Archive | January, 2008

Single Answer or Multiple Answers

I was having an interesting discussion yesterday about how to solve a problem.  The two opinions were whether there is a best answer or whether there are multiple best answers.  It’s a great question.

Let’s frame it this way.  Is there a message that is most likely to drive compliance for a group?  I gave them the benefit of the doubt that they aren’t crazy enough to suggest that one message works generally with no segmentation.  (McKinsey‘s article “Getting Patients To Take Their Medication” has some good research around creating segments and showing how some of the segments vary in what they want.)

The other person was presenting a case that they could do lots of research on linguistics and other topics and suggest one optimal message that would work across broad segments of the population.  I was of the opposite opinion that a personalized message that had certain core research but varied by geography, condition, age, income, benefit type, prior interactions, etc. was better.  And, that what is good today may change both generally and individually over time.

I would rather get all the micro-niches of people to their highest compliance and adherence level versus getting a better average across all group. 

Basically, my position is that there are multiple optimal solutions to the problem not just one.  It triggered a memory for me of when I first went to business school.  In architecture school, design is somewhat subjective.  (There are some logical rules such as the Fibonacci Sequence which serve as guiding principles of scale…for example.)   We were taught to always bring three solutions to our initial presentations to let the judges decide which one we should push to finalize.  We had to pick one for a deliverable, but it was always a tradeoff.  In business school and the hard sciences, there is often only one answer that is valid.  (1+1 always equals 2.)

But, for communications, marketing, and other things, it seems obvious to me that companies are best served by dynamic flexibility that allows them to bring multiple solutions to the market in parallel that adapt to different patients and change over time to respond to the market and the patient.

Here is a quick snapshot of the segmentation from the McKinsey report…


Call Center Metrics – JD Powers

As you know, I love metrics.  I began my business career in that space working on Balanced Scorecards and Datareferee.jpg Warehousing.  I got a press release announcement the other day about CVS/Caremark winning a JD Powers Call Center Award.  It caught my attention.  Obviously, I haven’t dug into all the data, but from how it is described, it appears that they are focused on the right metrics and winning an award for this would be meaningful.

In order to qualify for certification, a call center must perform within the top 20th percentile of all centers evaluated nationwide, based on benchmarks established by J.D. Power and Associates for courtesy; knowledge, concern for the customer; usefulness of the information provided; convenience of operating hours; ease of reaching a representative and timely resolution of issues. Call centers must also successfully pass a detailed audit of their recruiting, training, employee incentives, management roles and responsibilities, and quality assurance capabilities. As part of its evaluation, J.D. Power and Associates conducted a random survey of Caremark’s customers who recently contacted its call centers.

Excellent Versus Very Good Service

On my vacation, we took the kids on a Disney Cruise.  We also went last January.

For the first time, I think I can actually differentiate between very good and excellent on the survey.  I always struggle with that and tend to grade down.  In general, we love the Disney experience and the cruise is very well run.  We are already booked for next year and will be going with several other families.

Anyways, on the boat, you go to a different restaurant each night and your wait staff follow you.  This year, they were attentive.  No food was messed up.  They were polite.  They did magic for the kids each night at the table.  They engaged us in conversation.  It was very good service.  Better than almost any restaurant.

BUT, since we were there last year, we had a very high expectation.  Last year, the wait staff learned each day.  After day one, they knew what drinks my kids liked and had them waiting for them when we arrived for dinner.  By day three, they knew my son was a picky eater and had one of his favorite foods on the table.  And, they knew that my daughter wanted some snack other than the typical appetizers and they had that waiting.  Basically, they learned, adapted, personalized, and acted proactively.  The difference was amazingly clear within very tight parameters.

Of course, it took someone else to point out to me that this was an example to share since this is the key point for my healthcare companies.  You need to learn from your communications.  You need to adapt to today’s technology and your patient’s expectations.  The patient experience has to be personalized (in scale) to be in a message they respond to, in a channel they like, at a time that is convenient to them, and based on previous interactions.  And, you have to act proactively.  The patient doesn’t always know when to act.

Since traditional differentiators are basically null (i.e., network size, plan design), it becomes all about communications and service.  How do you drive the patient experience?   It is worth looking at the Forrester data on customer experience index.  Healthplans score incredibly low in terms of usefulness, ease of use, and being enjoyable.  The highest (that they looked at) was Kaiser at 63% with the lowest being Aetna at 49%.   [60-69% meant that the customer had an “okay” experience with the company.]

Diagnosis Code Plus Rx

In a WSJ Blog article about sound alike drugs, they have a potential solution about having the physician add information about why the drug is being used.  Obviously, the low hanging fruit here is to move to electronic prescribing where the clinical information (i.e., diagnosis code) is in the same file as the drug and technology can be utilized to look for potential issues.

In the short-term, adding the diagnosis code (aka ICD-9 code) to the prescription would have lots of benefits.

  • Avoid getting some point-of-sale rejects when a drug is used off label.  Or vice-versa, avoid off-label use by rejecting claims.
  • Avoid getting suggestions you change prescriptions only to find out that you should not do it given your diagnosis.
  • Development of proactive algorithms (e.g., macros) in the technology where whenever a doctor diagnosed diabetes then it would pull up their typical regiment of drugs based on formulary status and other inputs.
  • Better tailor / personalize information based on disease and drug to help the patient and their care team drive successful outcomes.

The issue of sound alike drug names is a real issue.  Obviously, any time you have multiple human handoffs in a process then you increase the likelihood of error.  As I think I have talked about before, I remember my MD prescribing an eye drop.  I picked up a prescription and the pharmacist clearly told me to put one drop in each eye twice a day.  At the end of the second day, I read the label in detail and realized that it said to put the drops in the ear only.  When I called them back, they talked to the MD and realized that they had heard the wrong name when they listened to his voicemail.


I can never stress the value of communication skills to anyone I met regardless of the path they want to go down in life.  I have had the luxury from an early age of public speaking beginning with something called Model United Nations (MUN) where you represent a country in mock-simulations of the UN process.  [We even won a national championship at my high school…and it really isn’t as geeky as it sounds.]

In graduate school, I participated in Toastmasters for a while which I think is great for someone who needs a casual setting to practice and get feedback.  I can even remember using one of the techniques from there (counting “ums”) when my sister told me she was going to be a lay minister in the Catholic church and be giving sermons.  [Note: Feedback on presentation skills isn’t always well received by people not seeking it out.]

I found a couple of presentations on the topic that I thought might be interesting to some of you.  Additionally, you might research the Minto Pyramid Principle which is a structured approach to communicating by an ex-McKinsey consultant.  (It was required reading/training at Ernst & Young years ago.)

This one is a little basic, but I have seen so many bad powerpoint presentations that obviously many people could use the primer.

One last one before getting back to work…Here is one on marketing which obviously has communications at its core.

Where Are The Evidologists?

After one of their team posted a comment on my site, I went to Bazian‘s website.  Very interesting.  They are a UK based company that focuses on providing evidence-based healthcare information to publishers, governments and insurers.  Sounds promising.  This is an important issue across the world as companies and practitioners look at how to embed intelligence into process and technology to deliver the best outcomes.  Here is a presentation that they have for download on their website.  In it, they propose a new healthcare role of the evidologist and draw a nice parallel to the radiologist.

“In late 2005, Bazian gave a presentation about putting evidence into practice – a much discussed topic in the world of evidology.  It summarised 10 years of experience in evidence-based medicine, and draws conclusions about who should be putting evidence into practice, when, and what has to really happen for evidence to become a routine part of medical practice.”

Ev·i·do·l·o·gy n.

A new medical specialty that enables medical research to be incorporated systematically into clinical practice [Latin videre to discern, comprehend; evideri to appear plainly]  

Factoid: Off-Label Use

I cut this from one of the many e-mail clipping services I use. It said that “20% …of the 725 million U.S. prescriptions written in 2001 went to treat conditions not approved on the drugs’ labels” according to a study published in Archives of Internal Medicine.

I always wonder:

  • How do physicians know to use a prescription off label?
  • How is that information shared? (I think drug reps are prohibited from promoting off-label use.)
  • How do patients and pharmacists respond to off-label use?

Concise Summary of Compliance Reality

I have shared other facts with you on compliance. This is a hot topic in healthcare right now. I thought pulling this one graphic out of my entry on Caremark’s trend report made sense. This really gets to the point. Take this in light of the following quote from WHO (World Health Organization) and you can understand why.

“Increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments.”


They have a good chart in the document about speciatly medications and the impact of medication management services.


Increasing GDR

I love reading healthcare articles which have acronyms that not everyone knows. (Maybe it was defined earlier, but I didn’t see it.)

Another nugget from the Caremark trend report is on programs and plan design components to drive generic dispensing rate (GDR) which is the number of prescriptions filled as generics divided by the total number of prescriptions filled. (Versus generic substitution rate which is the number of prescriptions filled as generics divided by the total number of prescriptions filled for which a chemically equivalent generic is available. I can’t remember whether we used only A-B rated generics or all generics, but that is a technical discussion for another time.)


This is great. It tells you the impact (on average) of implementing a plan design or some of their clinical programs on your GDR. (BTW…a good rule of thumb is that an increase of 1% in GDR is worth about 0.75-1.5% savings in your overall prescription spend.)

Caremark’s TrendsRx Report 2007

Well…I better get this posted before all the 2008 reports start coming out. I have started it a few times, but there is so much good content in here that I haven’t finished. I am determined to get this done tonight. As you may know, all of the PBMs publish very well done annual research reports on the trends in the industry and what they have learned from their data. I have talked about Express Scripts research and reports (here, here, and here) and Medco’s report (here). [Note: For simplicity sake, I am not going to put all the sources here. They are in the Caremark

“Consumers experience the [healthcare] system as complex, impersonal, disconnected, reactive, and increasingly unaffordable.”

  • In 2006, the average number of retail Rxs per capita was 12.4.
  • 59% of those <65 had an Rx in 2004 and 92% of those >65.
  • With consistent use of effective prevention, early intervention, and adherence strategies, they estimate that 30% of current healthcare spending could be eliminated. Image the impact of that on MLR (medical loss ratio) which is a key metric for managed care companies on how much of each premium dollar they actually spend on healthcare costs.
  • They layout a very logical vision that would take advantage of their unique set of assets with CVS, Caremark, and MinuteClinic.
    • Preference based consumer access.
    • Patient focused view within their systems and communications.
    • POC (point-of-care) connectivity. (i.e., pushing relevant information real-time to physicians and pharmacists to optimize care)
    • Personalized health advocacy (“make the healthcare experience less disconnected and impersonal”)
  • The price of brand drugs (on average) increased by a rate of 3x the CPI (consumer price index) in 2006…the highest since 2002. [In my opinion, this will continue as they face more price pressures with the government being the largest buyer now with Medicare Part D and with the majority of claims now being filled with generics.]
  • At the same time, the price of generic drugs decreased by 1.2%.
  • With Medicare, Medicaid, and other public payer, the government now pays 40% of the total drug spend in the US.
  • They are working with the Coalition for a Competitive Pharmaceutical Marketplace (CCPM) to reduce patent expiration “loopholes” (aka ways that brand manufacturers extend their patent lifecycles which are often perceived to not add any additional value).

Some of the graphs and charts that I found interesting and helpful are below. (I pulled one of my favorites out in its own posting.)





(BTW – If you don’t know who BOB is, it stands for Book of Business which means the payors whose data was included in the analysis.)

(They make the point that 5 of the 10 drugs face patent expiration by 2010 so as expected prices are increased in the years prior to maximize return.)

I haven’t talked a lot about specialty drugs here on the blog. Here is a good list of the top classes. Typically these drugs are either high cost and/or require special care (mostly meaning injection). The average specialty drug would typically cost $1,500 per 30-day supply versus more like $80 for a non-specialty drug.



Working With Clients: Some General Thoughts

One of the best discussions I have heard for account management was by Andrew Sobel. I was digging through some files today and came across some of my notes. I thought I would share a few of my takeaways which I think are good general advice.

  • It is essentially to be trusted.The four attributes of trust that he discussed were Empathy, Generalist, Synthesis, and Integrity.
  • Be an Advisor not an Expert.Experts are afraid to learn anything new.
  • An Expert’s mind believes that there are few options that make sense. A beginner’s mind is open to many options.
  • At 5-years old, we ask about 200 questions per day. By age 20, we only ask about 20 questions a day. Ask more questions. [Reminds me of another piece of advice that said that to “ass-u-me” is to make an “ass out of you and me”.]
  • Perceived competence leads to trust.
  • Empathy means listening, know your own biases, and having humility.
  • Reflection leads to creativity.

He also suggested acting as if you were independently wealthy. [Not always easy, but not worrying about the politics and other issues frees you up to speak your mind.]

He (or his company) laid out the following comparison on their key point which was “Be an Advisor not an Expert”.


It is easy to play the expert. It is much harder to play the role of advisor.

    Medical Mistakes

    •  Wash hands with soap.  Check.
    • Clean patient’s skin with antiseptic.  Check.
    • Wear sterile mask, gown, and gloves.  Check.
    • Put sterile drapes over  entire patient.  Check.

    And that’s all it takes to reduce common infections from medical tubing by 2/3rds.  (12/28/06 study in the New England Journal of Medicine looking at 108 ICUs in Michigan hospitals)  Seems pretty simple.checkup.jpg

    Do you remember when the Institute of Medicine put out their study in 1999 that said that 100,000 people died annually from preventable hospital errors?  People were shocked.  The medical profession thought the numbers were too high.  So, I find it more that a little interesting that the Institute for Healthcare Improvement (which includes 3,000 of the 5,000 hospitals in the US) put out a report in 2006 on saying that they had saved over 120,000 lives.  [If that was for 3/5th of the hospitals, I guess that means that about 200,000 people were dying per year in the US due to preventable hospital errors.]

    So, it is with mixed emotion that I look at their latest campaign which is the 5M lives campaign to reduce deaths, injuries, and near misses in US hospitals.  Now, I am being a little sensationalistic.  The fact that hospitals are collaborating, sharing information, being transparent, looking for best practices, and trying to improve is great.  Sometimes, it is just shocking what has been going on.  [Imagine the error rates in some 3rd world countries.]

    Here is an article from today in the LA Times about this.

    Quick Update – Zyrtec OTC

    Getting back into the swing of things today, I decided to run out and buy some Zyrtec OTC.  It should be out this week from everything I know.  But, my grocery store didn’t have any.  The first Walgreens I tried had received some, but it had sold out.   The second Walgreens had some but had sold out of several sizes.  And, it had a stack of $3 off coupons.

    I paid $7.99 (less $3) for a pack of 5-tablets of 5mg chewables.  Seems like a lot ($1 per tablet) until I realize that I was paying $50 in copayments for a 30-day supply for my kids.

    For me, I bought a 45-day supply of the 10mg for $28 (less $3) which seems like a bargain compared to the $75 copayment I would have had for an equal supply of the Rx or even the $45 copayment, I would have had for a formulary agent (aka brand drug that was covered at a $30 copay for 30-day supply).

    Nuclear Medicine – What???

    I compare what I know about nuclear medicine today to what I knew about genomics back in 1998.  [I remember my boss calling me and telling me to pull together a presentation for our team at E&Y to give to Jay Geller (CEO of Pacificare at the time) on e-business with a focus on how the Internet would effect genomics.]

    Nuclear medicine is a branch of medicine and medical imaging that uses the nuclear properties of matter in diagnosis and therapy. More specifically, nuclear medicine is a part of molecular imaging because it produces images that reflect biological processes that take place at the cellular and subcellular level. Nuclear medicine procedures use pharmaceuticals that have been labeled with radionuclides (radiopharmaceuticals).  [Wikipedia definition]

    I don’t know a whole lot about nuclear medicine today, but after seeing that Dom Meffe who was the CEO of Curascript, a specialty company we bought at Express Scripts, is now CEO of Triad Isotopes, it caught my eye.  He was an incredibly charismatic leader and seemed very passionate about driving patient care.

    But, even reading the definitions of nuclear medicine and skimming the site, I feel like I need to go back to school.

    A nuclear pharmacy is a pharmacy that compounds and distributes radiopharmaceuticals used primarily in imaging procedures for cardiac and cancer diagnosis. Cyclotrons are utilized to produce FDG (Fluorodeoxyglucose) a short-lived positron-emitting isotope suitable for PET (Positron Emission Tomography), an imaging technology that can be used to assess tissue biochemistry.  [Triad Isotopes press release]

    Another Quickie – DM Megatrends

    Here is another blog entry and linked presentation to look at on Disease Mgmt and some of the trends.

    Predictions…Not Mine

    Rather than rehash or even post my thoughts right now (still digging out from vacation)…I will simply point you to a good summary on the WorldHealthCareBlog about what people are predicting for 2008 and beyond around healthcare.

    It is a summary from IBM, Deloitte, and many others talking about spend, technology, adoption, new drugs, etc.

    Freakonomics on Pharma

    The Freakonomics blog has an interesting piece on pharmaceuticals.  It basically asks five experts what is the best secret in the industry.  Here were a few of the quotes from the posting…

    1. “Events are revealing that many pharmaceutical companies, along with their consulting academic physicians, have engaged in practices that obscure or misrepresent information about their products.”
    2. “The United States is subsidizing prescription drug prices for the rest of the world.”
    3. “The obscene profits made on generic drugs by the large chain stores.”
    4. “While most people understand in a vague way that modern biomedical science is advancing at a remarkable pace, many people are less aware that we have been far less successful at translating science from the laboratory bench to the clinic. This is not to say that the pharmaceutical industry has been quiescent; total spending on health related research by the drug industry has increased from about $6 billion in 1980 to about $39 billion in 2004. During that period, basic science research has increased the number of potential drug targets (the biological site on which a drug is intended to act) from 500 to more than 3,000.”
    5. “Underpinning many of the marketing strategies of big drug companies is a very sophisticated and comprehensive plan to widen the boundaries of illness, and create an environment in which more and more formerly healthy people are defined as ‘sick.'”

    Paying MDs to Switch

    Another WSJ article that I caught on the plane ride home last night was about Doctors Paid To Prescribe Generic Pills. When I read the WSJ Health Blog about this, I was shocked by the comments. It would appear that the blog is followed by people that don’t believe generics make sense. That perspective is a little outdated now that most therapy classes have one of the most popular drugs available as a generic.

    Yes, in some cases there have been minor improvements, but I don’t think anyone can (with a straight face) get up and talk about how Nexium is clinically superior to generic or OTC Prilosec (see general comments about category of PPIs). There has been numerous research showing that the probability of having success with any anti-depressant is the same regardless of what drug you begin therapy with (so why not start with a generic). And, generic drugs have been around for a long time so all their side effects and drug-drug issues are well known and documented. There has never been a generic drug pulled from the market.

    Here was what I posted there.

    Wow! There seem to be a lot of the glass is half-full people out here. What if the generic (which often was the most prescribed drug in the class before the patent expired) is clinically appropriate.

    There are 10,000+ drugs out there. Physicians can’t be expected to know and monitor the comparisons on each one. That is what technology and pharmacists are focused on. So, if companies can identify a way to help the patient save money, what’s wrong with switching drugs.

    The exact process of paying the physician seems suspect, but some incentive to reward them for their time (perhaps regardless of outcome) makes sense. You are asking them to pull the patient’s file, look at a different drugs and perhaps some clinical information provided by the payor, and determine if a switch makes sense.

    Physicians today rarely have an incentive linked to drugs so why not prescribe the most expensive, most heavily sampled, most advertised drug. That’s the easy path.

    I don’t disagree that more sharing of the benefits might make sense, but the market has changed. Generics and therapeutic conversions can make a lot of sense.

    The issue of incentives is a broader one.  Paying physicians directly per switch seems a little suspect.  But, incenting them to save money for plans and patients makes a lot of sense.  But, like any incentive system, it has to be balanced.  Health outcomes balanced with cost management.  Patient satisfaction balanced with simplicity of the process.  I won’t get on my soapbox here.  Metrics are difficult, but the system today doesn’t always align the parties correctly.

    Wal-Mart: New PBM?

    Well.  I am back from vacation.  I grabbed a WSJ on my way home from Orlando and was surprised to see an article about Wal-Mart potentially going into the PBM businessNot a surprise that they would go into the business, but a surprise that they would build it organically.  (Although I don’t believe they have confirmed their exact intent.)

    Of course, pre-stock market correction, the PBM stocks (Medco, Express Scripts, and Caremark) were all very expensive, but there are numerous smaller PBMs which could be bought and give Wal-Mart the adjudication systems, logic, and other processes to jumpstart the business.

    Logically, Wal-Mart is strong at many of the core PBM functions – supply chain management, cost management, and distribution.  But, this is not a retail play.  There is no efficiency per square foot to compare to other functions.  And, you are selling primarily to the payor not the individual.  And, face facts, Wal-Mart hasn’t traditionally been recognized as the healthcare friendly company for many of its million workers.  Would employers face backlash trying to convince their employers that they were simply containing costs or actually engaging Wal-Mart to educate and help employees make good health decisions?

    So, it bears the question of whether they see a broader trend.  Could consumerism spell the end of the traditional business-to-business PBM and drive a business-to-consumer PBM?  Since the Wal-Mart Bank idea never took off, could they get into the space through healthcare.  [The convergence of Health and Wealth has been written about numerous times.]

    Obviously, CVS saw a strong play in the PBM space with its purchase of Caremark.  Walgreens already has their own PBM.  And, with Wal-Mart being the third largest retailer, it would seem like a logical trend to build out their PBM functions.  [I think they have some PBM services that they provide today, but mostly for their own employees.]

    On Vacation

    I keep thinking I will get through my pile of draft posts to do a big data dump of ideas in the blog, but I have been crunching all week to get some major deliverables pulled together.  It’s now almost 11:00 for the 4th night in a row.

    Given that I leave tomorrow and have one big item to finish up, I am not sure I will get all (or any of) my ideas posted.

    Prevalence of Chronic Illnesses

    I found this concise slide showing the number of patients with certain chronic diseases along with the financial impact to our economy.


    Handwriting Analysis

    This has always been a topic that fascinates me.  Learning from someone’s handwriting.  So I liked seeing a cliff note summary of The Complete Idiot’s Guide to Handwriting Analysis by Sheila Lowe in Spirit Magazine.  I am not sure I would be ready for this to be part of an employment process although I have taken personality tests such as Myers-Briggs (test yourself here) before.

    Here are a couple of the items on handwriting:

    • Balanced margins; clear spaces between words = ability to plan ahead
    • All the letters connected in every word = logical thinker who enjoys debating to the point of nitpicking
    • Abrupt breaks between letters = person who jumps to conclusions without the benefit of logic
    • Large letters = loves the spotlight
    • Small letters = finds more satisfaction in working then socializing
    • Lots of rounded letters = outgoing person
    • Straight lines and angles = aggressive person who pushes hard for what they want
    • Lots of loops and close spaces between words = big imagination and need for social contact
    • Few loops and wide spaces between words = intellectual loner
    • Thin writing with illegible words = creative genius OR slippery character
    • Hidden personality traits are seen in the lower loops of letters g, y, f, p, and z):
      • Moderately wide loop =  welcomes a variety of experiences
      • Skinny loop = sticky to what they know
      • Extremely wide loops = bragger who doesn’t follow through
    • The upper loop slant measures emotional responsiveness:
      • Extreme right slant = emotionally explosive
      • Moderate right slant = warm and responsive
      • Vertical = cool headed
      • Left slant = friendly on the surface but hard to get to know

    Now, I know you are dying to go look at your writing and see what it says about you.

    Overload: Why We Don’t Pay Attention

    Why don’t people read your messages and respond to marketing activities or even educational materials.  Overload.

    With the average white-collar worker receiving 140 e-mails a day, being booked in meetings for hours, getting numerous voicemails, spending an average of 87 minutes a day in the car,  getting traditional mail, and (of course) trying to work and spend time with their family and friends, there isn’t much bandwidth left over.  You could argue this is a reason to be creative and spend a lot on branding.  You could argue this is a reason to make your messaging concise and to the point.  As most bosses I have had would argue, this is a reason to make your communications deliver value.

    1. Tell them who you are (branding).
    2. Tell them why you are contacting them (value).
    3. Then, if their still reading or listening, tell them very clearly what you need them to do.

    Heart Attack Not Urgent Enough At ER

    With an increase of Emergency Room (ER) patients from 93.4M to 110.2M from 1997 to 2004 and a reduction in 24-hour ERs by 12%, it now takes an average of 30 minutes to get seen. If you are a heart attack victim, it takes an average of 20 minutes with 25% of the cases taking almost an hour to get seen. Since every minute counts, that seems pretty worrisome. Where else are you supposed to go with a heart attack? [This is all according to a new study in Health Affairs that is described in USA Today.]

    “We can no longer guarantee that a bed is going to be available when you have your heart attack.” Linda Lawrence, president of the American College of Emergency Physicians

    Interestingly, when I was looking at this article, I clicked through a few links and found a CMS tool to compare hospitals called Hospital Compare. Just selecting a few local hospitals and looking at some metrics raised some questions. Here is one quick metric. Obviously, like anything, a single metric in isolation isn’t the best way to judge, but it certainly might make you do more research.  [HINT – Click on the image below to be able to read it.]


    EDM, Gartner, and Event Driven Communications

    I mentioned the EDM (Enterprise Decision Management) Blog a few weeks ago. James Taylor has a post out there today about Using EDM to deliver event-based marketing. Those of you that know me or have been reading the blog for a while know that this fits into what I talk about perfectly. It involves decomposing a process into its key tasks, understanding the rules behind the process, determining data events that can be used to identify opportunities, and then executing a coordinated communication process.
    He references a Gartner publication with the following abstract:
    “Successful event-triggered marketing is a process of identification, categorization, monitoring, optimizing and executing. Marketers that do this right will see their marketing messages receive up to five times the response rate of nontargeted push messages.”
    He also talks about key considerations such as rules, analytics, predictive modeling, champion/challenger, and multi-modal.

    Using Thermometers To Avoid Foot Ulcers

    600,000 diabetics get foot ulcers each year and over 10% of those lead to amputation of toes, feet, and lower legs.  A study discussed in USA Today showed that almost 2/3rds of those ulcers could be avoided by using a thermometer to identify whether an ulcer is developing.  So simple…so much savings (pain and financially)

    So, assuming there isn’t some analysis or clinical bias that I don’t know about, this seems like a low-hanging opportunity for managed care companies.  What are you doing to reach out to your patients, get them a thermometer, collect their data, and remind them to use it on some regularity?

    Coordinated Communications

    A few days ago, I talked about a press release from Express Scripts around formulary change programs to encourage patients to move to a different drug (same therapeutic category different chemical entity). I mentioned in there a single frame that I created to organize the program. Happily, I found it publicly so I can share it. Here it is. The key points here were – identifying the different constituents, determining the best mode of communication, coordinating across channels, and determining how to sequence communications based on events (aka triggers) which might be a date or a percentage of their prior prescription being used.


    While I was searching, I also found the presentation we gave on how multi-modal coordinations using a letter and an automated call impacted success for my retail-to-mail program. The key to remember here is that we targeted people who had already received one or more letters and had not responded. The results were great.


    The Wii – Learning Tool / Real Exercise

    After posting on Sunday about “embodied cognition” which talks about learning better while being active, I found it interesting to play a Wii that my kids had borrowed that night.  Initially, it simply made me think about what a great medium this could be to teach people especially people that learn through experience.

    Then, I played the Wii boxing and actually broke a sweat.  I hadn’t believed friends of mine that told me this was true [and I certainly wasn’t going crazy playing the game].  I do think it is a very interesting technology, but this isn’t an advertisement for the product.  From a healthcare perspective, it seems like the technology could be exploited to get less active people to exercise and teach people.

    Our beliefs about health are embodied in the way we live.  We need to leverage different media to drive that message home to all generations.

    How Some People Feel About HealthComm

    Healthcare Communications (HealthComm) are never what we run home to receive, but they are often important.  Unfortunately, it has lacked a focus historically.  Most of the focus was on claims systems and underwriting and network size.  Not that those areas work perfectly, but there is clearly a movement toward customer service, patient satisfaction, and communications (inbound/outbound, letter/call/e-mail/live agent).

    Look at this blog entry on a very popular blog and some of the comments.  It is a big uphill battle.

    Learning Deficit In Healthcare Setting

    Typically, when you are receiving care and instructions from a physician or other medical staffer, you are sitting down or laying down in a hospital bed.  Given some of the research discussed in an article today in the Boston Sunday Globe, it makes me wonder if patients are immediately at a disadvantage.  This article discusses research which correlates learning and the brain with physical movement.  An area called “embodied cognition”.

    “Work led by Susan Goldin-Meadow, a psychology professor at the University of Chicago, has found that children given arithmetic problems that normally would be too difficult for them are more likely to get the right answer if they’re told to gesture while thinking. And studies by Helga Noice, a psychologist at Elmhurst College, and her husband Tony Noice, an actor and director, found that actors have an easier time remembering lines their characters utter while gesturing, or simply moving.”

    see-hear-speak.jpgObviously, there is lots of research about how people learn.  At the simplest level, some people learn by reading, some by hearing, and others by experiencing.  Plenty have studies have been done to say people who get information in multiple ways are the most likely to learn it.  I don’t have it with me right now, but when I have done communication seminars for people before, we have talked a lot about why you want to teach and/or present using all three modes.

    Tell them…Show them…Make them experience it.

    This is why multi-modal coordination (e.g., letter followed by call or call giving you a website) has value and is more effective.

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