Archive | November, 2007

New (to me) Blog – Consumer Focused Care

November 19, 2007 by George Van Antwerp 1 Comment

I found a new blog this morning called Consumer-Focused Healthcare written by an ex-McKinsey consultant which seems to have a very similar focus to my blog – “refocusing healthcare on serving consumer needs“.  [As a sidenote, the benefit here of LinkedIn was that I could quickly look him up and see that we have a mutual friend which instantly gives him some validation.]

Vijay has a lot of posts that I liked.  Here are a few exerpts:

  1. “the consumer often pays MORE for a visit to a retail clinic than a physician’s office. The implications are that they really prize the convenience and time taken far over the extra training provided by the physicians.”  In this blog entry, he shared some data about out-of-pocket expenses for clinic visits.
  2. “It is pretty clear that many doctors don’t know how to tell their patients that they have no idea”  In this blog entry, he talks about the inexact aspects of patient advice.  Determining a diagnosis or the right advice is very situational.
  3. “why are people willing to spend $3.50/ pill on sleep meds when they’re discouraged by $10 co-pays to take other, potentially life-saving medication?”  In this entry, he talks about consumerism.
  4. He also points out an assumption from Google that technology will push physicians to spend less time with patients which I think isn’t logical based on the work I did around e-prescribing.  I already put a comment in this blog entry this morning.

And, these are just his most recent entries.  I am interested to flow his blog more.

Consumerism, Healthcare, Innovation, Managed Care, Marketing / Communications, Research, Technology, Weblogs

Tonik Health Insurance

November 18, 2007 by George Van Antwerp 2 Comments

I always smile when people ask about using SMS (or text) messaging to communicate with patients. Interesting. Perhaps even “cool”, but not real practical. You have limited message length. You have to have cell phones for people, and with all the privacy issues, can you control it.  There are a lot more opportunities to communicate better with patients than use SMS.

So, I was intrigued to find out about Tonik Health Insurance which is an offering by Wellpoint for the Generation X or Generation Y population. If you go to the site, you will see things like:

  • Edgy graphics
  • Slang / informal language (e.g., “Tonik offers three straight-up affordable health insurance plans to cover your A-Z“
  • At one point, the site mentions Borat (not typical in a healthcare website)

I don’t know much about it, but it seems very interesting.  I am a little surprised to see it offered by such a mainstream company.
I even came across a publication called “NOT ur parents’ healthcare anymore: The 411 on selling health via new media” which is a 35-story report on targeting this young population. I have not read the report, but it sounds interesting. (Order Here)

Consumerism, Healthcare, Managed Care, Marketing / Communications

Bing Blog – A Little Harse?

November 18, 2007 by George Van Antwerp 0 Comments

Stanley Bing has written for Fortune for a while and now has a blog.  One of his latest entries is about healthcare and insurance.  Obviously, we have problems with the system (as pointed out in Sicko), but I found some of the comments a little harse.

We can get better, but we should all be thankful for what we do have which allows us access to experts 24×7 using good technology.  We pay a lot per measure of clinical outcome but we have lots of options for how to get treated.  The system isn’t seamless, but it generally works.

I guess for all the criticism which is easy to lob sometimes it seems too harse when people focus only on the negative.  The more you work in healthcare the more you realize how difficult it is to find the right solution.  I don’t envy the politicians.

Healthcare, Managed Care, Weblogs

P4P Survey and Comments

November 18, 2007 by George Van Antwerp 0 Comments

The American College of Physician Executives did a survey on P4P.  Here are a few of the survey results (from over 900 participants):

  1.  Only about 40% of the organizations had a P4P program.
  2. 58% of those without a P4P program are considering it.
  3. 60% think P4P will be a permanent part of healthcare.

I found the comments even more interesting.  Here are a few:

  • It is sad to see some HMOs to put the programs (carrott) out there and then look for every loop hole to deny payment.
  • The challenge is defining the performance and quality improvment. Clearly rewards for volume through the office or RVU’s per month work, but the real issue is the quality of the outcome for a given patient. Defining the clinical outcome is the slippery slope. I think physicians are going to resist being told what they get to create for fear of being judged less than capable. So, the tendency will be to set the bar lower that what could be achieved.
  • In California the P4P program is working very well with significant improvement in outcomes.

payforperformance.gif

Healthcare, Marketing / Communications, Research, Value Propositions

What Have You Failed At Today?

November 17, 2007 by George Van Antwerp 0 Comments

I caught this story on ABC last night about entrepreuners.  It made an interesting point about the need to fail and learn from your failure.  In summary, it was basically saying that people who took risks, failed, and spent the time to learn from their failures ended up more successful.

I think that is very relevant to the world of healthcare communications.  Any program should have a test plan of ideas that are constantly being varied to see what works best.  Each micro-niche of the population is going to respond differently.  If you aren’t out there trying different things, you won’t optimize the success of your programs.

Of course, this is easier said than done. You need a culture that believes in failure.  You need a way to learn from your mistakes.  You need people that are willing to admit they were wrong.  You need a measurement tool to document the success of one attempt versus the other.  And, you need to understand what can be varied to drive change.

Let’s take a simple example here.  In the world of automated voice communications, you can vary dozens of things:

  • Which voice should you use – gender, age, accent?
  • How should the voice speak – casually, formally, authoritarian, consultative?
  • What speed should the voice be at – normal pace, fast, slow?
  • What time of day should you call?
  • What day of the week should you call?
  • Should you leave a message or call back?
  • How many times should you attempt to reach the patient?  Within what window?
  • How long should the call be?
  • Should the call be complemented by letters or other outreach?
  • Should the call offer to connect them to a live agent?

I could go on, but I think you see the point.  Experimentation is key and makes a difference.  I am not even getting into the thousands of variables in the messages. 

So, go out and fail at some new program to communicate and engage with your patients.  Learning faster is your best way to succeed. 

Consumerism, General Business, Healthcare, Innovation, Leadership, Managed Care, Marketing / Communications, PBM / Pharmacy

Would You Use a Pharmacy Kiosk?

November 17, 2007 by George Van Antwerp 2 Comments

Another question from a few years ago that I thought I would throw out here [while I wait for my connecting flight in Charlotte]. Would you use a pharmacy kiosk to drop off your prescription and pick up your prescription as long as you had access to a pharmacist via video conference?

This was an idea that I worked on for about a year. The concept was the following:

  1. Develop a kiosk that had the following functionality:
    • A scanner for you to scan in your paper prescription, insurance card, and identification;
    • A video conference connection for you to talk to a pharmacist who was located remotely using a phone receiver for privacy;
    • A credit card swipe for payment; and
    • Stock the top 200 drugs which could be picked and labeled via robotics and dispensed real-time after your claim was adjudicated and copay collected.
  2. The technology was going to be a blend of what Duane Reade had piloted in NY and what RedBox had created in the DVD space.

redbox_kiosk_1_300.jpg + dr-kiosk.jpg

These kiosks could then be used by the different constituents in the following way:

  • Retail pharmacies to serve as an afterhours pharmacist for certain drugs
  • PBMs as a way to serve employers by putting a kiosk on-site for employees to get acute drugs or short-fills for movement to mail order
  • FDA as a secure way of managing behind-the-counter drugs such as Sudafed where dispensing could be tracked electronically across pharmacies
  • Grocery stores or other retailers as a low-cost customer service play of offering their customers access to drugs without having to invest in inventory and physical assets

I had lots of debate with pharmacists about this.  The pushback of course was whether I was trying to replace or dis-intermediate them.  That was not the objective but rather trying to find a way to allow them to focus on truly providing counseling to patients who needed it while allowing patients filling maintenance drugs or simple acute drugs to get them delivered at the lowest cost.

Given the pharmacist shortage, this seemed like a logical solution to me.  Who knows.  There might be an adoption of this.  It is probably like automated grocery store lines.  I remember seeing them about 10 years ago at a few places and just within the past 2 years they have taken off everywhere.

instymeds.jpg 

The one company that had a similar concept, raised funding, and seems to be getting a little progress is Instymeds.  They have focused on using the technology for rural hospitals where pharmacist staffing and afterhours pharmacy access is difficult.  When I spoke with their CEO, they had raised over $10M, had very patient VCs that were willing to wait out the changes needed in the regulatory environment, and had millions from previous successes in the entrepreneurial space.  I wish them luck.

Here is my older entry on some basics around kiosks in healthcare.

Healthcare, Innovation, PBM / Pharmacy, Software, Technology

Some Pharmacy Statistics

November 16, 2007 by George Van Antwerp 0 Comments

statistics.jpgWhen I worked on my start-up, I collected a bunch of data that I used in my business plan and pitch documents.  I thought they would make an interesting read for many of you.

  1. Size – The prescription drug market is enormous and growing every year. Current estimates put the market size at $221B, and it is projected to grow to $520B by 2014 .
  2. Marketshare – In 2004, according to the National Association of Chain Drug Stores (NACDS), the pharmacy market share was divided as follows traditional chains (41%), mass merchants (9.7%), supermarkets (12.2%), independents (18.3%) and mail order (18.7%). Walgreens had 14% market share.
  3. Cost Pressures – The economic situation for pharmacies is complicated by several forces putting pressure on them:
    • The growth of the Pharmacy Benefit Management (PBM) company has increased the concentration of insured lives within a few Fortune 100 companies forcing the pharmacies to accept lower reimbursement rates;
    • There are now more than 55,000 retail pharmacies in the US and an overcapacity of mail order pharmacies which is more than can be profitably supported;
    • The largest companies such as Walgreens are rapidly leveraging innovative technologies to allow them to fill drugs at a much lower cost while others are clinging to a high touch, convenience model that is not sustainable; and
    • A shortage of thousands of pharmacists in the US has driven starting salaries for pharmacists above $100,000 in some markets.
  4. Growth – The cost pressures facing pharmacies are mitigated by two things – inflation and utilization. Both continue to go up year over year and have dulled the effect of economic pressure. According to Express Scripts 2004 Drug Trend Report, Per Member Per Year (PMPY) utilization is 13.1 prescriptions for insured patients. Assuming a 6% annual growth in prescription utilization, that means that the average insured consumer would use 18.6 prescriptions PMPY by 2010.
  5. Pharmacist Staffing – A recent article estimated that the current pharmacist shortage in the US of 4,000 to 8,000 open positions will increase to 157,000 by 2020. This staffing crunch combined with the payor’s move to consumer driven healthcare where the patient has greater responsibility for their healthcare dollars will put incredible stress on the system. Just as patients need the trusted pharmacist to play counselor or coach, the workload will have increased to the point where they do not have the time to spend with them. In 2005, these issues led Walgreens pharmacists to briefly strike noting the risk to patient safety.
  6. New Models – An increasing number of employers are building on-site pharmacies, and several companies are piloting “vending machine” type solutions for pick-up of dispensed medications. In late 2005, the Department of Defense issued an RFI to explore a telepharmacy solution to replace their Military Treatment Facilities (MTFs) . Some states such as North Dakota are piloting a telepharmacy solution which is a model allowed in several states where a pharmacy technician can dispense while being monitored remotely by a pharmacist.
  7. Patient Satisfaction – Although studies show that pharmacy patients are generally satisfied, 56% of household consumers report that they use more than one pharmacy to fill prescriptions according to the WilsonRx Report 2005. And, according to NACDS, 68% of people choose a pharmacy based on location.
  8. Loyalty – Even though location is a huge influencer, a Morgan Stanley report showed that the willingness to switch to mail was highest at big chains – Walgreens (44%), Wal-Mart (41%), and CVS (35%). Given the concentration of marketshare in these stores and their growth forecasts, it seems logical that the marketshare could be re-distributed to locations that are already visited like grocery stores. According to the Food Marketing Institute (FMI) shoppers make and average of 2.2 visits to the grocery store each week.
  9. Consumer Driven Healthcare (CDHC) – CDHC is used to refer to a lot of different scenarios in which the burden for managing cost is pushed to the patient. This includes high deductible plans, Health Reimbursement Arrangements (HRAs), Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs). One of the biggest issues is that this is similar to the movement to 401K plans, but in healthcare, there is no decision support infrastructure. Initial estimates are that 40% of employers will offer this type of plan design over the next few years. This will put pressure on the pharmacist to act as this decision support resource.
  10. Aging of the Population – With the ongoing aging of the population and forecasted growth in people age 65+, this growth in prescription drug use will continue. Based on the Medical</a Expenditure Survey from 2002, the differences in utilization of prescriptions increases dramatically as people age. For example, people 35 to 44 use 7 prescriptions per year while those 45 to 54 use 12 prescriptions per year and those 65 to 74 use 24 prescriptions per year.
Consumerism, Healthcare, Innovation, Marketing / Communications, PBM / Pharmacy, Research
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Where are the generic only pharmacies?

November 16, 2007 by George Van Antwerp 1 Comment

A few years ago when there was all the debate around Canadian reimportation of drugs, I had the opportunity to write the position paper for Express Scripts on this topic and work with our internal and external counsel to summarize our position with our clients.  At the time, payors and patients were very interested in getting branded drugs filled outside the US and shipped back to them.  [Or, in some cases, driving across the border to get the prescriptions filled.]

In working on that project, I learned that the government control that worked to keep brand prices low – at a simple level think one buyer – had the opposite effect on generics.  Generic drugs actually cost more outside the US where there is massive competition for the drugs.

As I have talked about before, consumers who pay cash pay a ridiculous mark-up on generic drugs even in the US.  Given those two facts, I remember talking with a friend of mine about opening generic only pharmacies just inside the US border to attract Canadian citizens.  Problematic legally I am sure, but the concept seemed like a genius move pre-Medicare Part D.  You could save the uninsured and seniors massive amounts of money.

I haven’t had the time to do the research, but I still have to believe there is an opportunity for a highly efficient pharmacy which offers generics closer to cost.  I would see it more like a membership.  You pay $100 per year to belong and you get your prescriptions for the pennies that they cost rather than your copay or the cash price.  Everyone wins.

But, here we are four or five years later and to the best of my knowledge no one has done it.

General Thoughts, Healthcare, Innovation, PBM / Pharmacy
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Companion Global Healthcare

November 15, 2007 by George Van Antwerp 0 Comments

BCBS of South Carolina has been a progressive Blues plan for years.  Under Ed Sellers’ leadership, they have tried new services and built new businesses.  It was surprising, but not shocking, to see that they had opened a new company called Companion Global Healthcare which is a medical tourism company to help people get costly surgeries and care outside the US.

medical-tourism.jpgI talked about this whole business a few months ago (old entry).   But, seeing BCBS-SC and HealthNet of CA [who has been working with a Mexican healthplan for 6 years] focus on this and take advantage of these services is an interesting development and says a lot about the status of our system.

Here is another article in the Providence Journal.

Consumerism, Healthcare, Leadership

Are We Asking the Right Question?

November 15, 2007 by George Van Antwerp 0 Comments

Obviously, one of the big mistakes that people make when they are trying to solve a problem is to ask the wrong question.  I was thinking about this on the plane and wondered if we think about healthcare wrong.

In a fully-insured world, managed care companies make the most money when patients are healthy.  In an ASO (employer self-insured) world, employers save the most money when employees are healthy.

In both cases, prevention and wellness are drivers of business value.  Obviously, retention and turnover impacts companies ability to capitalize on their investments in these areas.  But, I don’t hear people asking how can I drive wellness and preventative activities to maximize savings and profits simultaneously.  All I hear people asking about is how to fix our confusing and broken system.

Maybe we need to find a way for insurance to stay with the individual (not a new scenario but not one I hear much about right now) – aka portability.  In that case, the company would want to drive satisfaction and minimize costs to retain the members and keep them healthy.  A win-win??

It’s certainly not that easy, but a quick thought on the topic.

Certainly someone can figure out tax incentives and a framework for crediting companies that invest and the member is no longer associated with them…As long as they have done something to improve the condition…

General Thoughts, Healthcare, Value Propositions

Emotional Intelligence (EQ)

November 15, 2007 by George Van Antwerp 0 Comments

I will admit that I have a lot to learn around EQ which is firmly grounded in neuroscience, but I wonder why I don’t hear a lot about this from a communication perspective. Obviously, our reaction to information varies based on where we are emotionally. At the simplest level, I think EQ is why guerilla marketing or grass roots marketing can sometimes be so effective. For many people, group interaction and group perceptions drive their behavior.

   

Daniel Goleman is the author who popularized the EQ term with his book “Emotional Intelligence” published in 1995.

He has identified Five Dimensions of Emotional Intelligence. The first three are personal and the final two are social.

  1. Self-Awareness – Knowing one’s internal states, preferences, and intuitions
  2. Self-Regulation – Managing one’s internal states, impulses and resources
  3. Motivation – Emotional tendencies that guide or facilitate reaching goals
  4. Empathy – Awareness of other’s feelings, needs and concerns
  5. Social Skills – Adeptness at inducing desirable responses in others

After typing these out, I wonder if we could get an EQ score for companies. That would be an interesting ranking to see how aware and empathetic companies really are.

I liked this image I found that represents Executive EQ or EQ for Business.

eq-for-business.jpg

So, I think the key question here is how could we capture an individual’s EQ (or a proxy for it) and use that in our targeting and messaging to them about healthcare.

Books / Articles, Business Tools, Consumerism, Healthcare, Marketing / Communications

Most Prescribed Drugs for Kids

November 15, 2007 by George Van Antwerp 0 Comments

Another factoid from USA Today…Healthcare (due to costs) has been a front page issue in business for most of the past decade. Just over the past 3-5 years has it become a front page consumer issue. It is rare that I can pick up USA Today, go to MSN, or open up my iGoogle news page and not see one or more article about healthcare. This is certainly a positive step in the consumerism path.

None of us would be ready to take on more responsibility for our healthcare until it becomes ingrained in our head about the basic market dynamics and sources of information.

This list of drugs is pretty telling about children. As I have heard asked many times “Are these conditions really more prevalent today or are we better at diagnosing them or are we simply a culture that is more willing to medicate marginally impacted people to stop any problem?”

Here is a chart from the 2004 Medical Expenditure Panel Survey which shows the top 5 drugs based on spending (in millions). (shown in USA Today Snapshots on Nov. 13th on the frontpage of Section D)

Healthcare, PBM / Pharmacy, Research

P4P – Pharmacists vs. MDs

November 15, 2007 by George Van Antwerp 0 Comments

p4p.jpgI only heard a piece of the presentation yesterday at AHIP (America’s Health Insurance Plans), but I was a little surprised. They were talking about the topic of P4P (pay for performance). The survey population clearly supported P4P for MDs with the primary objective being preventative care and compliance. This focus did surprise me since I imagined it would have been more focused on cost management.

The survey population wasn’t interested in all at P4P for pharmacists. This surprised me a little bit especially given the access differences. Certainly, physicians can impact bigger dollar decisions (e.g., drugs vs wellness or surgery vs other options), but if the focus is on preventative care and compliance, they pharmacists have easy access to the patients.

Pharmacists are a walk-up option. No appointment is needed. Some pharmacists really know their patients. Both parties are really busy so rewarding them for the additional responsibility is appropriate.

I think it was about 20% that thought about rewarding pharmacists and clearly the focus (not surprisingly) was on driving formulary compliance and generics. In many cases, they have rewards to do this today.

If you’re interested in seeing one of the studies out there, here is one on Medicaid. The conclusion was:

“Medicaid directors and their staffs generally report positive feedback on their pay-for-performance programs and believe that the overall quality of care being provided is improving, although they have mixed opinions about cost savings resulting from the programs. Directors are considering changing some of the measures, incentives, and even the data collection strategies to improve their existing programs and to shape planned programs. Overall, they believe that pay-for-performance is adding to their repertoire of tools to improve the care provided to their Medicaid populations.” [K. Kuhmerker and T. Hartman, Pay-for-Performance in State Medicaid Programs: A Survey of State Medicaid Directors and Programs, The Commonwealth Fund, April 2007]

Business Tools, Healthcare, Managed Care, PBM / Pharmacy, Research
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AHIP Panel

November 13, 2007 by George Van Antwerp 0 Comments

I am at the AHIP meeting here in Chicago. This morning, I had the opportunity to facilitate a panel which included three speakers on the topic of communicating with members:

It was a great discussion with strong attendance. I think we had 20 people standing in the hall outside the room listening for an hour. Here are some of the questions we discussed. Since I normally give my opinion (and couldn’t this morning), I will here. [And, since ½ the questions were ones that I thought of on the spot, the panel did great on their feet.]

  • How has Medicare Part D changed the way that healthcare companies interact with consumers?
    • It has forced them to think about members as consumers. They can vote 100% with their feet (within a window). And, this is the group with the most spend and highest utilization. They require segmentation and new services to drive behavior. All of this is new.
  • Healthcare is a front page topic in the news and the upcoming election. How has this changed consumer expectations for healthcare communications? And, what are the top 3 challenges for dealing with this consumer?
    • Consumers know what to expect and what to ask for. They want transparency (whatever that means to them). They want information. They expect companies to do more than simply react to claims. There is a proactive expectation and patients are comparing them not to healthcare companies but to retail companies like Nordstroms or Disney. (see blog entry on “If Disney Did Healthcare“)
    • The top challenges – understanding what is valuable to them, understanding how they digest and react to information, and providing them with a single face that isn’t disjoined across functional areas, business units, and external companies.
  • In most companies, there if no “patient ombudsman” that drives branding and message consistency. How can healthcare companies overcome this functional or process “silo” approach to communications?
    • Companies need to do a communication audit to understand how communications get out the door and how many communications a patient receives. They need to integrate their programs (inbound and outbound) and set a series of rules and triggers to manage communications across all medium. They also need to establish processes that are integrated cross-functionally to initiate communications but reference them back to a corporate set of rules.
  • Up until recently, much of the members experience with the plan was based on the service experience they got from the inbound call center. How has that changed and what are the elements in this new world that will drive satisfaction and loyalty?
    • I don’t think much has changed. The high utilizers of heathcare are still seniors. As someone else first said “pushing Health2.0 to a 1.0 population is difficult”.
    • But, I think that retention and loyalty are new and important. Most companies don’t understand satisfaction at an individual level. Nor have many health plans embraced loyalty type programs. Personalizing the value proposition, constant communications, and establishing incentives to drive healthy and cost effective behavior is essential.
  • Every company struggles with budget and ROI. The key is getting more for less. How are companies optimizing their communications and are they embracing a permission based approach as in the right message to the right person at the right time via the right channel?
    • Companies are aggressively looking at communication objectives and think through how to use multi-modal approaches. No one has really figured out permission based marketing (that I know of). Having a clear purpose for touching a patient and finding a metric to study the impact of that communication is essential to developing an ROI. Communications (and your vendors) have to have shared incentives that drive the right behavior which is focused on clear ROI.
  • Give me your craziest idea about how technology can change the healthcare communication framework over the next 5-10 years?
    • Integration of health, Rx, and lab data into a PHR that is embedded in a smartcard and which launches proactive communications to the health team using intelligent, learning algorithms which are personalized based on individual genetics
  • Since MDs, RPhs, and RNs are some of the front line contacts for patients, how do companies engage them to drive behavior?
    • This is still the problem. These people are so focused on care and so bombarded with information from multiple payors that unless there is a concentration from a single payor or technology that doesn’t impact their workflow it is hard to get them involved. And, in many cases, without P4P (pay for performance), there may not be much of an economic incentive for them to do things differently.
  • How will things like JD Powers and HEDIS focusing on communications and measuring satisfaction impact communications?
    • I think this is the key. Plans need to get scored, ranked, compared, and published relative to what they do, how they do it, effectiveness, cost per success, complaints, and patient satisfaction with the communications.

I am getting a little wordy here so let me move on. The point is that this is a great topic with lots of passionate people figuring it out. I have seen more consumer packaged goods people coming into healthcare over the past few years than anyone could have imagined a few years ago.

Consumerism, Events, Healthcare, Managed Care, Marketing / Communications, PBM / Pharmacy, Technology

Employer Sponsored Healthcare to Disappear

November 13, 2007 by George Van Antwerp 0 Comments

USAToday had a good article about Healthcare this morning on the front page. I think the article makes some key points that many of us would prefer to think won’t come about.

Imagine that healthcare benefits went the way of the pension and basically disappeared. After a transition period, I am sure it would be fine, but the short-term impact, chaos, and safety net issues would be significant.

The article mentions several ideas being discussed in DC, both of which would likely cause employers to lose their ability to write this off as a business expense:

  • A health insurance market in which people buy policies on their own while armed with tax credits or deductions or
  • A market where people are able to buy insurance through group-like “exchanges,” with some government oversight.

A few statistics in the article include:

  • The percentage of all employers offering health insurance in the past eight years peaked in 2000 at 69% and has fallen steadily since, hitting 60% this year, according to an annual survey of employers by the non-partisan Kaiser Family Foundation.
  • Among small firms of three to nine workers, the percentage offering insurance has dropped even more — from 58% in 2001 to 45% this year.
  • From 2001 to 2005, the number of uninsured U.S. workers rose by 3.4 million.
  • Almost 19 million workers — 17% of all employees — were uninsured in 2005, according to the Kaiser Commission on Medicaid and the Uninsured.
  • A household earning $40,000 this year would have to pay 8% of its pretax income to cover the average share paid by workers — $3,281 — for a typical family policy offered by employers, which this year cost $12,106. That doesn’t include deductibles and co-payments that those with coverage must pay.

“People should be nervous,” says Len Nichols, an economist at the Washington think tank New America Foundation. “People aren’t so afraid of losing their jobs as (of) not being able to afford health insurance even with a good job,” he says.

The whole scenario makes me think of a worse case scenario like you get from your cable company or phone company. You are one of millions of customers. Especially if you are not a profitable customer. What is their incentive to serve you and make you happy. What are you going to do – go someplace else?

With the restrictions on pre-existing conditions and without some government oversight, individual insurance would not be a model I would actively embrace. We have seen homeowners insurance companies discriminate against people with claims. It would expose a problematic set of misaligned incentives.

Healthcare

Patient Centric Healthcare

November 12, 2007 by George Van Antwerp 0 Comments

I changed the name of the blog last week. (I am still debating changing the URL since I don’t want to lose too much of the traffic I get today.)  It fits what I want to talk about (with the exception of some of my ramblings about technology, leadership, innovation, etc).

I was trying to describe this concept of patient centric healthcare to someone the other day when I realized that I have a deck I used over the summer that was a perfect fit.  When I was debating moving from a consultant back into a corporate role, I needed to tell people what I wanted to do and how I could help them.  So, I created a slide deck that I used with executives and recruiters.  It worked well.  I trimmed out the “why George” section, but the rest of this is a good summary of how I see the market evolving.

It is also exactly why I joined Silverlink Communications.  We share the same vision and dedication to process excellence.   Their technology already does what I think is critical:

  • Create personalized communications that target patients based on data driven models.
    • Push information
    • Collect information
    • Drive behavior
  • Use dynamic call algorithms that respond to patients words to take them down different paths is key.
  • Using technology to automate processes and augment your human capital based on proven value propositions.
Consumerism, General Thoughts, Healthcare, Leadership, Managed Care, Marketing / Communications, PBM / Pharmacy, Technology
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Mashup Idea – Twitter + Telemedicine + Second Opinion

November 12, 2007 by George Van Antwerp 0 Comments

I spoke a little on Mashups the other day in my Geekipedia entry, and I was thinking about it yesterday while I ran.

Here are the concepts that could come together:

  • Realtime blogging through Twitter
  • Telemedicine especially around remote monitoring and access to experts
  • The need for quality assurance in healthcare for complex or even routine procedures
  • Transparency and the need to expose more to the patient
  • Voice to text
  • Intelligent data mining and algorithms

The specific example that came to my mind was when a complex surgery is being done by a surgical team with little experience and where the procedure takes hours.  The team could talk through the process and a voice to text program could document all of what they said.  The text could then run through an algorithm looking for key words or phrases.  Depending on what was being said, it could be sent to a team for QA or to provide a second opinion real-time.  Additionally, it could be sent to the family to keep them up-to-date on progress.

There would need to be a lot to build this out, but I could see a lot of advantages to it.  Just a thought.

Healthcare, Innovation, Software, Technology
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Time to Change

November 9, 2007 by George Van Antwerp 0 Comments

Do you ever wonder why you have to change?  Things are going well.  We are making money.  Healthcare is recession proof.  We’ve been doing this for 20 years.

Well…the world is changing.  This deck is a good reminder of what happens outside the US and how fast things will change.

General Thoughts, Innovation, Marketing / Communications, Research

Leadership in 60 Seconds

November 9, 2007 by George Van Antwerp 0 Comments

I have always been fascinated by two topics – leadership and innovation.  They have driven me to read many things and try different roles.  I also believe my pursuit of both architecture and business as a combination of right and left brain challenges was a way for me to try to learn both.

I found this presentation on leadership which is a quick summary of many points.  In the end, it is a little more of a teaser deck for a book, but it is a good reminder of many things about leading.  Since I believe healthcare companies have a chance to lead the market right now before government leads them, it is a topic to think about.

Books / Articles, General Thoughts, Leadership

Intelligent Paper

November 9, 2007 by George Van Antwerp 0 Comments

As healthcare is such a paper centric industry (as is financial services), I often wonder why we can’t get to the point of having intelligent paper.  I looked around a little and have never found anything so let me describe what I envision.

A regular paper that is embedded with intelligence such as RFID and the ability to receive and deliver text and/or graphical messages to the consumer.

digital-newspaper.jpgImagine for example a label on a prescription bottle which changed colors when it was time to refill and offered the consumer the ability to request a refill by pressing a digital button that was only available after the refill-too-soon (RTS) edit was passed (typically after 66% of the days supply dispensed should have been used).  Or, imagine new patient registration forms at the physicians office where you filled out one piece of paper that was auto-populated with information from your personal health record (PHR) based on your fingerprint.  All the forms could be brought up one at a time on the digital paper and your answers immediately pulled into the system of record.

Less paper.  More consistency.  Easier communications.  Better quality information.  Less costs associated with data entry. Fewer HIPAA risks.   

epaper_product.gif

Consumerism, Healthcare, Innovation, Marketing / Communications, Technology

Scary or Interesting Technology

November 9, 2007 by George Van Antwerp 0 Comments

After my post the other night about analyzing your writing, I had a chance to talk with a technology company about how they digest and use text from things like letters, e-mails, and call recordings.  It was fascinating.  They were describing to me a system they developed for the military which is now available commercially.

They can take all these communications and use them as part of a segmentation or targeting model that is based on patient behavior.  How great (and scary) would that be?  (Big Brother is always watching.)  Imagine that you have a model that tries to identify how to best incent a person to improve their health.  If you could input any e-mails or letters they have sent into your company and input any call recordings using speech to text, you would have all types of indicators about personality and interests along with communication modes, time of day that they respond to information, etc.

big-brother.gif

Obviously, a patient-centric healthcare model means really understanding things about people.  To do that, we have to get multi-dimensional and think differently.  Rather than simply focusing on moving people to mail order from retail, shouldn’t you focus on attracting the people that are most likely to stay with it and not move right back?  If you are going to offer an incentive for taking a Health Risk Assessment, don’t you want to offer it only to the people that will act on the results?

Compliance with prescriptions or testing is a great example.  There are certain people that are more inclined to stay compliant.  But, it is also important to understand what message will motivate them to stay compliant – not dying, seeing their kids get married, saving money, not missing work, etc.

And, because we are in healthcare, there are some legal constraints about when you can make different offers within the same or similar populations.

Healthcare, Innovation, Marketing / Communications, Software, Technology
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4th Graders Drinking?

November 9, 2007 by George Van Antwerp 0 Comments

I was reading USA Today on Tuesday while I was flying and was pretty shocked to see the results of a survey of over 37,000 school children by Pride Surveys that showed:

  • 4.9% of 4th graders
  • 8.6% of 5th graders
  • And 12.9% of 6th graders had alcohol in the past year.

With little kids, this is pretty scary. Some of it is peer pressure, but at this age, parents can play a strong role.

“There is a fairly sizable amount of literature showing that the earlier people start to drink, or even have their first drink, the more likely they are to have problems later in life with alcohol, drugs, delinquency, risky sexual behavior (and) motor vehicle accidents.” John Donovan, associate professor of psychiatry and epidemiology at University of Pittsburgh Medical Center

Healthcare

Analyzing Your Writing

November 6, 2007 by George Van Antwerp 0 Comments

Lois Kelly has an interesting post on her blog about the Linguistic Inquiry and Word Count program. You run text through the program and it categorizes the writing style. She compares 3 CEO bloggers. I grabbed text from my site and ran it through.

If I understand the results below correctly, it says I am fairly honest, somewhat outgoing, not very optimistic, have no anxiety, am actively thinking about the topic, and use lots of big words. I am sure my writing about all the problems in healthcare explains the low score on positive emotions, and I intentionally try not to make things too personal.

LIWC dimension

Your data

Personal texts

Formal texts
Social words – outgoing

7.08

9.5

8.0
Negative emotions – anxiety

1.13

2.6

1.6
Big words (> 6 letters) – higher grades which tend to be less emotional

22.35

13.1

19.6
Business Tools, Marketing / Communications, Technology, Weblogs

Permission Marketing – This is What I [patient] Want

November 6, 2007 by George Van Antwerp 0 Comments

Permission Marketing is certainly not my concept. Seth Godin invented the term and wrote the book on this several years ago. But, I think it is a concept way behind it’s time in healthcare.

“Permission Marketing cuts through the clutter and allows a marketer to speak to prospects as friends, not strangers”

The concept (in my words) is that you ask the consumer (aka patient) what they want.

  • What information do you want from us?
    • Opportunities to save money
    • Alternative therapies
    • News about your drug
    • Benefit information
    • Compliance reminders (Rx, lab visit, tests)
  • How do you want that information delivered to you?
    • Phone
    • Voicemail
    • Cell phone
    • SMS / Text message
    • E-mail
    • Fax
    • Letter
  • Does the channel you want the message delivered through vary by the message?
    • Deliver savings information within 24 hours to me via my cell phone
    • Send benefit information via PDF using my home e-mail address
  • When do you want that information delivered to you?
    • Pro-actively
    • Reactively
    • Bundled (i.e., send me one “package” of information monthly)

Wouldn’t that be nice? Most of us don’t even know what the options are. We just get bombarded with information from our employer, managed care company, pharmacy, PBM, disease management company, wellness programs, HSA / HRA account manager, etc. Different messages. Different information.

In reality, one of the biggest problems is that our healthcare companies just can’t manage these type of personal rules today. Managing do not call lists are difficult enough. This should change over the next 5 years, but it will be a combination of patient generated preferences along with data mining to develop algorithms that predict what channel and message is most effective at driving behavior for certain patient segments.

Books / Articles, Consumerism, Healthcare, Leadership, Marketing / Communications, Weblogs

Dark Data

November 6, 2007 by George Van Antwerp 0 Comments

As we all know, the only research that we ever see is research that is successful. I start with a null hypothesis (i.e., I believe X is driven by Y). I then collect and analyze data to look at facts to see if I can prove the null hypothesis. If I don’t prove it, I move on to another project.

Occasionally, I find out something completely surprising which makes a career or a performance year. Think about all the analysts that find correlation between different variables and the stock market. For example, the stock market does X after a democrat is elected. The stock market does Y after a long, cold winter.

In healthcare, there is an amazing amount of clinical data out there being collected and analyzed. People are looking for new cures and new drugs all the time. The question is what happens with all the “dark data” that gets put in the closet. Should it be shared? How? Would it help other people?

I don’t know the answer, but I am a big believer that more data is better. If I can predict something off just pharmacy data, I should be much more accurate with medical claims and lab values (for example).

In another Wired Magazine article from October 2007 called “Mind the Gaps” by Thomas Goetz, he talks about this topic and several efforts here:

Healthcare, Research

Text Google for the 411

November 6, 2007 by George Van Antwerp 1 Comment

Google seems to be everywhere. It is probably the one site that I have to teach my kids to know to get anywhere. Perhaps they need a “Google Kids” which offers games, safe content, etc.

Anyways, this is more of a tip than anything about healthcare, but I was fascinated to find out about Google’s SMS service (aka text message) yesterday. I tried it a few times this morning right before I got on the flight. If you go to Google’s page at sms.google.com, you can find out more.

All you really need to know is that if you send a text message to Google (466453) you get information back almost instantly.

For example, I sent a text message saying “weather Boston” and before I could even type my next message, I had the weather report. Then I sent in another text for “AA 1577” (American Airlines flight 1577) and instantly had information on flight status and what gate it was leaving from. You can do it for scores (e.g., “Red Sox”) and many other things. If you are like me and on the go a lot and hate to pay fees for 411, this is great.

Business Tools, General Business, Technology

Geekipedia

November 6, 2007 by George Van Antwerp 2 Comments

Sure…a little off topic, but understanding technology is one of the critical components (in my humble opinion) to driving innovation and change in healthcare. Healthcare is not an early adopter of solutions. There is too much fear about change (and litigation).

So, when Wired but out this magazine supplement called Geekipedia, I knew it was a must read. As it says on the cover “149 people, places, ideas and trends you need to know now”.

Here are a few that jumped out at me:

  • AJAX – a suite of web-development technologies which produce squeaky clean surfaces. This allows web designers to build web sites that act like applications and accept user input and computing results without fetching entirely new pages from a server. I have worked with developers to use this before. Very cool. You see it on a lot more sites now, but anytime you enter data and the site changes without refreshing it…they built the site using AJAX.
  • APIs – application programming interfaces are sets of rules that govern how apps exchange information. These have been around for years and typically only mattered to the programmers and your engineering staff…but today APIs allow you to create custom applications using desktop widgets and mashups to have personalized sites that do all types of cool things.
  • Collaborative Filtering – this is the recommendation algorithm you see on Amazon or Netflix or many other sites. I can see healthcare one day embracing this in patient centric forums – patients with your similar benefits and genes were most likely to respond to this form of treatment.
  • Distributed Computing – most of you should know about this as the use of our computers to solve problems has been part of the news (good and bad) for years, but the point is to leverage the memory of individual computers in a network design to create a virtual supercomputer to solve complex problems that look at lots of data over years – e.g., SETI@Home that looks for extraterrestrial intelligence or FightAids@Home which looks for new AIDS treatments.
  • Mashup – these are sites / applications that are combinations of existing offerings that are cut and pasted together. For example:
  • Meganiche – with the Internet’s utilization now, it is possible to have a niche within a niche. For rare diseases, this could have some value.
  • Neurologism – all of the new areas of research driven by the breakthroughs in understanding the brain.
    • Neurofitness
    • Neuroceuticals
    • Neuroinformatics
    • Neuromarketing
    • Neuroergonomics
    • Neurosemantics
  • RNAi or Ribonucleic Acid Interference – “the silent assassin of cell biology”. It protects against viruses by tearing up the viral RNA and preventing it from making copies of itself.
  • RSS or Really Simple Syndication – you see this everywhere – on my blog, on websites, even in the new Outlook. This allows you to stream information to your reader (e.g., Google Reader) to see new information without having to go to all the individual sites. I wonder how many managed care companies and PBMs offer this on their websites today. It would be nice to get this pushed right to my personal Google page.
  • SEO or Search Engine Optimization – this is the use of tags and other links to maximize how your website shows up in a search.
  • Ultrahigh-throughput gene sequencing – this is all about the speed at which genes are sequenced which is obviously a big driver of personalized medicine and genomics. I am not sure I buy the prediction of “it won’t be long before a stall at the local shopping center will work up your genome ‘while u wait'”.
  • Widgets – these are small applications which can typically be embedded in a website using reusable code (e.g., a BMI calculator or mortgage calculator)
  • Wikipedia – this is a site that provides the modern encyclopedia full of links and information that is created by the net community – are you out there? Is your company or product?

It makes you wonder. As healthcare moves to more consumer centric and sales to commercial patients mimics Medicare Part D, will you see a United Healthcare avatar in Second Life or a Medco Facebook page. And, when will be see YouTube and Flickr being used to paint positive pictures of our healthcare system for the many people that it does work for. If politicians can begin to use these sites and big corporations encourage personal advertising of their brands, healthcare should give it some consideration.

Business Tools, General Thoughts, Healthcare, Innovation, Marketing / Communications, Software, Technology

Calculator Culture

November 6, 2007 by George Van Antwerp 0 Comments

As technology becomes ubiquitous (everywhere and anytime), do we run the risk of losing our sense of logic and memory around health (and other issues).

For example, I bet most seniors could tell you their medicines (name, dose, cost). I was asked recently what medications I took and didn’t have a clue. (If you remember, after my visit to a clinic, I got several allergy medicines.) My immediate reaction was to type medicine into my Blackberry and see what it told me. Did I have a note or some file tracking my prescriptions? I was clueless.

(Again, maybe another business idea – a simple Personal Health Record application for the cell phone.)

There was an article in Wired Magazine’s October 2007 edition called “Your Outboard Brain Knows All” by Clive Thompson which made this exact point.

“In fact, the line between where my memory leaves off and Google picks up is getting blurrier by the second. Often when I am talking on the phone, I hit Wikipedia and search engines to explore the subject at hand, harnessing the results to buttress my arguments.”

The question of course is what happens when that’s not appropriate. Multi-tasking and relying on technology works great when you are virtual, but it is hard when you are in a face-to-face conversation to inject technology.

Maybe some day when we are all “bionic people” with some robotics this could work.

(In case you don’t get the calculator culture title…the point is that people are less likely to know their basic math if they grow up doing even basic calculations with a calculator.)

General Thoughts, Healthcare, Technology

Blunt Healthcare

November 6, 2007 by George Van Antwerp 0 Comments

Obviously language is a key building block in communications.  It is one thing to say “your cholesterol is above normal” and another thing to say “if you don’t control your cholesterol, you will die before your 60”.  But, are physicians and other health professionals willing to be that blunt?  And, can us patients receive the tough love?

Between all the legal caveats that regulators and lawyers force into messages combined with companies unwillingness to offend, it seems hard to imagine many people delivering the blunt message.  But, I personally know it makes a difference.  About 5 years ago, I had a physician tell me that I was overweight.  He had calculated my BMI and suggested I lose weight.  My initial response was okay (sure).

bmi-status-english.png

My wife was there and was quick to tell him that he needed to push me on the issue if it was important.  So, he changed his words and told me that according to my BMI I was obese.  Now, that caught my attention.  I wasn’t going to be obese by anyone’s standards. 

So, he told me that I needed to lose 40 lbs to be in the normal (clinically acceptable) range going from 215 to 175 lbs on my 5′-10″ body.  I hadn’t weighed that since high school (or earlier). 

But, in 60 days, I lost the weight.  I ran or did aerobic kick boxing every day for 60 days and lost 40 lbs.  From there, I started running and within 12 months of my appointment I had run my first marathon.  Now, 5 years later, I have put some of it back on, but even at my worse since then, I have been down 20 lbs and have a solution to apply.

The point here is that to motivate consumers like me I believe that the healthcare system needs to be more blunt (or harse or direct) than it is.  Communications have to drive to an action and push people to take it. 

Consumerism, Healthcare, Marketing / Communications

Coverage Flip-Flop

November 5, 2007 by George Van Antwerp 0 Comments

I was talking with some friends at a PBM a few months ago and they were talking about putting Lipitor back on formulary (i.e., the covered drug list) that they took off two years ago.  It made me wonder about what a confusing message that is to consumers.

For years, you are taking Lipitor.  All of a sudden, Lipitor moves to the 3rd tier because Zocor goes generic.  You can stay with the drug and pay a lot more or try a new drug.  Now, 2 years later, Lipitor is back in favor because the manufacturer has offered enough rebates to make the branded drug cheaper than some of the generics.  Great for the manufacturer who extends the life of their drug and reaps economies of scale for a while longer.

But, for consumers, this means another visit or call to the MD.  It may mean more lab tests.  It means changing prescriptions again which could trigger drug-drug interactions or other issues.  It changes physician’s information and sets them up for more calls.

Obviously, changing for clinical reasons is one thing.  Trying to move marketshare and failing is another.  And, simply flip-flopping to save pennies is not logical (to me anyways).  Imagine if your provider was in network one year; out the next; and then back in.  I am sure it happens, but it is a pain.

Hopefully, the savings to the employer, consumer, and benefits to the PBM outweigh any disruption issues.

indecisive.gif

I guess the question here (as it often is) is alignment of incentives.  I had to wonder the other day when a friend at a large managed care company told me that their PBM wouldn’t implement certain programs for them since they were in the PBMs best interest.  BUT…they save the patients and the MCO (their client) money.  Wouldn’t you at least offer to do them for a fee that covered your lost profit?  (maybe I’m being too practical here)

Consumerism, Healthcare, PBM / Pharmacy
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