One area where healthcare has definitely lagged other industries like consumer products and financial services has been in the area of analytics. Silverlink Communications is the first company to bring analytics to the area of healthcare communications.

We have been doing this for years and focus on the different ways to use analytics to improve results. This is not simply custom reporting which is what lots of people mean when they talk about analytics. And, it’s a lot more than simply best practices like co-branded communications (i.e., employer plus health plan) work better than communications simply from a health plan to a member (patient / consumer).

Interested in learning more…We are hosting a webinar series this month that might interest you. The first one is tomorrow.

It includes Stephen Baker who wrote The Numerati; Kinney Zalesne who wrote Microtrends; and Tom Davenport who wrote Competing on Analytics. You can register here.

If you enjoy this topic, I would also encourage you to register and read our white paper on Adaptive HealthComm Science (which is what we call our approach to healthcare analytics for communications). We also have a video on engaging consumers in their healthcare. Both can be found at the bottom of our homepage at www.silverlink.com.

I hope you all had a good Fourth of July. One thing I always think about this time of year is my perception of fireworks. I’ve never been a big fan.

Of course, like most young boys, I had my fascination with fireworks, but after two incidents, I began to view them as more dangerous.

When I was about 10, I had a pack of firecrackers go off right near my ear just as I threw them. Then, in high school, I remember watching bottle rockets hit someone’s house and worrying about it catching fire (which it didn’t).

Why should you care (this is a health care blog – right)?

I think it’s important because our frameworks about going to the doctor, going to the dentist, eating healthy, exercising, preventative care, and so many other things are set in place as we grow up. As a parent, you need to think about the example you are creating. As a communicator to the patient later in life, you need to think about what their attitudes are towards health.

According to the latest research from a Kaiser Health Tracking Poll of 634 respondents from June 1-8^th:

Since, I strongly believe responses are biased by context, I wonder how many people respond that way when they realize that they will be pushed to this plan. [The Lewin Group estimates that as many as 118.5M people (2/3rds of those who have insurance today) would be shifted to public coverage.]

A hot topic is how much is an additional day / month of life is worth.  With some costs for a medication rising to $50,000 or more, this is something that we need to grapple with.  I’m interested in your thoughts on the following questions:

• What would you pay for an additional day / month of life?
• What would you expect your employer to pay for you to have an additional day / month of life?
• What would you expect your insurance company to pay for you to have an additional day / month of life?
• What would you pay if there was a 1 in 1,000 chance that the additional month turned into an additional year?
• Does that change if there is significant pain involved in the extension of life (i.e., you aren’t comfortable during your additional days/months)?

I mentioned a few weeks ago my need to get a new name since the people that had Trademarked “Patient Centric Healthcare” asked me to stop using it for the blog.  I looked at a bunch of names.  Finally, I’m going with “Enabling Healthy Decisions SM”.  I think that summarizes what I’m interested in – healthcare communications, healthcare analytics, healthcare marketing, healthcare technology.  I generally am most interested in those subjects when they relate to leading consumers to make better decisions about their health.

This is based on a Deloitte web-survey of 4,001 Americans in October 2008.

• 73% are confused about how the US healthcare system works
• Over 1/2 believe that 50% or more of healthcare dollars are wasted
• 7 of 8 Americans believe themselves to be in good health
• 1 in 3 are interested in working with a health “coach” to help them create and stick to a plan
• 68% are interested in home monitoring devices that would check their condition and send results to their MD
• 3 in 5 say financial penalties would improve their adherence
• Only 1 in 3 Rx users say they compared treatment options
• 22% say they looked or asked for information about a health insurance plan in the last 12 months
• 9% have a PHR
• Physicians who are more prescriptive (paternal) were preferred by a ratio of 2:1
• 8 in 10 say they would consider switching from a physician recommended Rx if a pharmacist (RPh) indicated a cheaper alternative was available
• Only 12% said they understood the term – biologics (should they?)
• 35% are willing to accept a smaller provider network for a reduced premium and lower copayments
• Only 25% favor increasing taxes to help cover the uninsured

Their major conclusions were:

1. Health care is a consumer market
2. The health care market is not homogeneous
3. Cost concerns are changing behaviors
4. Consumers want holistic care and resources to pursue wellness and healthy living
5. Consumers embrace innovations that enhance self-care, convenience, personalization, and control of their personal health information

I’ll stay with the same theme here for a minute…

I found this one page graphic in the back of Newsweek (6/22/09) which caught my eye.  It was titled “Can You Cheat Death”.  It had some interesting facts from Livingto100.com, Archives of Internal Medicine, PLOS Medicine, and the Journal of the American Board of Family Medicine.

• Life expectancy for the average American man = 75.2 years (80.4 for a woman).
• Positive impacts:
  • +10 years if you have a blood relative who has lived to be 95 or older
  • +5 years if you regularly play puzzles like Scrabble or Sudoku
  • +5 years if you’re a married man
  • +5 years if you take 81mg of aspirin a day
  • +3 years if you eat 5 daily servings of fruits / vegetables
  • +2 years if you floss daily
  • +1.7 years if you go to church regularly
• Negative impacts:
  • -0.5 years if you drink more than 5 cups of coffee a day
  • -1 year if you get less than 6-8 hours of sleep a night
  • -1 year if you have a family history of diabetes
  • -2.5 years if you don’t wear sunscreen and are outside a lot
  • -5 years if you are slowly putting on weight
  • -5 years if you regularly feel stressed out
  • -5 years if you eat red meat more than 2x per week
  • -5 years if you have less than 12 years of education
  • -7 years if you engage in unprotected sex with multiple partners
  • -15 years if you smoke
  • -15 years if you use IV drugs

Obviously, these are only average so you’re not doomed, but I view them as reasonable indicators of how you might influence your length of life.

So, if smoking a cigarette knocks 11 minutes off of your life, you would think that would capture people’s attention.  Or would you?  Given the framework of hyperbolic discounting, what is the value we put on that 11 minutes of life.  If I’m young, I see that as a very distant value with a lot of things that could happen between now and then.  The “benefit” of smoking the one cigarette is very real and immediate.  (I’ve never been a smoker, but I assume there is an enjoyment.)

It’s not very different from eating.  The extra spoonful of sugar in my coffee can (over the course of a year) add a pound and over the course of a decade add 10 pounds…BUT can I really make that tradeoff.

This is one of the fundamental challenges in healthcare especially for asymptomatic diseases where there aren’t regularly experienced symptoms – e.g., high cholesterol.

To Whom It May Concern:

You should be embarrassed to produce this bill. It’s obviously based on a one-sided view of the world regarding Pharmacy Benefit Managers which is generated by sensationalist journalists, jilted employees, independent pharmacists who have lost marketshare to chain drugstores, and pharma manufacturers who have seen their marketshare decline. This type of legislation will only serve to drive up healthcare costs and is exactly the reason why a government run plan won’t work in this country. They’ll focus on lobbyist interests and not the true interests of the consumer.

Let’s go point by point through your legislation and point out some flaws – (see bill here)

1 – Why would a PBM have to tell a consumer what they pay the pharmacy? That’s like Best Buy being required to tell the consumer what they pay for a TV. Most PBMs and/or pharmacies often print on the receipt what the consumer’s payor (employer, managed care company) paid for the drug (i.e., your insurance saved you $100).

2 – Why is the government telling businesses how to do their job? As an HR manager, if I can get a better discount for my employees on their prescription drugs by limiting the pharmacy network, why shouldn’t I have that option. We have preferred vendors in most companies. Why shouldn’t that be true in pharmacy? There are ~60,000 pharmacies in the US which is more than enough.

3 – Again, why is the government interfering in pharmacy law and telling me (the consumer) what I can or can’t do? Why can’t I move my prescription from one pharmacy to another based on discount, convenience, service, or other issues? All you are doing is creating a consumer burden and physician burden with no benefit to anyone.

4 – Now you want to take away my ability to manage drug coverage. There are plenty of circumstances where limiting or denying coverage makes sense due to inappropriate utilization, availability of lower cost options, abuse, and other issues.

5 – I’m completely confused here. You want to tell the insurance companies that they can’t increase the percentage of costs that the member pays (which is really a benefit design issue for the employer) unless the drug prices go up.

6 – This topic has been discussed a lot around switching medications. Of course, the communications should be clear. The patient should understand their choices. They physician should be in the loop (which they are since they have to write the new prescription). You hopefully realize that these are done to lower healthcare costs AND that physicians neither discuss costs with patients (generally) nor do they believe it’s their job to do this.

7 – Do you really believe that the dispensing physician who is focused on caring for their patients has the time to keep up with all the medical literature that a Pharmacy & Therapeutics (P&T) Committee reviews in determining protocols around step therapy? Look at the research…it shows that it takes 17 years for evidence-based standards to become standard practice. I personally don’t want to rely on my individual physician (who does a damn good job) to understand all the latest literature (w/o an EMR). And, I would hope no MD would willingly write an Rx that causes harm. All step therapy programs offer a prior authorization override to the MD and the PBM systems look for drug-drug and other types of interactions.

So, I guess the question is why are you (the legislation) trying to force me (the consumer) to have more administrative headaches, higher costs, and be treated with outdated protocols? And, at the same time, you’re going to force my employer to have higher costs and likely have to stop offering healthcare. And, you’re going to put more administrative burden on my physician who is already overworked and potentially underpaid.

Oh, wait, I get it…If you make the existing companies unable to run their business and unable to use evidence-based standards to lower costs then a government run experiment in socialized medicine will look much better. I hope that the Obama camp recognizes you for your hard work in advocating for them.

In reading the article about generic drugs and the subsequent comments, I am amazed at how much mis-information and confusion exists.

Let’s start with a few facts:

• Generics are approved by the FDA and have to have the same manufacturing standards.
• Generics receive a rating (e.g., A-B) and are chemically equivalent to the brand drug upon whose patent they are based.
• Chemically equivalent drugs have the same active ingredients but different inactive ingredients.
• Generics cost less since there is no research and no sales and marketing activity to support.
• A high percentage of generic drugs are made by the brand drug manufacturers.
• Consumers save money on generics.  Pharmacies and PBMs make money on generics.  Plan sponsors (i.e., employers) save money on generics.  Everybody wins!
• The variance in active ingredients is no different on generics than it is on brands.

There is definitely plenty of misinformation out there.  I would suggest sticking with sites like the FDA’s site on what’s real.

As the study by Prescription Solutions (United Healthcare) shows, there is confusion in the market.

• Nearly 1/3rd of Americans don’t know or believe that generics are identical to brand drugs.  (They’re not identical, but the active ingredients are.  I would have asked the question differently.)
• 2/3rds of respondents didn’t know that generics typically cost 50-70% less than brands.  (That surprises me.)

Jacqueline Kosecoff, Ph.D., chief executive officer of Prescription Solutions, said, “Using generics helps make health care more affordable without compromising results. Many Americans erroneously believe that the most expensive drug is always the most effective drug, so by helping to change perceptions, we can help people save money and still get the best treatment available.”