Archive | May, 2008

Reminder: It’s Time For Your Patient To Come In For A Visit

May 6, 2008 by George Van Antwerp 0 Comments

Aetna announced that it is launching electronic alerts to 320,000 physicians. They will be called Care Considerations.

My understanding is that they will use the ActiveHealth engine to compare claims data to treatment guidelines to identify gaps in care. They will then send the physician a message through the NaviMedix platform and through fax, e-mail, or the phone.

This will be an interesting program to follow:

  • Will physicians take action off the alerts? How?
  • Since the NaviMedix system will allow two-way interaction, what will they say about the alerts?
  • Will this impact health outcomes?
  • Are these preventative alerts or are they catching things late in the lifecycle of a disease?
  • What will patient’s reactions be to their physician reaching out to them? I would be a little hesitant.

I am a little surprised that the program doesn’t include outreach to the patient also. I would be skeptical of a request to schedule an appointment without some understanding of why I should do it. Otherwise, it would look like an obvious attempt to drive revenue. It reminds me of something a physician said to me once. He said that they can control revenue in many cases. For a patient with mild pain, they can send them home and suggest they take Advil and call them if the pain continues. Or, they can write them a prescription, send them for a test, and schedule a follow-up visit in a few days.

This gets to the issue of Defensive Medicine which I talked about a few days ago.

Consumerism, Healthcare, Managed Care, Marketing / Communications, Technology, Value Propositions

Health Reform and Tax Reform

May 6, 2008 by George Van Antwerp 0 Comments

Maybe it’s a stretch, but I think that conceptually there is a parallel here. If we had to all of a sudden pay all of our taxes in one big check at the end of the year, I think people would be a lot more focused on taxes. How much they are? How they are calculated? But, we pay each paycheck (or at least most of us), and the impact is muted.

Even if employers simply transferred the dollars to us and we bought individual insurance through our employer to get the group discount, we would still be writing the monthly checks and be much more sensitive to the costs and what we get for our money. Today, those of us still lucky enough to have group health insurance often don’t realize the true cost of an office visit, a surgery, a medication, or any of the other things we use.

Consumerism, Healthcare

Home Delivery Versus Mail

May 6, 2008 by George Van Antwerp 0 Comments

Do you care what it’s called? Some people really dislike Mail Order Pharmacy and go with Home Delivery. I made that change when I was responsible for the product at Express Scripts.

It becomes a little bit more meaningful when you talk about Mandatory Mail which is a benefit design where you are required to fill your maintenance medications at a specific mail order pharmacy after you have titrated to (i.e., found) the right strength for your chronic medications.

Should it be Exclusive Home Delivery? How about Retail Refill Allowance? Or Mail Preferred? Do they make a difference? Do you feel better about being forced to use one particular pharmacy?

On the other hand, if they are giving you money (i.e., a lower copay), to do something that saves your employer money and is equally as safe and more convenient, should you care?

Healthcare, Marketing / Communications, PBM / Pharmacy

Virtual Consultations

May 6, 2008 by George Van Antwerp 0 Comments

When I talk with people about using American Well or some other type of service, I continually get two very good questions which point to a next generation offering (I think).

  • How can they get my vitals – temperature, blood pressure, etc.?
  • Can they write a prescription?

For the first question, there is a logical future state where we have home devices for these things that are wirelessly connected to our PC and data can be captured and pulled back to the consulting professional (i.e., doctor, nurse, pharmacist).

For the second question, I think it is more complicated. A prescriber can write a prescription today without seeing you. But, they traditionally have data available from looking up your nose or feeling your throat or listening to your cough. There is a fine line to walk between self-diagnosis and prescribing off limited information. This is especially true when the physician is only seeing the patient for the first time and has no history.

Consumerism, Healthcare, Technology, Value Propositions

Surgery To Make You Taller

May 4, 2008 by George Van Antwerp 0 Comments

I read about this years ago, but I am still amazed by it.  Did you realize that there is limb lengthening surgery that you can undergo to grow taller?  And, that you can do it cosmetically?  It basically involves cutting your legs, breaking the bones, and then over months slowly stretching them by turning screws in braces in your legs.

A friend of mine told me that his cousin who is a surgeon in the US has even done it to make someone shorter so that they could do some undercover work.  That is dedication to your job.

Imagine, if you will, a surgeon breaking your leg bones in four places, then attaching a steel scaffold frame to the outside of your limbs with metal pins jutting into your bones.

Every day for months you rotate screws attached to the pins in your legs. There are many moments of excruciating pain and the constant worry of infection. After that there is a grueling regimen of physical therapy. (ABC News)

Here are a few articles:

Books / Articles, Healthcare

Drugs Down. Gas Up. Food Up.

May 3, 2008 by George Van Antwerp 0 Comments

With most of our good going up.  According to CNN, I heard them say this morning that gas is up $0.60 per gallon in the past year and earlier this week, they said that food is up 35% in the past year.  (Neither of these are scientific, but they make the point.)

That makes me wonder how our impression of price changes.  Will we become less price sensitive as we get used to higher prices on everything.  A friend of mine told me that when they had a global meeting the people from Europe were commenting about how great it is to come to the US where taxes are low and gas is cheap.  It’s all a matter of perspective.

So, with most things going up, I found this press release from Express Scripts interesting:

Last year marked the first time in at least five years that consumers paid less, on average, in their prescription drug copay, according to the 2007 Drug Trend Report released by pharmacy benefit manager Express Scripts. The average copay dropped 25 cents to $13.20 even as the average total cost of a prescription rose from $55.01 to $55.93.

Express Scripts attributed the average copay decrease to greater use of generic drugs, saying in the report that consumers saved an average of $15 per prescription each time they moved from a brand to a generic.

Where $15 was once a big deal, will that need to be increased over time to have the same effect as the price of goods increases?  My dad still talks about seeing movies for $0.10, but we know those days are gone and a dime doesn’t buy much any more (if anything).

Books / Articles, Consumerism, Healthcare, Marketing / Communications, PBM / Pharmacy, Research

Drug Testing At 12…At Home

May 2, 2008 by George Van Antwerp 4 Comments

My local area paper – West NewsMagazine – has an article in the April 30th edition about Teens and Drugs.  I will save my comments for the end here, but I found it an interesting read.

  • The company they talk about is TestMyTeen.com.  They distribute one free kit to the parents through school and they charge $18.99 for additional kits that test for the 10 most commonly used drugs.
  • It says that drug testing gives teens a socially acceptable excuse to say no.
  • The article has several people talking about testing before you have a problem as a source of prevention.
  • According to the Drug Test Resource of St. Louis which also offers a home drug test kit for $49:
    • 54% of all high school students will use an illegal drug by the time they are a senior
    • 82% of those that use a drug try cocaine
    • 2 of those that use a drug try heroine
  • They say that the average age for first drug use is 12.
  • The article talks about making it routine and providing rewards for a positive test.

“We should be telling our children that we love them and trust them, but we don’t trust the environment they’re going to be in.  In the end, I’d rather they think we don’t trust them than to bury them.”  Shelley Kinker, co-founder of Drug Test Resource of St. Louis

“The problem is, you’re not dealing with the issues that caused them to use in the first place and drug testing them might just drive them to use something else, like more alcohol or a substance you’re not testing for.”  Tish Fontana, a professional counselor

WOW!!  I am not sure where to start.  I certainly worry about my kids and peer pressure.  Some days, I feel like I want to have software to record their every keystroke on the computer; give them a GPS tracking watch so I know where they are; and eventually have a way of recording the speed and location of the car at all times.

BUT, I ultimately think it’s our duty as parents to teach our kids how to make decisions and enable them to become productive adults.  Let me go point by point here:

  • Testing for the most common drugs.  Great, but doesn’t that just encourage creativity to get around the system…look at steroid use?  Isn’t drinking a bigger issue with teenagers?  Isn’t abuse of prescription drugs a real issue?
  • I can’t see kids (that wouldn’t already say no) using the excuse of being tested to stop peer pressure.  And if they do, what are they going to do when they go to college?
  • I really can’t see testing my kids at 12 without any reason to suspect they were using.  I agree that trust is earned, but don’t we start with the assumption of innocence in this country.
  • The age and prevalence of use statistics are scary.  I wonder what the frequency of use is.
  • Rewarding your kid for not using drugs.  How about punishing them for using drugs?  Or rewarding them for stopping using drugs.

I care, but I think this is pretty extreme.

Books / Articles, Healthcare, Technology

Kaiser Kid Advertisement

May 2, 2008 by George Van Antwerp 0 Comments

I am sure it is out there somewhere, but I found this on the EverythingHealth Blog and thought it was a cute video capturing the Kaiser advertisement along with an Ellen interview of the child “star”.

Healthcare, Managed Care, Marketing / Communications

Deloitte On Healthcare Consumers

May 2, 2008 by George Van Antwerp 1 Comment

Deloitte recently published their results from a survey of more than 3,000 Americans on healthcare.  Here were some of their high level findings:

  • 93 percent of consumers say they’re not adequately prepared for future health care costs
  • 79 percent say candidates’ positions on health care are likely to influence their presidential vote
  • 46 percent place health care among their top three voting concerns
  • 26 percent would pay more for online access to medical records and results
  • 84 percent prefer generic drugs to name brands
  • 39 percent say they’d go abroad for treatment if quality was comparable and the cost was cut in half
  • 66 percent either strongly support (36 percent) or might support (30 percent) state-mandated health insurance
  • 63 percent either strongly support a tax increase to provide coverage for the uninsured (29 percent), or are inclined to support one (34 percent)
  • 52 percent understand their health insurance plans
  • Only 8 percent understand their health insurance completely
  • 18 might turn down a job to retain current health care coverage
  • 34 percent would use a retail/walk-in clinic; 16 percent have already have
  • 78 percent want to customize their insurance to include the features they value, with the cost changed accordingly

“The U.S. health care system is in the midst of a transformational change that many believe is centered on consumerism — the process of enabling and engaging consumers more directly in selection and purchase decisions regarding health care services. A traditionally one-way conversation is becoming a dialogue as the health care system transitions from patient-oriented to consumer-oriented. Industry stakeholders need to prepare to address the challenges and opportunities that consumerism presents.”

They have a lot more on their website about this:

Books / Articles, Consumerism, Healthcare, Managed Care, Research
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