Archive | April, 2008

Social Media in HC Presentation

When I was posting the uninsured presentation, I stumbled upon this.  It is a good summary of some of the things going on in the industry today.

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Facts About The Uninsured

The Robert Woods Johnson Foundation has a project called Cover The Uninsured.  As we all know, this is a major issue which is only getting more pressing with the economy the way it is today.  With food going up and gas going up, it is putting more and more economic pressure on people.

Granted…not all the uninsured are uninsured due to their economic condition, but even those that think they are invincible would be better off with some safety net.

I point this out since this is Cover the Uninsured Week (April 27, 2008 – May 3, 2008).

Here is a slideshow of data from their website:

Defensive Medicine

On April 23rd, USA Today had an article on Defensive Medicine by Kevin Pho (a PCP who blogs at KevinMD).

It was a well written piece with a few facts that I thought I would capture here:

  • $2.2T are wasted in our healthcare system (per PWC) due to medical errors, inefficient use of technology, and poorly managed chronic diseases.
  • Defensive medicine was the situation where physicians order tests to avoid the threat of malpractice.
  • Defensive medicine was estimated to contribute $210B annually to this $2.2T in waste.
  • According to the JAMA (2005), 93% of doctors reported practicing defensive medicine.
  • An American Academy of Family Physicians cited a study that physicians who had fought medical liability cases which showed that 90% “suffered significant mental effects from the lawsuits” and 10% contemplated suicide.
  • The New England Journal of Medicine analyzed 1,400 malpractice claims and found that 40% of cases had no medical error.

Kevin goes on to explain that most patients don’t mind the extra tests.  I would argue that patients probably feel that their doctor cares by going the extra mile.

As he talks about, more isn’t always better:

  • Risk of a false positive
  • Radiation from a CT scan might be unnecessary
  • Biopsy can lead to complications

Researchers at the Dartmouth Atlas Project concluded that higher intensity medical services have led to worse outcomes, higher costs, and an increased number of medical errors.

It’s a pretty sad state of affairs.  Physicians afraid of being sued.  Consumers with no direct understanding of the cost.  Again, it gets back to incentives and communication.  We have to align interests and protect people who are doing the right thing.  But, all parties have to be willing and able to provide information and disclose the implications and rationale.

Healthcare Retention

Retention in healthcare has become an emerging focus.  With the initial land grab for Medicare lives over, it is more and more important to retain them.  Focusing on new lives is becoming harder.  And, with one of the few green fields out there being individual lives, retention will continue to be a business driver for the next decade (or until we move to a single payor system).

Fortunately or unfortunately, there is no silver bullet.  But, this is clearly the time to act.  Figure out what works.  Set your baseline.  Learn from the consumer, customer, patient, or member.

I recently gave a webcast on this topic, and without giving away anything proprietary, I thought I would share some cliff notes.  If interested, feel free to contact me for the content or even to learn more about our retention solution.

  • Retention is a journey from employee satisfaction to customer satisfaction to loyalty and ultimately retention.
  • There are many different types of loyalty – price, programmatic, experience, and relationship.  (Forrester Research)
  • There are many lessons to be learned from outside the industry on the value of retention, how to measure retention, and what drives it.
  • A data centric approach to learning and understanding your consumers is critical path.
  • There are some basic programs emerging as foundational.
  • Health plans unfortunately start by having to build trust.
  • One way to build trust is to demonstrate that you are looking out for the best interest of the patient.
  • Your brand is affected by all the constituents in the delivery chain.
  • Price and product are the obvious drivers of satisfaction, but there are others.
  • The most satisfied are not always those with the lowest price.  (There is a great example of this in another industry.)
  • Your healthy members are the most likely to disenroll.
  • Satisfaction varies by condition.
  • There is a big difference in likelihood to renew between someone that scores you in the top box (i.e., 10 out of 10).

Lots more to come on this topic.

Doctors Won’t Trust PHRs

One step forward and two steps backwards is my reaction to this comment…if it’s true.

Steve Leiber — who runs Healthcare Information and Management Systems Society, the trade group for health IT — told the WSJ Health Blog that physicians won’t trust PHRs.  As John Sharp mentions on the eHealth Blog, this points to the need for PHR certification especially around data sources (i.e., payor claims data, patient self-reported).

Wow.  I just assumed that was part of any legitimate PHR.  I have asked the question of several vendors and always thought I got the answer that you could tell where the data came from.  I would certainly think some data in an emergency situation is better than none especially if you have some understanding of the source and date of the information.

If PHRs just become a tool for patients with no use in the medical community, they are doomed for extinction or will simply be marginalized.  We need solutions that bring us together.

What A Difference A Few Years Makes

Before a whole week passes, I need to capture my interview with Gene Drabinski from Trizetto. Gene is the President of Cost and Quality of Care. This was a fun interview where we just kicked back at the end of day two at the World Healthcare Congress and talked.

I haven’t spent much time around the Trizetto people recently and still thought of them as Facets which was the software that I remember from my payor days at Ernst & Young LLP.

Of course, I had done some homework prior to the meeting and began by asking some questions about being acquired by Apax who is taking them private. We talked about the advantages of being private versus public. The big one being the ability to plan long-term and make investments rather than try to make each quarter’s number.

He was then kind enough to walk me through some of the history of Trizetto. If you go to their news page off their website, I had realized before I talked to them that I was outdated in my frame of reference. They are talking about social networking and consumerism and decisioning not about claims processing and efficiencies.

We talked a lot about the CareKey application which they acquired. CareKey (now CareAdvance) is a PHR (personal health record) which sits on top of a member database. He described several key features of the application:

  • Good metadata (i.e., data about data)
  • Ability to reach out and capture new data systemically
  • Custom rules environment
  • Able to be integrated with workflow and used in disease management, case management, and utilization management

CareAdvance Enterprise – Enterprise software that allows health plans to automate utilization, case, disease and population management, and to extend a personal health record and personal health management tools to their members. The system includes two modules: Personal CareAdvance and Clinical CareAdvance, which integrate with the health plan’s core information systems, aggregating the member’s personal claims and diagnosis history, current prescriptions, and laboratory data into a single data repository.

We talked about transfering the information from one PHR to another. He clarified that the transaction data was transferable but not the context. We then spoke about their vision for Integrated Healthcare Management as an out-of-the-box solution to make the patient “be the best I can be”. From what he said, the physician is the final constituent that they need to get integrated.

“Integrated Healthcare Management is the systematic application of processes and shared information to optimize the coordination of benefits and care for the healthcare consumer,” said TriZetto Chairman and CEO, Jeff Margolis.

From Gene’s session at the conference, he facilitated a panel that included Vicky Gregg who is the President and CEO of BlueCross BlueShield of TN. One of her slides which captures the Trizetto IHM vision is here:

My takeaways were (a) Gene’s would be an enjoyable person to work with and (b) Trizetto is doing a bunch of interesting stuff and focused on how to use technology to transform the industry.

It’s also worth reading through Jeff Margolis’ document called The Health Plan of Tomorrow.

E-mailing Your Physician – A Likely Trend?

This seems to be a topic hotly debated right now. I certainly would love to e-mail my physicians. Between travel and phone calls, we end up playing tag for days. Additionally, I love e-mail for its ability to provide me with a trail of what we discussed. Of course, there are lots of issues not least being reimbursement:

  • The studies show that visits go down when they use e-mail. Will they willingly reduce revenue?
  • If it is simply replaces the call, that is probably easy to justify. If it becomes more clinical in nature (i.e, an e-visit), what new issues does this bring in?
  • Is it secure? Is security any different than the phone today?
  • Is it your physician responding or someone on staff? Do you care?

“People are able to file their taxes online, buy and sell household goods, and manage their financial accounts,” said Susannah Fox of the Pew Internet & American Life Project. “The health care industry seems to be lagging behind other industries.” Doctors have their reasons for not hitting the reply button more often. Some worry it will increase their workload, and most physicians don’t get reimbursed for it by insurance companies. Others fear hackers could compromise patient privacy — even though doctors who do e-mail generally do it through password-protected Web sites.

There are lots of blog posts on this so I will point you to a few of them rather than starting a whole new discussion:

From a corporate perspective, I then have to ask whether health plans and PBMs should (or could) communicate with the physician through e-mail. Again, more efficient, allows them to track history (no more he said she said), accessible anytime, and can link to more information. My general opinion is that there must be a mechanism to parse the e-mails into buckets (general patient exchange, e-visit, payor information). They should get paid for the e-visit. The other two are just a new channel for what they do today. (There are separate arguments for whether they should get paid for those functions, but let’s not let that detract from solving one issue at a time.)

Silverlink Coming To A City Near You

I am really excited about a new initiative at work.  We have pulled together a great set of speakers and are doing a road show around the country.

The speakers include:

The topic of the event is Healthcare Communications: Think Differently and is about how to engage the new healthcare consumer and drive behaviors in scale.  Very much like what a lot of the talks were about at the World Healthcare Congress.  It’s not simply getting data and information, but it is about making that information actionable.  That is exactly what this 1/2 day session will be about.

The meetings will be in Boston, NY, Hartford, Minneapolis, Oakland, and Westlake (CA).  Click here to find out more information and to get registered.  We hope to see you there.

OptumHealth Interviews

Both Rob Webb (CEO of OptumHealth Care Solutions) and Chad Wilkins (CEO of OptumHealth Financial Services) were presenting at the WHCC in DC and were able to sit down with me for an hour to talk about their business.

Let’s start with some of the basics:

  • OptumHealth is part of United Health Group.
  • OptumHealth Care Solutions provides consumer advocacy, wellness, health care decision support, disease management, case management, health information portals, and specialized networks.
  • OptumHealth Financial Solutions is a health care financial services provider which provides consumer health accounts (HSAs, FSAs, HRAs), benefits administration, and debit cards (among other things).

In preparing to write up my notes from the interview, I retrospectively read the press packet. My one takeaway is that most of the programs here (e.g., dental or incentives) are not what you typically think of when you think of UHG. They second caveat I will add is that we jumped around a bit as I was interested in learning about lots of little things versus creating one big story.

I began by asking them what they thought about using flat dollar copays on drugs versus percentage dollar copays. [Dr. Gupta from CNN had done a report that morning around how patients should look for health plans with flat dollar copays. And, the WSJ had earlier in the week had a story about how percentage copays on specialty drugs disadvantage the sick.] I think their response (rather than no comment) was appropriate in saying that:

  • In general, simpler plan design eases adoption which I take to mean drives the intended behaviors. (and I know it reduces calls)
  • Using a percentage copayment brings the condition into play. (I completely agree)

We moved on to my favorite topic – communicating with patients. We talked about how socio-economic conditions play into prevalence of conditions and phases of change in terms of messaging. Rather than being big believers in the Pro-Change model, they talked about focusing on “how compelling is the case for change”. They focus on delivering a message that says something like “we have something for you to consider” and including some data to reinforce that suggestion. I will have to follow-up with them to get the data, but we then spent some time talking about using inductive call logic versus deductive call logic.

I can’t talk about communications without talking about messaging channels so we addressed that next. I specifically asked them what if anything they had done on the SMS / text messaging front. Although I am generally a skeptic about text messaging in healthcare for things that require lots of PHI (protected healthcare information), I do think there is a role for some wellness type activities like smoking cessation and weight loss. There has also been a study done over in Scandinavia that had positive results (although the cell phone culture there is more like Japan than the US). They mentioned two things:

  • They added a second phone option for cell phones several years ago.
  • They recently added an “opt-in” type of field for patients to say they were willing to accept text messages. (Since some people still get charged per message, this is important.)

After that, we spent a few minutes talking specifically about each of their businesses. First, Chad talked about the Financial Services business giving me some of the history. We then talked about their scope of services. A couple of interesting takeaways were:

  • They are able to take the card data and integrate it into their PHR. (Which I think every PHR should do.)
  • 27% of the people with HSA plans used to be uninsured. This is a very interesting fact.
  • Since it was Earth Day, their PR person pointed out the amount of paper they save per year by moving all these things to electronic.
  • He talked about linking accounts, cards, and incentives.
  • We also spoke about the impact that the economy would have on the business. He pointed out that at $1 to print a check, $30 to talk with a provider, and $5 to re-process a check that the current downward trend in the economy would likely drive cost-focused programs.

Next, I talked with Rob specifically around Care Solutions. A few of my takeaways here were:

  • They focus on trying to identify why a patient has (or could have) a gap in care and solve the problem systemically (what I would call quality at the source) versus how he positions their competitors as focusing on the gap in care.
  • Since United Health Group is the biggest buyer of their services, he believes they bring a healthy skepticism to the table in terms of evaluating program outcomes and ROI.
  • I asked him about their predictive engine which I know companies like ActiveHealth have. He talked about the fact that they have a similar model, but that ActiveHealth has done a great job of bringing back the appeal of the predictive engine. And, he talked about their interest in pursuing a low-cost model for intervention using letters at $1.50 per intervention. [It was hard for me not to point out here that for similar or less cost we could probably get them a much higher response rate and ROI using our personalization engine and automated outbound call technology at Silverlink.]

Overall, I found it a very interesting conversation about two areas of United Health Group that aren’t always the first thing consumers think of. I am sure our interactions with them are more that each of us think given their market prevalence.

WHCC 2008 Potpourri

I am flying home and trying to catch up on all my notes so that I can get back to work. It has been a good 2.5 days, and I got some business done, learned several things, and met a bunch of interesting people. Not bad. I have a few more interviews to write up, but I want to throw some of my notes out there so that you can pick up some of the other comments / thoughts that I captured.

  • Michael Leavitt (Secretary, Department of Health and Human Services) spoke at the end and talked about several things:
    • He told the story of someone saying “the great thing about healthcare standards is that there are just so many to choose from” and went on to talk about how problematic that was.
    • He talked about 4 things:
      • Standard quality measures
      • Standard cost-of-care groupings
      • Interoperable EMRs
      • Incentives to seek value
    • He said “the billing system in healthcare is insane”. And had an analogy that I am sure many traditionalists thought naïve about what buying a car would be like if it had the same billing process as healthcare…starting with making a purchase with no price available.
    • He said that things are so bad that “people with average intelligence and limited patience can’t understand healthcare pricing”.
    • He talked about moving to a value-based system and compared it to video games. He said we are at Pong today and need to evolve through Donkey Kong and Pac-Man to get to Wii. (Nice vivid analogy)
    • It was refreshing to see a government official very passionate about the dilemma. He talked about ongoing cost increases as the most serious economic threat to our country. He talked about how there is an inflection point in every generation where we have to prove ourselves and healthcare reform is ours. He said we have three options:
      • Fight change and fail
      • Accept change and survive
      • Lead change and prosper (which is what he called upon us as Americans to do)
  • In a session yesterday, there was talk about:
    • DASH – Dietary Approach to Stop Hypertension – where EMC talked about saving $1,000 per participant.
    • The Prochaska change model looking at different stages of change and moving from awareness to education to supportive environment to changing behavior to sustaining change.
    • Engaging consumers through education, motivation, access to reliable information, reinforcement, and support. But the speaker lost me when she claimed that consumers don’t engage since they assume their physician is taking care of their health. What consumers are these?
    • I liked the analogy of “supersizing” referring to the fact that healthcare often delivers more than needed.
    • I was a little shocked in watching a video which made three suggestions that I didn’t agree with:
      • Patients should go to hospitals with the most experience (what about the best outcomes)
      • Patients should always go to the health plan website (since they don’t trust this source is that really the default answer)
      • You should call your MD first at 3AM. (are they really going to call you back to triage you)
    • I liked the positioning that “there is no free lunch” to make the point that there is a tradeoff between spending. Sure you can have more health benefits, but we will have to limit benefits elsewhere. The speaker also compared healthcare to giving someone a “platinum charge card” and that there needed to be education about how and when to use it responsibly.
    • And, I believed it but was surprised to hear one speaker say that when they educated their members about what questions to ask their physician that physicians complained saying they didn’t have time to answer all these questions and see all their patients. (Now there’s a systemic problem.)
  • One of the best speakers (who deserved a longer dedicated session) was Reed Tuckson from UnitedHealth Group. He spoke with Peter Neupert from Microsoft about “Achieving a Consumer Focus”:
    • He talked about changing the question from what is the best hospital in Chicago to what is the best hospital for me based on my preferences and my conditions.
    • He talked about segmentation and targeting communications.

“Data is only exciting if you can do something with it.” [Reed Tuckson]

  • He talked about two challenges literacy and longitudinal view of the patient. He said today’s students don’t know “diddly squat about science.”
  • There was a good discussion with the moderator about whether people perceive the Internet to be secure or whether that is still an issue.
  • Peter provided two differences that he thinks makes healthcare security still an issue:
    • Work about discrimination if the information were to be misused
    • Work about insurability if the information were to be misused
    • Both of these being a much bigger deal than having your bank account compromised
  • There seemed to be consensus that consumers wouldn’t mind de-identified healthcare information being shared for the purpose of public health research which is clearly a benefit of aggregating data, but Peter clearly pointed out that HealthVault’s data belongs to the consumer so they would have to opt-in.

“Today’s system is broken and fragmented…you can’t track a patient through the system.”

  • In a session on Massachusetts with people from BCG, Tufts, Harvard Pilgrim, and the Commonwealth Health Insurance Connector:
    • What should come first was the question – access, quality, or payment? Great discussion.
    • The typical uninsured was a 37-year old male who was “just starting to think they weren’t invincible”.
    • This will be an interesting example of a stick. People who don’t have coverage will be penalized $75 a month on their taxes for 2008.
    • They were able to offer 50% more benefits at 50% of the costs.
    • The deficit issue is mostly due to too many people signing up (and I suspect too many employers taking the smaller penalty to get out).
    • They talked about most reform being historically killed by either the broker community or the managed care community and that they needed to get a broker representative more involved versus simply having a broker advisory role today.
    • They mentioned the website several times – www.maconnector.org. They compared it to Travelocity.
    • They also talked about www.notinvincible.org.
    • Today, more people are choosing the higher premium plan options but that will likely change as they push the last people in their under a penalty model.

Sorry for the long mix of stuff, but I think it will cause you to think and share some of the experience. I have to write-up my last interviews later today.

Putting Faces On Fellow Bloggers

I had a chance to meet up face-to-face with several of the other bloggers at WHCC 2008 which was great.  Some of them were also Twittering during the conference (here’s an example).  We shared one common thought which was that this was exhausting.

Also a few of us shared thoughts with at least one friend about blogging out of passion versus blogging purely for a corporate reason (see types of blogs).  Not sure any of us could do the second.

Too Popular To Get In The Room – Part II

It’s amazing to me that a company that hasn’t launched yet has been at two conferences with standing room only (in the hallway), but that is the story for American Well. At both Health 2.0 and at the WHCC 2008, the crowds packed in to hear Dr. Roy Schoenberg (CEO and founder) speak. Fortunately, I had scheduled a meeting with him offline so I got to spend an hour talking with him about what they are up to.

So…who are they:

  • “American Well has created a new healthcare marketplace where consumers and physicians can come together online to acquire and provide convenient and immediate healthcare services. Using the latest technologies in Web communications and digital telephony, American Well extends traditional healthcare services to the home setting.”
  • Roy is a physician who previously founded CareKey which was sold to Trizetto.
  • Their solution (launching at the AHIP conference later this year) plans to create a win-win-win for patients, providers, and payers:
    • Patients get a convenient, easy to use solution for anytime access to physicians. (Depending on the payer model, they may get a lower copay.)
    • Providers get a new revenue stream, access to new patients, and an opportunity for a new business model without traditional limitations and costs (i.e., space, office staff).
    • Payers get a new service to offer patients which should avoid urgent care and emergency room visits ultimately saving them money.

Some of the basic questions (coming from a blend of the press kit and our conversation):

  • Don’t we already have this? Most services today are e-visits which are asynchronous (not live or interactive) while these are live visits.
  • Will this be covered by my insurance? Yes. Payers are their clients.
  • How will this compare with the retail clinics? It has the same concept of convenient, no-appointment care, but it is in your home and it is provided by physicians. Additionally, the patient has the option to choose the attributes of the physician they want and evaluate the experience.
  • Will the patient or the physician be required to have certain hardware (e.g., web camera)? No. This can be done with a web camera or just over the Internet or just over the phone.
  • Is the physician flying blind (i.e., having no data about the patient)? No. The idea of working with the payers is that they can have access to claims information about the patient. [This is a big step from other ideas I have seen. We talked about batch access and real-time access to the data which they apparently have both options.]

Roy is a very engaging and comfortable CEO. You can tell that he feels passionate about the idea and has been here before. He talked about being disruptive to the system but the importance of disrupting one area not the entire system with your solution. [This is a good point that I have never heard someone stress before.] Listening to him talk about working with the payers and comparing this to different models made me realize: (1) they basically have created a solution where the payers are their recruiter (for MDs) and their marketing arm (for consumers) and (2) will we see a place where there are additional tiers of copays (i.e., $5 for an e-visit, $10 for a virtual visit, $15 for a retail clinic, $25 for an office visit, $50 for an urgent care visit, and $100 for an ER visit).

I liked a couple of his vivid phrases. He talked about the need for high deductible patients to have a “GPS to navigate smartly” through their options. He also talked about an “end of days PPO” which (if my memory serves me) was referring to the open access to primary care and specialist through the American Well platform. We talked a little about the type of users they might expect from acute (urgent) to preventative (purely convenient) to chronic. It made me wonder in the last situation whether you could see plans pushing a visit for conditions where adherence or compliance with therapy is an issue and they are concerned about the patient. We also talked about their workflow type solution to capture data and push it along to the next visit to (for example) a specialist. It made me realize that there is probably a big drop off in visits to specialists based on the lag to get an appointment. If my PCP recommends I talk to someone, but it takes me a month to get an appointment, how likely am I to go?

I had a question about why you wouldn’t put the care team (MD, RPh, specialist) all on the session at the same time. I think his response about the challenges in doing this made a lot of sense. You put people who don’t know each other into a real-time session without a facilitator and would likely end up (in my words) with too many cooks in the kitchen.

Given all the talk about PHRs, I wondered how patients could extract information from their virtual visits and pull it into their PHR. He told me that this was part of the service and since they come from the PHR world, that makes a lot of sense. Since this also might create a two-way opportunity for the PHR to be used by the consulting clinician, it might actually impact PHR utilization and make it a more valuable tool.

Obviously, one challenge will be managing supply and demand especially around peak times. He talked about how many requests they get today (pre-launch) from MDs who want to participate. [Given the frustration I hear from many physicians, I believe it.] He talked about their matching algorithm along with their plan to predict volume and type of skill set needed to proactively recruit real-time logins (i.e., I predict we will need 3 oncologists in the next 10 minutes so let me send a call / e-mail out to 20 and see if they can log-in).

The patient will get a standard 10 minute interaction which is managed by the system and as the time elapses, there will be a gentle reminder. The physician will have the option to slightly extend the “visit” from a care perspective at no additional cost or offer to add 5 minutes at a cost directly billed to the patient. I wondered (perhaps naively) why you couldn’t just extend it for another 10 minutes with another copay, but he reminded me that no plan was going to allow you to go to the same doctor multiple times in the same day.

The other thing that I thought about but we didn’t discuss is the opportunity to use this for MTM (Medication Therapy Management) which is a service provided around Medicare Part D from pharmacists to patients. Could this become virtual which would make it more scalable.

Overall, very interesting. With 2 young kids, I know of many emergencies. As a working professional who travels a lot, I know the challenge of making appointments and even talking with my physician. I look forward to testing this service out later this year.

Hidden Gem at WHCC 2008

For those of you missing the World Health Care Congress 2008 in DC, you are missing a good meeting.  It has lots of networking opportunities, good speakers, lots of company booths, and good content.  I have been here and trying to run between presentations, meetings, and interviews.

I went to a presentation yesterday on PHRs (personal health records) which is a hot topic here.  I think the presentation by Jan Oldenburg (Practice Leader, Health Content, Internet Services Group, Kaiser Permanente) could be the the hidden gem of the conference.  I know a lot of people will immediately discount it for being part of an IDS (integrated delivery system) but don’t.  There is a lot to learn here.

Some of the key things include:

  • Integration of the PHR and EMR.  [Their EMR is from Epic.]
  • A focus on four key attributes – transparency, accessibility, consistency, and security.
  • Four major components: record of information (lab values, visits, notes), an interaction tool (e-mail your physician, HRA), transaction engine (refills), and links to health content.

They have an amazing 2M members on the PHR with over 60% who signed in and used the tool more than 5 times in 2007.  [They probably deserve an award just for this ability to create a sticky application.]  And, 16% signed in more than 12 times.  […which is probably all of their chronic patients with co-morbities.]

Jan talked about their promotion of the site which includes all of their materials, registration drives, and even physicians giving out cards promoting the site.  She talked about making meaningful improvements like moving from mailing out the password to the patient to instant password set-up using a similar algorythm to what banks use.  (This improved their activation to 88% over the past 2 months.  They used to lose 30% between password request and actual registration.)

And, it sounds like they have taken a very thoughtful approach to the application:

  • She spoke about the fact that they had over 3.6M e-mail exchanges between MDs and patients in 2007.  Originally, they didn’t pay MDs for e-mails since it was like returning phone calls.  But, they are looking for how to distinguish between an e-visit and an e-mail.

“E-mail helps me take better care of myself” [a quote from a patient]

  • In a published study, they showed that patients using e-mail had 7-10% less visits and 14% less use of the phone for support.  [very impressive]  But…to George Halvorson’s point on day one, this is a perfect example of misaligned incentives.  The MD uses e-mail to improve health and patient satisfaction but makes less revenue.
  • They addressed one not so obvious issue which is timing of data being released.  For sensitive lab values, they are either delayed so the physician sees it first or its only released after the physician approves it.  The key is that the physicians don’t want the patients to see the data before they get a chance to call them.
  • The patient can take an HRA (health risk assessment) and decide whether or not to share it.
  • They have some impressive statistics around changing behavior:
    • 55% lost weight
    • 58% decreased stress
    • 78% had better pain management
  • They are just beginning to analyze who the users are (e.g., chronic patients, acute patients, family).  This was a question in every PHR meeting yesterday.
  • Some of their key learnings included:
    • Information has to be timely and current
    • You have to create “in the moment” opportunities to act (i.e., e-mail your provider)
    • You have to create teachable moments
    • You have to meet members where they live
    • You have to heal the fractures of our healthcare system

“Patients who use the PHR are 65% more likely to stay with Kaiser when they have a choice of plan options.”  [WOW!  Talk about a case for adoption.]

  • They were one of the first ones that I heard talk about working with portability standards to move data from PHR to PHR and to a DTC model (i.e., Google, Microsoft).
  • The final point which was similar to what I discussed with ActiveHealth was around genomics.  Jan talked about some of the analysis they were doing thinking out years in the future about how that data could influence generations.

This is certainly worth following and looking at as a model.  Some of the things are easier because of their model (e.g., getting MDs to use e-mail and promote the web), BUT somethings are lessons that can be leveraged.

Data + Rules + Transportable = ActiveHealth PHR

I had the chance yesterday to sit down with Nita Stella (SVP of Product Management at ActiveHealth) and talk about their PHR.  It was a helpful meeting given that I spent much of today in PHR discussions.  Some of my takeaways were:

  1. You have to have a PHR which pulls in your claims data.
  2. You need to have rules which use the data to drive specific actions.
  3. The PHR has to be transportable.

ActiveHealth has two ways that the PHR is offered: (1) through your payor and (2) direct-to-consumer (launching next week).  This works great if you originally get it through your payor and have your claims data pulled in.  Then, even if you leave, you can take the data with you.  Additionally, they are linked to HealthVault (Microsoft offering) which should help address some of the transportable issues.

Their key offering has been about using an evidence-based approach to drive decisioning using business rules so from what I know this is a key component of their offering (see more on Care Engine).

We talked a little about size and utilization.  Some of the statistics that I wrote down were:

  • They have 6M eligible users (i.e., provided through their payor).
  • Average use is 40% (i.e., meaning that they register and sign-in).
  • Use ranges from 10% – 75% with the top client using incentives to drive adoption.
  • Based on some initial data, they are getting 1.7 visits on average.
  • Most of the repeat visits are due to an e-mail being triggered to let the patient know of some care alert.  [Since e-mail is not secure and you can’t send PHI (protected health information), I wonder how much more effective this would be using a different medium that included personalized information.]

She gave me a tour of the application which has a nice GUI (graphical user interface).  I liked the fact that that alerts and reminders were at the top of the page when you logged in and prompted you for an action.  Additionally, so you couldn’t just defer the action, it asks you for a reason if you choose to ignore it.  [That would be interesting data to see and track.  Why do consumers ignore opportunities and how does that vary by segment.]

I asked her what they were doing about using genetic markers and pulling in data from companies like 23andMe.   [A topic that came up in several PHR presentations today.]  She mentioned that they were talking with Rand about this and thinking through it.

The final point that I took away was that in using their business rules they are focused on pulling out the alerts and/or reminders where they have more than one marker to indicate a possibility (to eliminate false positives).

Obviously, the key to all of this is getting consumers engaged; keeping them engaged; and making the application valuable in ways that they want to use it.  A challenge for everyone in the space.

Consumer Engagement Tools

This next session is with James (Jim) Roosevelt (President and CEO of Tufts Health Plan) and Phyllis Anderson (VP of Marketing from Humana). It should include real-life discussions on what works.

Interestingly, Jim is making a point that he made earlier which is about how to differentiate when all the providers are in each plan. I talk about this a lot. My opinion based on what JD Power showed in their study is that communications is the differentiator. How? What? When? Personalization? Rules? Preference based? Integrated?

Jim said that 3-years ago they were in touch with 1.5% of their members on a regular basis…that number is now 22%. I am not sure there is a benchmark to know if that’s too much or too little…but it seems good. Some of the words he uses which I think are important are – cost management, quality improvement, evidence-based, self-care, comprehensive and integrated, effective, and positive ROI.

He laid out a good continuum of programs moving from low cost, healthy programs (wellness) to more expensive programs for at-risk people (disease mgmt) to high cost programs for the chronic patients. Tufts is moving to a consumer empowerment plan called My Wellness Plan which will focus on engaging 100% of their members and still get an ROI of greater than or equal to 1.5:1. He showed a chart that 50% of health costs are driven by health behaviors (good news in that it is an addressable challenge).

He talked about an example around bariatric surgery which I thought was a good case study. Rather than simply not covering it, they cover it after certain steps including a six-month lifestyle modification program. The key point he made is that surgery without behavior modification is dangerous.

They have 3 categories for engaging members:

  1. Lead a Healthly Lifestyle
  2. Manage Care and Treatment
  3. Effectively Navigate Health Care System

He made the point that it could be copied, but the question is do you act first. I think the question really is how well do you implement the vision. It’s easy to envision and know what to do. It’s very difficult to execute it well and make a difference.

Phyllis started with some patient messages which were interesting.

  • Take a deep breath. We dare you.
  • The food groups are your friends.
  • Make you next smoke break a clean break from smoking.
  • Where do you see yourself in 5 pounds?
  • Lower back under attack?

“Healthiness is a nuance.”

As the quote indicates, health information and engagement varies dramatically, and it will take a while and some trial and error.

“Incremental change will ulimately result in significant impact.”

She talked about a pilot they did and what they learned:

  1. Create real-life goals (relevant to where they are and where they live)
    • Want to fit a dress by reunion versus lose 100 pounds in the next 6 months
  2. Community is key
    • Coach
    • Peers (the participants blogged and got feedback via the blog)
  3. Rewards and incentives are necessary
    • Personalized to individual
    • Not just monetary
    • Include recognition

“It costs less to support well people.”  Phyllis went on to make the point that it’s worth spending the money now rather than waiting until people get sick.

There was a good question from the audience on whether ROI mattered.  Apparently, some of the employers here at the conference had said that they were willing to invest in programs that promoted health without any ROI.  I think the key is that there are limited resources…I would spend money first where I got a return.  I am willing to bet that I don’t have much money (or time) to address the other programs.

Who is the health care consumer?

I guess it gets to the question of how you refer to people in healthcare.  Are they individuals?  Are they patients?  Are they members?  Are they customers?  Are they consumers?

I was talking with an MD yesterday who asked me what I thought to the question “who is the consumer in health care?”.  I clearly think it’s the patient.  He thought it was the providers as they were deciding what goods the patient should buy.  I was surprised.  I could have said it was the payor, but I never would have said the provider is the consumer.

Some of it’s perspective, but some of it is definition.  I think if you add copays plus over-the-counter spend plus spend on things like alternative medicine and gym memberships then it is a lot bigger question that simply who pays claims.  It’s a key question.  if you can’t determine who’s the consumer, it’s going to be hard to agree on the strategy.

Michael Moore Endorses Obama

Do we really care? Maybe.  I found his movie on healthcare (Sicko) pretty interesting.

But, I don’t view it as realistic.  Change in the healthcare system is not going to happen without the establishment being involved.  Moore clearly doesn’t like the plans that exist and will likely alienate some of Obama’s potential supporters.  Could his endorsement rally the average consumer of healthcare?  I doubt it?

Consumerology?

Express Scripts launched their Center for Cost-Effective Consumerism just recently.  If interested, here is the site.  Impressive group of contributors.  I know and respect the staff.

Is it enough to drive differentiation?  We will see.

It has a blog.  Does it become a “corporate blog” which is just informal PR speak or does it actually have the team’s raw thoughts?

What learnings will they share publicly versus keep internally?

Can We Build The Goodies (PHR)?

I am sitting in on a discussion around PHRs and Consumer Connectivity which features Jeffrey Gruen (Chief Medical Officer at Revolution Health) and Jeffery Rideout (Chief Medical Officer from Health Evolution Partners).

Let’s start with utilization – only 10% of people have access to a PHR (Personal Health Record) through their plan and only about 2% actually use it (at best).  This brings three challenges to the table: (1) building awareness; (2) security and trust and (3) automating the data load.  The next question is can you make these fun and engaging tools (i.e., the goodies).

The presenters and the facilitator who is from Carol all start with a fairly skeptical view of the world.  They pointed out that it’s like an ink test…everyone sees something different.

It seems to be a big challenge.  Do you build it for what everyone wants which would be a laundry list or do you build it for what you think they want which generalizes?  I do agree that systemically the value is collecting and tracking data that can be shared with your care team across providers and insurers.

I must admit that some of the things that I would want include:

  1. Claims access (lab, medical, pharmacy)
  2. Tracking of OTCs (pulled from my savings accounts)
  3. Current benefit information (which assumes it is transferable across payors)
  4. Disease information
  5. A communication hub for sending and receiving secure messages
  6. Outbound reminders to me about events or opportunities
  7. Identification of care opportunities
  8. Tracking of information
  9. Integration of health social networks
  10. Recommendations of things to do or act upon

But, like I would consult any sales person, why are we talking functionality and features versus value.  From a value perspective, I want a safe, proactive application that helps me become healthier.  Not an easy request.  If I track my running, can it tell me that I am adding miles too fast?  Can it tell me about a drug-drug interaction?  Can it tell me that I paid too much for a treatment?  Can it track my total spend?  Can it help me predict comorbities based on data and possibly even my genomics information?

One of the members of the audience chimed in (rather passionately) that no one wants a PHR from a payor or stand-alone company.  The majority want it from the physician.  [An opinion of one, but I don’t and can’t imagine getting anything from my physician.  Maybe I don’t have the right relationship or the right chronic diseases, but I move and I want to have the choice to find the best doctor and not feel stickiness to them.]

Here’s a couple of presentations on this:

I didn’t realize until yesterday that for the DTC (direct-to-consumer) PHRs that are available the consumer has to actually enter all their own data.  It isn’t automated.  What a potential nightmare.

So, a real couple of questions are:

  • Who is this for – patient, providers, payors, care team?
  • Why would I ever spend anytime on a PHR if I couldn’t transfer it to my next payor?  I think this makes a play for Google and Microsoft and Dossia to provide a backbone that all the other PHRs use to create interoperability.

Upcoming Webinars

If you missed it last week, I am giving a repeat performance of my webinar on retention.  I am going to talk about driving customer satisfaction and building loyalty to improve retention which is and should be a hot topic for everyone in healthcare. (Sign up here for the 23rd at 1:00 EDT)

Additionally, my peers are giving a webinar on closing the adherence gap which should be another hot topic for many of you.  (Sign up here for their sessions on April 30th and May 22nd)

Wrong Question: What Does The Consumer Want?

After hearing Grant Harrison (VP, Integrated Consumer Experience) speak a few times on stage yesterday about his role at Humana, I was glad that I had time booked with him to learn more about what he does. I found it to be a very interesting discussion. Grant works in the Innovation group at Humana, and he brings a background which includes Virgin HealthMiles where I believe he was one of the founders and time at Tesco and SkyTV (among other consumer facing experiences).

The first thing we talked about was their VirtualMe initiative which is the creation of an avatar (i.e., virtual persona) for use on the web. They haven’t launched it yet, but it sounded like it was an effort to give some personality and interactivity to the consumer. Interestingly, they are already working on a mobile solution and how to use this in kiosks within the physicians office to pull up your data and minimize your rework. As we continued to discuss this, Grant talked about pushing it to the physician as an interface for them to input data essentially into the patient’s page or portal. I asked him if this would essentially create an integrated PHR / EMR which was shared by both parties which he agreed it could. [Maybe someday they will use the avatars in Second Life to open up a virtual Humana location.]

I asked him about creating a points program since he had done that at Tesco in the UK. He mentioned that they were looking at it. One of the things he mentioned was that they believed the amount of points or incentives you had to offer someone was directly linked to how good of an application you had and how clearly the patient saw value from their interaction. [It’s a great point.] Interestingly, he used RealAge as a good example of an HRA that people willingly do all the time. I never thought of RealAge that way.

When I started asking him about measuring success, he pointed out to me that people who ask “what does the consumer want?” don’t know what they are doing. Essentially, they are trying to generalize the healthcare masses when it is all about micro-segmentation. [It was clearly an opportunity for me to plug what I work on at my day job at Silverlink, but I was good and stuck to the press role.] He talked about a current effort they have to learn about the “care-giving woman” who is between 35-65 and has both a child to care for and a parent.

In talking about groups, we talked about a few things like measuring happiness. He had mentioned that this was their objective and talked about the whole body of international research on this topic and how you could look at proxy metrics like their engagement as a measure of happiness. We also talked about segmentation models and tracking things like their awareness and/or interest in communications from Humana.

We talked briefly about retention at the end of the discussion which seems like something they are getting ready to address with a focus on group retention, brokers, and Medicare lives. [He is one of a few healthcare people I know that ever talk about retention in groups…which I believe is a clear opportunity.]

“Not an insight unless you act on it.”

I think this quote was a good ending to the discussion since I was asking about what they were doing to actualize this information. Another question I had had was whether they would really build out all this within Humana or take it out to an Entrepreneur in Residence at a VC firm. I know we struggled at Express Scripts when we looked at how to develop and manage businesses that had little (operationally) in common with the core business. [As an interesting side note, I asked him what he thought about Express Scripts recent announcement about their Center for Cost Effective Consumerism, but it wasn’t on his radar screen at all.]

Reverse Engineering and the Golden Goose

I listened to part of the initial presentation by Hans Rosling from Sweden which was very interesting, but I was mostly getting coordinated for the day.

Here is the video of a similar talk he gave at TED.

I am very excited to sit down and listen to George Halvorson’s presentation called “A Practical Model to Achieve Health Reform”. [George is the Chairman and CEO of Kaiser and recently wrote the book Healthcare Reform Now! A Prescription for Change. Some of my notes on this are here although I am still finishing up the book.]

Here are some of his quotes and some of my notes. [You know you are a key person when you are able to quote yourself.]

  • Talking about Kaiser, “When we look for someone to blame, we have to look in the mirror.” He talked about how they play all the positions all of the time (payor, provider, lab, pharmacy).
  • Said that they had about 2M e-visits last year and have 92,0000 member contacts per day on the Internet. They are trying to figure out how to leverage the new toolkit in a way that makes sense.
  • He dedicated his presentation to Dr. Jerome H. Grossman who recently passed away.

“American health care could be transformed fairly quickly if a number of high leverage buyers chose to strategically use their market leverage.”

  • Reform can’t be voluntary…it needs to be a product…defined, purchased, and paid for by buyers.
  • He talked about the old market:
    • Hundreds of “slices”
    • Commodity products
    • Financial conduits rather than care delivery focused
  • He talked about the new market:
    • Sumo wrestling
    • Total replacements
    • Shrinking total market
    • Growth focus to drive stock value
  • This new market reality gives power to the employers in terms of pushing change. This is an interesting perspective really pushing the employers to drive for change.
  • It is a great, simple point that he makes around HC in America is becoming unaffordable…BUT financing reform is not enough. Most of what we hear about is financing change. He points out that the multiple payor system only explains 20% of the cost difference between the US and Canada.
  • What we need:
    • Universal coverage
    • Individual mandates
    • Guaranteed issue
    • Subsidized coverage for low income

“Care delivery in the US is uncoordinated, unfocused, inconsistent, unmeasured, extremely inefficient, perversely incented, and excessively expensive.”

  • He talked about how healthcare is the fastest growing and most profitable segment of US economy ($1.2Trillion). [Key point on profitability.]

“HC takes everyone’s money with an amazingly low level of accountability for the product it sells.” [Key point on why HC will never reform itself.]

  • Smart people don’t kill the geese that lay the golden eggs. We have lots of smart people and golden geese in the US HC system.
  • More efficient and effective caregivers simply deprive themselves of income.
  • Truths:
    • Current increases in cost are unsustainable.
    • Current rates of increase for Medicare and Medicare with eat entire budget by 2050.
    • 1% of people drive 35% of costs
      • If everyone in CA had coverage – $300 per month
      • If only 1% – $12,000 per month in cost
    • 75% of cost is from chronic care
      • Eliminating breast cancer would be create but only impact 2% of costs
    • Benefit design is clumsy and even inept
  • Some realities that drive out costs assuming we start with roughly the same base as other countries: [Although he points out that we do start at a higher base than Canada around office visits…$23 in Canada…$73 in US…$150 in NY.]
    • Inflation
    • Worker shortages – lab techs, nurses, pharmacists
    • New technology, treatments, drugs, etc. which all drive costs
    • Number of MRIs, transplants, etc. all higher…more high tech care (tertiary care)
    • No value screen for technologies or drugs…test is will someone buy it [Seems like an obvious problem]
    • Inefficient, uncoordinated, unlinked care
    • Multiple mds with no coordination
    • 10,000 codes for units of care
    • No reward for outcomes
    • Aging population

“We can’t stop aging, inflation, new technology and provider financial motivations.”

  • What we can do:
    • Focus on chronic conditions (CHR, Asthma, Diabetes, +2 others)
    • Work backwards (continuous improvement)…where do we want to get and then how do we get there

“Random reengineering doesn’t work…need a goal in mind.”

  • Tools:
    • Benefit design
    • Public messaging
    • Care tracking – PHR/EMR
    • Mandatory care registries and care linkages (tools will evolve once we have a goals)
  • Nurses spend 25% of their time on direct patient care [a pretty low amount]

Innovation Discussion at WHCC

We are just starting the 4th general session here.  [This is harder to do real-time blogging than I thought…and keep paying attention.]

The panel is Toby Cosgrove from the Cleveland Clinic, Grant Harrison from Humana, and Lee Shapiro from AllscriptsJustin Fox from Time and Clayton Christensen from HBS are the moderators.

Clayton is talking about disruptive technologies:

  • There is one line for performance that customers can utilize or absorb which has a moderately upward slope.  There is a higher sloped line which indicates the pace of technological progress.
  • Incumbents nearly always win when it is a sustaining innovation.
  • Disruptive technologies start with a technology that is not as sophisticated and less expensive then improve until it meets the market demand.  In these cases, new entrants usually win.  (e.g., PC versus mainframe)
  • Hard for companies to pursue disruptive technologies due to the pursuit of profits.  (Toyota started in US with Corolla and only eventually moved to Lexus.)
    • Koreans now doing this to Toyota.
  • 3 enablers of disruption:
    • Technological
    • Business model
    • Commercial system
  • Focus of enablers in healthcare:
    • Movement from specialist to family MD to nurse to parent
    • Movement from general hospital to focused hospital to outpatient clinic to office to home
  • He talked about the movement from intuitive medicine to empirical medicine and eventually to precision medicine (precise diagnosis by cause not by symptoms).

Toby Cosgrove is now talking:

  • Clayton’s model is right.  Gave example of moving from surgery to drugs to prevention.
  • Talked about work being done around using technology to address Parkinson’s disease.
  • Innovation is only answer to affordability challenge.

Grant Harrison from Humana:

  • Absolutely focused on innovation within Humana.
  • Focused on changing things for consumers.  What do they want?  What do they want improved?  What is health mean to them?
  • Research says health means being able to do what I want to do with my life…So how are people living their lives.
  • How does this change what we provide?
  • The end goal is happiness not just elimination of disease.

Lee Shapiro from Allscripts:

  • EMR plays a substitutive role for paper chart.  It is transformative is the ability to introduce evidence-based rules and connect providers with information that they need and other services and providers that are important to care.
  • Talks about their web-based e-prescribing tool used by thousands of MDs.  [Indicative of how slow adoption is happening.]

Clayton  says  that today’s hospitals and specialist practices are agglomerations of three business models he talks about which include solution shops, value chain, and facilitated-user network model.  When we separate those out into distinct models, then the value can be assessed and priced appropriately.

  • MD value prop: the solution to any problem starts here. (solution shop which over-prices for basic acute disorders by its design.
  • Clinic value prop: fast, convenient resolution of rules-based acute disorders.

Clayton showed an interesting slide mapping (X) the role of the patient and family’s intuition in effective therapy versus (Y) the important of MD’s intuition.

  • Bottom left has diseases that fit a clinic – GERD, myopia, HIV, migraines.

Presidential Discussion at WHCC

Joanne Silberner from NPR is moderating a panel on the Presidential HC Agenda which includes people from McCain, Clinton, and Obama’s campaign.

  • Regardless of who wins…we must have reform was the way that Jim Cooper from the State of Tennessee started when talking about Obama. [I must admit I missed much of his talk.]
    • 50% believe it is feasible.
    • 54% believe it would impact cost.
  • Thomas Miller who advises McCain is talking now. A few things I heard from him were a focus on financial incentives and talking about outcomes. (a good point) He talked about focusing on the family and empowering them. (Although I generally agree conceptually, we are a long way from having information in a format that the family can digest and leverage.) He just blasted the dems for requiring purchase of politically motivated, cookie cutter plans. (I think this is my first experience listening to a political script which is clearly being read.)
    • 45% believed his plan was feasible.
    • 46% believe it would impact cost.
  • Chris Jennings is speaking for Clinton. Affordability. IT. Effectiveness. Chronic care management. In concert with doctors and nurses.
    • 54% believe it’s feasible.
    • 51% believe it will impact cost.
  • All of them should have listened to Halvorson speak in the prior session. He is on the panel so I will be interested to see what he asks and his opinion. Will he support a particular plan?? His comments included:
    • Most sophisticated and informed debate on healthcare ever this year.
    • Candidates talking about chronic care and expenses of system. Talking about IT systems and best practices.
    • Candidates almost ahead of the policy wonks. He says he has great optimism.
    • McCain’s plan looks like a Switzerland model.
    • The Democrats look like the Netherlands model.
    • He wonders if they looked at the European models and what they learned.
  • George Shultz (former Secretary of State) was also a commenter:
    • Grow the pie…then it’s easier to cut a piece out. [I think I missed the point here.]
    • Lots of the things in the system fail to capture incentives to make them work.
    • Compare the GDP in the US in 2050:
      • $1T difference if you compare retiring at todays age versus scenario where you retire for the same amount of years
    • People are living longer and being healthier is NOT because of insurance. It is from lots of medications that have come out of research and equipment. “That’s a huge development.” Basic research is the key. Why we are flatlining this research from the NIH makes no sense.
    • Universal coverage should be a ground rule.
    • Doesn’t work to just mandate coverage.
    • Years ago, it was suggested that everyone get a HSA type offering based on a risk adjusted basis. (From Milton Friedman – conservative economist)
    • Competitive market for individuals will drive costs.
  • Audience question “How will you limit the greatest cost driver – technology – so that universal coverage doesn’t explode costs?” and “Do we need something like in the UK to evaluate new drugs from a value perpective?”
    • Obama Rep – Affordability is the key. UK approach goes too far. No one wants rationing. People will choose wisely with full information.
    • McCain Rep – Technology is how we have paid for technology. Subsidizes have diminishing returns. Need better research. No binary decision making like UK (coverage or not). Need information on how care is actually delivered.
    • Clinton Rep – Support around price management is growing. Will not go as far as UK. Need more support for NIH. But, funding needs to be linked to outcomes.
    • Schultz pushed back on research linked to outcomes. Interesting breakthroughs come from basic research not focused research. Manufacturer only wants applied research.
    • Halvorson – basic research. EMR. Linking EMR to DNA. Dozen different prostate cancers. Targeting based on DNA (genomics) will be much better. need to follow-up on technology once it’s used to see long-term impact. Systematic care delivery and follow-up important.
    • Schultz talks about education and people’s desire for information. People need to take responsibility for their health.
  • Another question “Would any of you mandate preventative care? Or provide incentives?”
    • Obama Rep – should certainly be part of any plan. customers shifting across plans limits ROI. Lots of things that could be done to push knowledge out. Tragedy in America that there is an 7-year lag between onset of Diabetes and diagnosis.
    • McCain Rep – can’t get in front of campaign which is thinking about this. Better educated Americans will navigate system better.
    • Clinton Rep – children can’t be exposed to what they are today leading to obesity without addressing this. People without coverage don’t seek prevention. Uninsured have big cost sensitivity. Uninsured going into Medicare drive costs high quickly. Education isn’t enough. There is some information about this in the senator’s policy.
  • Another question: “Do you think the candidate would win the presidency if they presented a workable plan that controlled costs?”
    • 68% said yes.
    • Schultz says that people respond well to straight talk. He encouraged the candidates to pledge to each other that they would support the plan of whichever candidate wins.

Interview with Phyllis Anderson (Humana)

As part of my opportunity to be part of the press at the World Healthcare Congress, I opted to interview some of the participants and speakers. This is my first of several that I have scheduled.

I had a chance to sit down with Phyllis Anderson who is the VP of Corporate Marketing for Humana. She has an interesting background from Pillsbury, Nabisco, and Bank of America as I discovered when I asked her what they were doing to bring in non-healthcare people to help them address consumerism within healthcare. Her story about working on healthier snack foods where they wanted to protect the quality of taste while addressing the healthy trends in the US seems very applicable.

How do we manage our history of healthcare while addressing the sea of change?

We talked a little about the paradigm shift that they are addressing in moving towards an individualized healthcare sell. Phyllis talked about focusing on the benefit to the consumer. Sticking on that same concept, when I asked her about how they were addressing preference-based marketing, she talked about creating “viable consumer experiences”. She talked about looking at 3 factors: message x channel x frequency. She mostly spoke about the differences in needs / interests around messaging by health status. I asked about using different models like Prizm versus Pro-Change, and she said they were still exploring the right model.

Given what she said plus what one of her colleagues had said on the main stage, I asked her about how they captured feedback (i.e., indirect on direct) about satisfaction. She said that they ask for feedback on a lot of their outreach programs today.

Listening and Leading

She talked about their CEO’s term of listening and leading and trying to balance those two things. Sometimes you have to listen. Other times you have to lead the consumer. We also talked about the fact that if the patient isn’t engaged then it’s pretty hard for them to give feedback.

I then asked about how they’re using JD Power and Forrester’s healthy studies. I was glad to hear that they had embraced the JD Power study and were working on an expanded relationship with Forrester.

Finally…Digitally Integrated Coupons

Using Shortcuts.com, Kroger has become the first retail partner to link their loyalty card to their digital coupon service.  I find this to be a great idea.  The consumer can go online and search for coupons by brand, product, or category.  They then add those coupons to their account.  When they use their loyalty card at checkout, the coupons are redeemed automatically.

No more paper.  No more remembering.

What a great opportunity.  If I worked at pharma, I would be looking at how I could get my over-the-counter products (OTCs) and even my Rx products into a program like this and link them to my health savings account or flexible spending account card from companies like the Benny Card or TriHealix (for example).

Picking the right incentives

Borrowing another story from the CMG Summit, the write-up in Chain Store Age talked about making sure the reward you select is what the employee wants.  In this case, Joe Wheeler from The Service Profit Chain and “The Science of Delight” talked about Prairie Store Pharmacy in MN.  They offered their pharmacists a trip to Hawaii, but they didn’t want it.  They simply wanted more access to their customers.

I am not sure you will get that same passion in all settings, but the point is critical.  If you are going to design a rewards program, make sure you are (a) rewarding the right behavior and (b) offering an incentive that will get people to stretch.

Commit. Don’t Just Try.

These were the words from Liz Murray (Homeless to Harvard) at the SMG Summit.  I am not sure of the context since I saw it in a summary in Chain Store Age this morning, but I think it is relevant in healthcare in so many ways.

  • Commit…don’t just try to build a focus on the patient.
  • Commit…don’t just try to understand how your processes impact the patient.
  • Commit…don’t just try to focus on outcomes over ROI.
  • Commit…don’t just try to create a positive, personalized experience for each member.
  • Commit…don’t just try to be responsive, timely, and meet the service needs of your patients.
  • Commit…don’t just try to improve.

NPS: The Most Important Metric You Might Not Use

NPS = Net Promoter Score = % of promoters – % of detracters

When working on my webinar on retention and how to improve loyalty, I stumbled upon this metric. I had used it informally without realizing there was a branded metric out there. You can get certified in it. There are entire conferences dedicated to it. It is featured in the book – The Ultimate Question. And, there are several blogs which focus on it.  [Boiling it down…it means asking customers whether they would refer you to a friend.]

Here are some scores from the top performing companies:

USAA 82%
HomeBanc* 81%
Harley-Davidson 81%
Costco 79%
Amazon 73%
Chick-Fil-A* 72%
Ebay 71%
Vanguard 70%
SAS 66%
Apple 66%
Intuit 58%
Cisco 57%
Federal Express 56%
Southwest Airlines 51%
American Express 50%
Commerce Bank 50%
Dell 50%

Not too surprising, but there weren’t any healthcare companies on this list.

So, are you capturing this today?  This is a simple predictor of loyalty and satisfaction.

The Implication Of Choices

I have heard this theory many times, but I was glad to run across an article on it.  The basic point is that too many choices have negative implications on people.  In this article from Health Day News, it discusses a study published in the Journal of Personality and Social Psychology about the effect of multiple choices.

“If people have a day or period of time in which they are making many choices, they will be vulnerable to low self-control,” said study lead author Kathleen Vohs, assistant professor of marketing at the University of Minnesota. This could lead “to overeating, overdrinking, overspending, losing one’s temper, and procrastination.”

This has a significant implication within healthcare.  How do you empower a patient in a consumer driven world and make information transparent without overwhelming them with options and data?  How do you communicate to a patient about their options without giving them every possible scenario? 

We generally want a simple solution and to be guided to a good decision without being manipulated.  How do we accomplish that?  It reminds me of a JD Power study on the auto insurance industry that I often quote that showed that the most satisfied consumers were not those whose rates went down, but those who rates went up BUT were proactively informed and offered options. 

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