesity in middle age increases risk for dementia

Let me give my hypotheses on why this might matter:

  1. In theory, this is supposed to increase the likelihood that physician’s talk about obesity with their patients.  This would be great, but I think most research shows physician’s aren’t prepared or comfortable with this discussion.  Will the fact that it’s a disease make this easier?  Maybe.
  2. This may be a boon for the obesity Rx market (assuming any of them work and have minimal side effects).  Physician’s may be much more likely to write an Rx for a disease than a lifestyle issue.
  3. This may help get obesity Rxs and bariatric surgery to be covered by health insurance.  The downside of this is that more people may not actually change behavior (diet, exercise, sleep) but instead look for a “quick” fix through drugs and surgery.

In my mind, there is a best case scenario here:

  • Calling it a disease drives awareness among the healthcare community.
  • This increases investment in resources to treat obesity.
  • Treatment is viewed more like mental health to include drugs and behavioral therapy.
  • Physician’s get trained on the disease.
  • Pharma details physicians on the disease and creates CME programs.
  • Patients start to take this more seriously.
  • Plans cover obesity – insurers, employers, CMS.
  • Obesity becomes a broad program including diet, exercise, coaching, Rx, and bariatric surgery following a progressive approach to treatment tied to your starting point.
  • Companies link incentives to managing weight.
  • New metrics are designed that are better than obesity.

Of course, one of the more recent articles which was depressing on this topic was that exercising regularly may not overcome the impact of sitting the rest of the day.  That makes it very hard to increase caloric burn while having a job that requires lots of desk, computer, and meeting time.

Costs Of Obesity In America

Pharmacy Non-Adherence Infographic

While I’ve moved most of the infographics I find to my Pinterest account, I wanted to capture and share this one from Stephen Wilkin’s blog since it hits so many of the points that I try to make with people.

patient-non-compliance-infographic3

Why Do People Think Adherence Is So Easy?

I think we all know that medication adherence is a big deal. The most common number quoted is the $290B waste number from NEHI. There are numerous studies that confirm the value of non-adherence even one that just came out.

The amount of money spent on trying to improve adherence is huge! Pharma has worked on. Retail pharmacies have worked on it. Providers have worked on it. Insurance companies have worked on it. Employers have worked on it… And all of these have happened across the world.

At the same time, you see people get so excited about things don’t make any sense to me.

Let me take an easy example. A few months ago, a company called MediSafe put out a press release around moving medication adherence on statins up to 84.25%. Nothing against the company, but I read the press release and reached out to them to say “this is great, but it’s only 2 months of data…most people drop therapy after the first few months so who care…call me back when you get some good 12 month data.”

But, a lot of people got all excited and there was numerous press about this – see list of articles about them.

Now, tonight, I see another technology getting similar excitement. Fast Company talks about the AdhereTech technology which integrates a cellular phone with a pill bottle. And, it costs $60 a month. In my experience, companies wouldn’t even spend $2 a month to promote adherence so $60 is just impractical. The argument is that this is good for high cost specialty drugs that are oral solids not injectables. But, this isn’t a new idea. Glowcaps already built this model with a very slick interface and workflow.

And, I don’t know about you, but I think this would be obnoxious. And, I love data and am part of the QuantifiedSelf movement. I’m not sure I understand the consumer research here. I would have to believe all of the following to buy into this model.

  • Non-adherence people are primarily not adherent due to no reminders to take their medication on a daily basis.
  • People with chronic conditions that require high cost specialty drugs are going to change behavior because some bottle sends them a text message.
  • Manufacturers or some other healthcare company is willing to pay $60 a month for this service.
  • There won’t be message fatigue after a few months (weeks) of messaging.
  • Pharmacies would be have to be willing to change their workflow to use these bottles.

Yes. Will this work for some people…sure. But, if it helps 10% of people, then my cost is really $600 per success.

Should we be working on better solutions to address adherence…of course.

But, let’s stop trying to figure out some gimmick to fix adherence. Let’s look at root cause.

For example:

  • People don’t know why they’ve been given a medication.
  • People don’t understand their disease.
  • People can’t afford their medication.
  • People don’t know what to expect in terms of side effects.
  • People don’t see value in improving adherence.
  • People don’t know they have to refill their medications.
  • People aren’t health literate.

We have a lot of problems.

How The CVS Program Will Change The Employer – Employee Contract

Have you heard that CVS Caremark is requiring employees to go get biometrics and going to take action on it? OMG!

I’m not sure I understand why people are all upset. Let’s look at the facts:

And, by the way, have we forgotten how much healthcare costs have gone up over time and who pays that bill. It’s either the employer or the government. Both of those things impact our pay as individuals either in terms of lower raises to cover healthcare costs, shifting healthcare costs to us, or taxes. It’s not sustainable so the person who pays the bill has to step in since we’re not. (Which is also why I support the NY ban on soda.)

Now, let’s look at our healthcare system where in the current fee-for-service model, there isn’t an incentive for physicians to address this.

For now, people should be happy. They’re only being required to do the biometrics. The penalty isn’t linked to whether they’re fat or have high blood pressure or smoke or have high cholesterol or have diabetes. A recent study by Towers Watson shows that while 16% of employers do this type of outcome based incentive program today (2013) that this is going to jump to 47% in 2014. So, this will be the norm.

And, guess what…sticks often work better than carrots in some cases.

And, healthcare costs are making us uncompetitive globally as a country.

  • The cost of healthcare is greater than the cost of steel in a car.
  • The cost of healthcare is greater than the cost of coffee in a Starbuck’s cup of coffee.

And, health reform is allowing (even enabling) this to happen. It says that you can treat people differently and create up to a 50% differential in costs associated with their health. (Not a legal definition so read the fine print.)

But, what I think all of us (consumers and employers) will need to realize is that moving to this (which I agree with) will change the employer and employee relationship in several ways.

  1. You can’t put these programs in place without something to help me manage my obesity, cholesterol, and/or other chronic condition. This will drive wellness and disease management programs to be more engaging and successful.
  2. This will put pressure on employers to create a culture of health since we spend so much time at work and work contributes to our health conditions.
    1. Need more time to be active. Less sitting. Treadmill desks. Standing meetings. Nap time. Walking breaks. Use of devices to track steps. Incentives. Gym discounts. Healthy food discounts.
    2. Need less stress.
    3. Need more sleep.
    4. Better food choices at work.
  3. This will drive a lot of the new tools and run counter to some trends about limiting dependent coverage since you can’t address obesity without engaging the entire family and the social network.
  4. This will also create a whole exception process by which people who gain weight due to certain drugs have to be excluded. People who can’t exercise may have to be excluded. People may have to see short-term goals (i.e., dropping BMI from 35 to 32). Physicians will have to be engaged.
  5. Coaching will have to expand to include dieticians, social workers, and others to help people beyond the historical nurse centric coaching model.

If none of this motivates you, then just think about the “gift” we’re giving our kids and maybe that will be a wake-up call why someone has to do something here. (As I shared the other day, I struggle with my weight so don’t think I’m some super skinny, high metabolism person who thinks this is easy.)

Why It’s So Hard To Improve Consumer Engagement In Healthcare?

I spend a lot of my personal and professional time trying to figure out how to better engage consumers in healthcare.  If you can’t engage them, you can’t improve outcomes.

Never mind the fact that people experience about 5,000 messages a day so you have to cut through that clutter.

Even if we do cut through the clutter, people are busy living their lives.  They’re worried about their family.  They’re worried about the economy.  They’re trying to keep food on the table.  They are generally overwhelmed with too little sleep and too much stress.

But, let’s even assume that you can cut through the clutter and get them to listen, you still struggle with getting a person at a time when they are open to change.  These “golden moments” require them to see value in the change and feel like the short-term effort is worth the long-term gain.  This “value exchange” doesn’t often exist.  And, with 30% variance in the healthcare system, people often don’t trust the system.

Even with all that in mind, people still don’t engage.  They don’t get flu shots.  They don’t fill their medications.  They don’t understand the messages that are delivered to them.

Here’s a quick image I created for a presentation later this week.

Consumer

A few of the sources for this are:

A Compelling Argument As To Why You Need More Germs

“In our modern effort to eradicate disease, we pop antibiotics like candy, apply hand sanitizers with abandon, and gargle mouthwash by the gallon. But this carpet-bombing of germs takes a huge toll on good microbes as well as bad. The March/April issue of The Saturday Evening Post, on newsstands now, reveals recent research pointing to medical problems including asthma, obesity, and chronic sinusitis that might be caused by the absence of certain microbiota in our bodies.”  (From a press release about the article Why We Need Germs.)

What if the bacteria in our body was a determining factor in chronic conditions?  Would you try to get more bacteria into your body?  Would you stop doing things to kill the bacteria?  Would this change our eating habits?

This is a fascinating article by The Saturday Evening Post, it shares some research that might explain why two people can have the same food habits and one be skinny and one be fat.  (A frustrating thing for many of us.)

You can even learn about a crowdsourcing project that will take your feces and tell you the bacteria in your gut.  

In the meantime, you might want to eat more asparagus and garlic.  Yummy!  And, be less stressed out.

For instance, Bacteroidetes—the microbes linked to slimness—proliferate in the presence of fructans, a form of fructose found in asparagus, artichokes, garlic, and onions, among other foods, notes microbiologist Andrew Gewirtz of Georgia State University. A diet high in fructans might support a good crop of slimming Bacteroidetes. On the other hand, he notes, stress decreases the abundance of Bacteroidetes, suggesting one more way stress causes obesity.

Healthcare Fails Again In Experience Survey

The fact that most people would rate their experience with their health insurer low isn’t a big surprise to most of us in healthcare.  But, with the Triple Aim and other quality metrics, the customer experience is becoming an increasingly important metric.  Several recent surveys have talked about this as one of the top priorities for hospital systems.  And, as use of CAHPS continues to grow, this will be more closely linked with incentives.

“Patient experience is on the radar of hospital executives, especially since Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores will soon affect reimbursement,” said Jason Wolf, executive director of the Beryl Institute. “However, the data shows that executives are still grappling with how to implement change within their organizations.” (source)

Like in years past, health insurers just barely nudge out TV service providers to prevent being the bottom of the industry in Bruce Temkin’s Benchmarking work.  While I’d love to see healthcare broken out into hospitals, physicians, pharmacies, insurance companies, PBMs, and care management companies, I think we can assume some similar concerns would fall out.

Healthcare companies need to find ways to address this.  I think there are several key first steps:

  1. Defining your customer;
  2. Mapping their experience;
  3. Creating personas or segments to think about (i.e., healthy, sick, insured);
  4. Identifying influences on their experience (some of which you might not control);
  5. Determining what matters versus doesn’t matter;
  6. Capturing baseline metrics; and
  7. Building a continuous improvement process.

Temkin Group 2013 Satisfaction Temkin Group Satisfaction

 

59% Of MDs Want To Know About Employer Care Mgmt Efforts

I just came across this survey data from January of 2010 where the Midwest Business Group on Health (MBGH) did a survey of physicians. I found it really interesting. Let me pull out a few points with some comments…

  • 72% of physicians agree that employers should have a role in improving and maintaining the health of their employees with chronic disease. [Since they ultimately are the one paying the bill, this seems like a reasonable expectation in today's world.]
  • 59% believe that they should be informed about employer efforts to help their patients manage chronic conditions. [This is increasingly becoming important as we move from a Fee-For-Service (FFS) world to a value-based or outcomes-based healthcare environment.]
  • 46% agree that employers should have a role in helping employees adhere to their medication and treatment regimes. [Since MDs generally don't view this as their task, if it's not someone acting on behalf of the employer, I wonder who they think should be doing this.]
  • 32% agree that employers should play no role in the health of patients. [With healthcare impacting productivity and global competitiveness, I think this is an unreasonable expectation.]
  • 61% want the employer to provide physicians with information on what is available to patients so they can counsel them on the value of participation. [How would they want this information and what would they do with it?]
  • 49% would like to receive workplace clinical screening results to reduce redundancies in testing. [Do the other 51% want duplicative testing?]
  • 48% want to receive actionable reports (e.g., screening results, health coaching reports) to support them in treating patients. [I would hope so. If the employer (or really their proxy) is managing the patient in a chronic program, why wouldn't the physician want this data?]
The study went on to say that physician’s want employers to provide support around weight loss, smoking cessation, flu shots, and other broad programs. They also want the employer to focus on lifestyle change and health improvement not the chronic disease itself. This makes sense, but in general employees are more focused on trusted information coming from their physician not their employer so there’s a clear gap here. (See graph from Aon Hewitt’s 2011 Health Care Survey, New Paths. New Approaches.)

Only 50% Of Healthcare Companies Respond To Twitter Messages – Test Results

12 Of 23 Companies

As I mentioned a few weeks ago (2/2/13), I wanted to test and see if healthcare companies would respond to consumers via Twitter. To test this, I posted a fairly general question or message on Twitter to see the response (see below). Of the 23 companies that I sent a message to, only 12 of them ever responded even after 6 of them received a 2nd message. Those results are shared below. What I also wanted to look at was the average time to respond along with which group was more likely to respond.

  • PBMs – All of the 3 PBMs that I reached out to responded. (This could be biased by my involvement in this space since two of them e-mailed me directly once I posted a comment.)
  • Pharmacies – Only 2 of the 4 retail pharmacies that I reached out to responded.
  • Disease Management Companies – Only 1 of the 3 that I reached out to responded. (I was surprised since Alere often thanks me for RT (re-tweeting) them, but didn’t respond to my inquiry.)
  • Managed Care – 5 of the 7 companies that I reached out to responded. (For Kaiser, they responded once I changed from @KPNewscenter to @KPThrive.)
  • Health Apps or Devices – Only 1 of the 5 companies that I reached out to responded. (This continues to surprise me. I’ve mentioned @FitBit on my blog and in Twitter numerous times without any response or comment.)
  • Pharmaceutical Manufacturers – Only 1 of the 3 companies that I reached out to responded. (This doesn’t surprise me since they are very careful about social media. @SanofiUS seems to be part of the team that has been pushing the envelope, and they were the ones to respond. I thought about Tweeting the brands thinking that those might be monitored more closely, but I didn’t.)

I will admit to being surprised. I’m sure all of these companies monitor social media so I’m not sure what leads to the lack of response. [I guess I could give them the out that I clearly indicated it was a test and provided a link to my blog so they could have chosen not to respond.]

Regardless, I learned several things:

  1. Some companies have a different Twitter handle for managing customer service.
    1. @ExpressRxHelp
    2. @AetnaHelp
    3. @KPMemberService
  2. Some companies ask you to e-mail them and provide an e-mail.
  3. Some companies tell you to DM (direct message) them to start a dialogue.

From a time perspective, I have to give kudos to the Prime Therapeutics team that responded in a record 2 minutes. Otherwise, here’s a breakout of the times by company with clusters in the first day and approximately 2 days later.

Company

Response Time (Hrs:Min)

Prime Therapeutics

0:02

Aetna

1:12

LoseIt

1:19

Healthways

2:07

Walmart

3:01

Express Scripts

8:35

Kaiser

29:22

BCBSIL

47:32

OptumRx

47:39

BCBSLA

48:18

Sanofi

53:30

I guess one could ask the question of whether to engage consumers via Twitter or simply use the channel more as a push messaging strategy. The reality is that consumers want to engage where they are, and there are a lot of people using Twitter. While it might not be the best way to have a personal discussion around PHI (Protected Health Information) given HIPAA, it certainly seems like a channel that you want to monitor and respond to. It gives you a way to route people to a particular phone number, e-mail, or support process.

As Dave Chase said in his Forbes article “Patient engagement is the blockbuster drug of the century”, this is critical for healthcare companies to figure out.

The CVS Caremark team told me that they actively monitor these channels and engage with people directly. I also talked with one of the people on the Express Scripts social monitoring team who told me that they primarily use social media to disseminate thought leadership and research, but that they actively try to engage with any member who has an actionable complaint. They want to be where the audience is and to quickly take the discussion offline.

If you want to see the questions I asked along with the responses, I’ve posted them below…

The Prescribing Apps ERA – Will Clinicians Be Ready? #mHealth

Dr. Kraft (@daniel_kraft) recently spoke at FutureMed and talked about the prescribing apps era.  I’ve talked about this concept many times, and I agree that we are rapidly moving in that direction.  And, there’s lots of buzz about whether apps will change behavior and how soon we’ll see “clinical trials” or published data to prove this.

From this site, you can get a recap, but here are the key points that he made:

1) Mobile Phones (quantified self) are becoming constant monitoring devices that create feedback loops which help individuals lead a healthy lifestyle.  Examples include; monitoring glucose levels, blood pressure levels, stress levels, temperature, calories burned, heart rate, arrythmias. Gathering all this information can potentially help the patient make lifestyle changes to avoid a complication, decrease progression of a particular disease, and have quality information regarding his physical emotional state for their physician to tailor his treatment in a more efficient manner.

2) The App prescription ERA:  Just as we prescribe medications prescribing apps to patients will be the future. The reason why this is important is that apps created for particular cases can help the patients understand their disease better and empower them to take better control.

3) Gamification: using games in order to change lifestyle, habits, have been mentioned before. A very interesting concept was that created in the Hope Labs of Stanford. The labs created a game in which children would receive points after there therapeutic regiment, once points were optioned they could shoot and attack the tumor. Helping with the compliance rate of the treatments

4) Lab on a chip and point of care testing

5) Artificial Intelligence like Watson and its application in medicine.

6) Procedure Simulation: Several procedures done by medical professionals follow (not 100%) a see one, do one teach one scenario.  Probably very few people agree with this concept and that is why simulation has great potential. In this case residents, fellows in training can see one, simulate many and then when comfortable do one.

7) Social Networks and Augmented Reality

At the same time, a recent ePocrates study hammered home the point that while this is taking off physicians don’t have a mechanism for which ones to recommend and why.

According to the Epocrates survey, more than 40 percent of physicians are recommending apps to their patients. In terms of the apps being recommended, 72 percent are for patient education, 57 percent are lifestyle change tools, 37 percent are for drug information, 37 percent are for chronic disease management, 24 percent are for medical adherence and 11 percent are to connect the patient to an electronic health record portal.

Physicians also have several different sources for identifying which apps to recommend to their patients. According to the survey, 41 percent get advice from a friend or colleague, while 38 percent use an app store, another 38 percent use an Internet search engine, 23 percent learn of an app from another patient or patients, and 21 percent use the app themselves.

That said, the survey also notes that more than half of the physicians contacted said they don’t know which apps are “good to share.”

As I’ve discussed before, this is somewhat of the Wild West.  Patients are buying and downloading apps based on what they learn about.  They’d love for physicians, nurses, pharmacists, and other trusted sources to help them.  But, those clinicians are often not technology savvy (or at least many of the ones who are actively practicing).  There are exceptions to the norm and those are the ones in the news and speaking at conferences.

IMHO…consumers want to know the following:

  1. Which apps make sense for me based on my condition?
  2. Will that app be relevant as I move from newly diagnosed to maintenance?
  3. Should I pay for an app or stick with the free version?
  4. Is my data secure?
  5. Will this app allow me to share data with my caregiver or case manager?
  6. Will this app have an open API for integration with my other apps or devices?
  7. Is it intuitive to use?
  8. Will this company be around or will I be able to port my data to another app if the company goes away?
  9. Is the information clinically sound?
  10. Is the content consumer friendly?
  11. Is it easy to use?
  12. Is there an escalation path if I need help with clinical information?
  13. Will my employer or health plan pay for it for me?
  14. Is my data secure?

And, employers and payers also have lots of questions (on top of many of the ones above):

  1. Is this tool effective in changing behavior?
  2. Should I promote any apps to my members?
  3. Should I pay for the apps?
  4. How should I integrate them into my care system?
  5. Do my staff need to have them, use them, and be able to discuss them with the patient?  (Do they do that today with their member portal?)

mhealth_infographic_large

Less Than 1/3rd Of Health Insurers Very Confident In Their Big Data Value To Consumers

With all the discussions these days on Big Data and how to use information to create insights and wisdom, I was really shocked when I looked back at this PWC survey from 2011.  In it, less than 1/3rd of health insurers were very confident in their use of informatics to add value around case management, disease management, wellness, and consumer health tools.  WHAT???

This seems crazy to me.  In this interconnected world where everyone is talking about connected devices, mHealth, and ENGAGEMENT, health insurers are in the optimal position to leverage their data to provide insights, to provide transparency, to create algorithms, to be preventative in their actions, etc.  Maybe their technology platforms are too old?  Maybe they’re too silo’d?  I’m not sure.  But, I find this an interesting arbitrage opportunity.

With a system that integrates data from claims, labs, patient reported sources, HRAs, and biometrics, you can add value by creating a personalized patient experience that adapts with their needs.

Clinical Informations for Care Mgmt

Two Examples Of How Healthcare Is Going Local

I remember when I first started working in the healthcare industry in 1998, people kept reinforcing for me that “Healthcare is Local”.  As we move into a national effort to transform healthcare, the question is how will healthcare transform to gain scale efficiencies while still taking advantage of this simple reality.

With that in mind, I found a WSJ article today about hospitals trying house calls very interesting.  It talks about how insurers and health systems are using the old fashion model of house calls to engage patients to reduce re-admissions and improve outcomes…while lowering costs.  Since healthcare costs are massively concentrated with 1% of patients driving 22% of healthcare costs, this becomes possible.  Additionally, as you focus .  on people at high risk based on some model like the Johns Hopkins ACG model or people who have been recently discharged or people with multiple co-morbidities and other risk factors, you have a chance to make a difference.  It will be interesting to see how this takes off.

Another example of how healthcare is going local is the use of health apps.  I saw a number earlier today where someone was saying there’s now 50,000 health apps.  I usually talk about 16,000, but it’s obviously going up all the time.  Employee Benefit News recently had an article about how health apps were changing the engagement rates for wellness programs.  Obviously, the phone is the ultimate in local allowing the creation of an app that’s with us all the time and can be real-time in terms of interactivity.

Wellness In The Workplace – Optum Research

I found a summary of this Optum Study – Wellness In The Workplace in the January 2013 Employee Benefit News:

  • 56% of companies (surveyed) have a formal, written strategic plan for wellness
  • 28% of companies have an onsite clinic
  • 49% of eligible employees participate in company wellness programs (seems really high to me)
  • 90% of companies with 3,000+ employees say wellness solutions are an important part of their benefits (compared with 79% of employers with 2-99 employees)
  • 83% of companies use coaching to address weigh management
  • The top barriers to employee participation are:
    • Lack of time / energy
    • Lack of interest
    • Effective communications
  • 52% of companies offer wellness programs to employee’s family members
  • Onsite clinics are offering:
    • 77% flu shots
    • 56% wellness communications
    • 43% fitness challenges
    • 42% preventative care
    • 41% health risk assessments

wellness participation

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