Insider’s View is Too Close

As I think it can be in any industry, a big challenge is immersing yourself in your field while at the same time maintaining and outside-in perspective.  The challenge of losing that perspective is (A) using language that people don’t understand or (B) creating elequoent solutions that aren’t practical.

(A) From a communication perspective, the issue of language is one where I am sure most of you could come up with examples.  There are numerous times when I have gotten something and had to read it a few times to understand whether it was an EOB (explanation of benefits) or a bill.  I remember trying to write letters to patients and having to re-write them numerous times to get them ready to be sent out.

For example, in the PBM world, we would talk about refills versus renewals.  (e.g. glossary) I don’t think many consumers know what a “renewal script” is…but that wasn’t intuitive to us.  [BTW – It means your prescription has no more refills left.]  We would talk about DAW prescriptions [aka Dispense As Written].  Even worlds like formulary caused people problems when we used it on the website or in a letter [preferred drug list sometimes worked better].  Another one that threw everyone off was saying “this drug is not covered”.  Did that mean the patient couldn’t get the drug?  Did that mean the patient had to pay cash for the drug, and if they did, did they receive the client’s negotiated discount at the pharmacy?  Did that mean it required a Prior Authorization? 

I think the point where this really threw people off was when we communicated to physicians.  In my job driving generics, I remember reviewing the physician letters and seeing that we always called the drugs by their generic name – omeprazole (Prilosec), fluoxetine (Prozac).  When I pointed out that physicians don’t always know the drug by its chemical name, people were shocked.  Sending a letter to a physician saying you should switch from Nexium to omeprazole was pretty ineffective if they didn’t know what drug we were recommending.  I always tried to get us to say “the generic version of Prilosec (omeprazole)”.


(B) On the side of an overly eloquent solution, I have been stymied by my insurance card.  It is a national coverage card from BCBSMA.  It may work great in Massachusetts, but in Missouri, the providers can’t find the group ID on the card.  This has happened everytime we use it.  If they hadn’t been a client at Express Scripts and I knew their group IDs by heart, then each provider would have to call them. 

The other challenge with the card is that they give you one for each person in the family.  So, if you have 5 kids, you would have 7 cards (which you are expected to carry).  At the doctor for our kids the day, we simply tried to give them the patient IDs for the kids.  They were upset since apparently they have a swipe card system for the BCBS cards and don’t know how to manually enter the patient ID. 

To me, this is a great example of something that has been totally reengineered and become less effective.  I am sure they were putting more information on the card and pushing the group number to a corner wasn’t a big deal.  I am sure individual cards is great for older kids that carry their own.  I am sure smart cards is a great thing.  Unfortunately, all it has done is make it harder not easier. 

On the positive, I like BCBSMA’s general approach, service model, and many other things so the card is a hassle but not likely to impact my overall satisfaction.

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