Archive | October, 2008

No More “Robo-Calls”

This is a phrase you have probably heard several times this election period.  Somedays I think the same thing when I get 5-6 a day mostly from the Obama campaign.  It reminds me of some education I do with a lot of companies on the technology evolution around outbound calling.  Let me hit a few key points here.

First, everyone across industries is trying to figure out how to improve their access to customers (members).  How do they keep them up to date with relevant information in a timely, efficient, and effective manner.  Direct mail is a dying strategy.  E-mail is good sometimes, but you can’t push sensitive health information out via e-mail.  Text messaging has a role, but it’s not relevant for everyone.  So, automated calling has become a first-line solution rather than using call center representatives which are expensive (or more often as a complement to the call center representative making them more efficient).

Historically, call center representatives would “smile and dial” just trying to catch someone at home.  You might get lucky, but in most cases, you call 5-10 times just to get a person on the phone to talk with.  It’s not a good use of resources and time.

The next evolution was the dialer technology which calls out to people and once it hears a voice, it transfers the respondent to a call center agent.  But, the voice could be an answering machine in some cases or in many cases it might not be the right person.  These are the annoying calls you get where there is a delay after you say hello and before the person at the other end responds.  The technology is searching for an agent that’s not on the phone to connect you with.

People realized that using agents to call out wasn’t always necessary so they moved to “blast” or “robo-calls”.  These are non-intelligent calls that simply push a message out to someone.  As soon as you say hello, they start playing a recorded message and likely repeat it at the end in case it’s an answering machine they are “talking” to.  There is no interaction and no personalization.

But, that technology too has evolved.  You can now place highly personalized and interactive calls that leverage speech recognition technology.  The calls use your name and ask you to confirm that they are speaking with the right person.  The calls use the name of the company calling and potentially your employer.  The calls can also provide personalized information such as the drug you are taking or the health condition you have.  The voice is a recorded voice not a text-to-speech (TTS) solution.

The calls respond differently based on how you answer certain questions – i.e., different paths are dynamically generated.  And, the calls start to interact with other modes of communication – would you like to transfer to an agent to talk further?, would you like a copy of this offer sent to you in a letter or e-mail?, would you like a reminder sent to you as a text message?, or would you like us to fax your physician to get a new prescription for you?

The technology focuses on the interaction with the consumer and making it a pleasant experience.  In healthcare, people respond to this technology because of several factors:

  • It’s highly personalized to them.
  • It’s coming from a company they trust – their health insurer or pharmacy.
  • It’s interactive and conversational.
  • It’s important information – refill reminder, savings information, benefit change.
  • They have to authenticate themselves in order to receive sensitive information.
  • It adapts to them (e.g., please call me for future calls in the morning).
  • It offers them an opportunity to talk to an agent by transferring.

Now, I would say most companies are evolving from individual campaigns using different modes of communication (letter vs. calls) to an integrated communication strategy which has common messaging and is based on consumer preferences.  This approach allows for even better results and continues to drive personalization and customization based on historical learning and experiences with the individual.

But, mass customization does require technology and analysis.  Pulling in different data elements and looking at how to best deliver a message and get someone to listen and take action is complex work.  But, it’s a lot of fun watching success and outcomes improve as you move across the continuum.

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PBM Promotion of Generics Over Brands

At the macro level, everyone is pushing generics. This is the lowest cost option for the plan sponsor, the PBM, and the member (consumer, individual, patient).

But in reading a white paper by one of the big PBMs, they talked about this issue of promoting generics in a way that was slightly misleading so I figure I would tackle the point head-on.

Let’s start at the beginning.

PBMs take rebates from the manufacturers for drugs that are “on formulary”. This is not a bad thing and the majority of these dollars are passed on to the plan sponsors and the total amount is often transparent. (It was not always this way.) These rebates are essentially a discounting method to make expensive products more competitive. Typically, the PBM and/or an independent group of clinicians looks at the net cost (Average Wholesale Price less rebate) compared to the clinical value of the drug to determine whether it needs to be on the formulary. If there are two drugs with similar clinical indications, but one is a lot more expensive. Why would you cover both of them?

[On the flipside, as an individual paying cash, this is not a good thing because the average price or list price can stay artificially high since it’s never actually paid by any company or plan sponsor…but that is an issue much bigger than rebating.]

The manufacturers obviously want to gain market share by have a preferred status on the drug list (aka formulary). Since members have lower copays on these drugs, they have more market share. Historically, the manufacturers therefore limited what is called “counter-detailing”…if you wanted to get the rebates. (I.e., Pharma sales representatives detail physicians so counter detailing is telling them why they should use a different product.) What this meant was that you couldn’t do anything to disadvantage their product from a communication perspective. That has been loosened up a little over the past few years.

Now, the primary area of “counter-detailing” is through the Internet (i.e., showing alternative therapies and their prices) and through plan design tools like step therapy that require the use of generics before a brand drug can be used. BUT, I am still pretty sure that most manufacturers don’t allow the PBMs to target patients on a brand drug that is on formulary and encourage them to use a generic alternative (i.e., not the same chemical but a similar drug for their condition).

So, if you’re a buyer of PBM services, I agree that a good question to ask is “Is the PBM free to promote generics in lieu of brands, regardless of the brand’s formulary status?” but make sure you clarify whether they are talking before a patient starts on the drug or after they start on the drug or both.

 

Complementary Webinar – Cost Savings Programs

If interested, I am going to host a webinar for managed care companies and PBMs.  (Sorry, but this is limited to clients and prospects only.)

Proactive Cost Savings Programs for Your Members

In these economic times, members are looking for all the opportunities they can find to save money and reduce their out-of-pocket spending.  This is a great time to drive loyalty by proactively interacting with your members and helping them understand how to save money.

Some of the timely communication programs that will make an impact include:

  • Movement to generics (i.e., therapeutic interchange)
  • Movement to mail or 90-day retail
  • Pill splitting or dose consolidation

This is true for your commercial members as well as your Medicare members who are in the “donut hole”.  Don’t let your members struggle and end up skipping doses or not taking their medication.  This can lead to much bigger issues downstream.

Join Silverlink Communications for this interactive webinar and learn how you can design communication programs that help your members save money while improving your bottom line.

Register Here.

Paying to Learn

I was just in Vegas and had the chance to go to a casino and play Texas Hold’Em. Even those we have casinos in St. Louis, this was really the first time I had been in a casino for more than 30 minutes. I play poker monthly with a group of 20+ guys in my neighborhood, and I was really interested to see how that game compared to playing for cash with locals in Vegas.

The next day everyone was asking me the logical question of how much did you win. I found myself personally much more focused on how long I lasted. I put up $150 and lasted for 6 hours at the table with a rotating group of 9 other players. I felt really good about this. I learned a ton about how I play and how the game is played.

When I first sat down, there were several players with $1,000 in front of them, and I watched many people buy chips several times. (You had to buy at least $100 and couldn’t buy more than $300.)

So…why do you care? Well I think there are a lot of analogies here to communication programs. I know we all think we want to find the silver bullet that drives success. Well, in general, it will never exist. You can continue to improve, but like at the poker table, the players (your members) change and vary. Everyone is different. And, as in healthcare, based on the situation, their behavior will change. A recent diagnosis (or a large pot) will change the way they look at information.

Sometimes, it is important to focus on learning quickly in an initial program to be better long-term. As long as you learn, capture what you tried systematically, look at the results, and improve over time, I think the cost of that is worth it. The cost of failure is often much larger.

Let’s look at programs to encourage patients to use mail order over retail pharmacies. For the PBMs, this is essential to their lifeblood. Moving patients to mail order not only increases their bottom line, but it allows the clients and members to save money. But, almost as important, it allows them to actively manage the patient encouraging adherence and driving generic utilization. After working on programs for more than 10 PBMs, it’s clear that there are lots of factors to consider and that success varies.

Does that mean you shouldn’t do anything or be happy with your success? No. You should be trying new programs and constantly iterating to drive improvement. Learn from your audience and continue to improve.

But, for those you interested in the poker story, let me finish it here…What did I learn?

  • I have a “tell” which allowed the players that had been playing at the table with me for a while to know when I had a good hand. But, I simply asked one of them what it was and learned something about myself.
  • When the stakes are low, everyone will stay in on the hand. (The game was a $1-$2 game meaning that it cost only $2 to play a hand. For someone with hundreds in front of them this meant that it was always worth seeing the flop.)
  • You have to make the price of staying in the game higher so as to control your fate and not have someone get lucky on the turn or river card.
  • Don’t get too focused on your cards and miss out what the other player has. Several times, I felt like I had the lead and then got a card to make two pair or three of a king and didn’t see the flush opportunity on the board.
  • People in Vegas play all the time and have learned. They knew the dealers, the waitresses, and had played with each other at different events.
  • They didn’t bluff. When they paid $20 to see a hand, they typically had cards.
  • It is all about coordination – getting the right cards, having the right chip stack, betting well, and acting so as to get players.
  • There are rules that are important to understand – e.g., how to call a raise.

But, I had a lot of fun. I learned that I could play with a lot of these people, and it only cost me $150. If I were to play again, I would be much better prepared. Now, we will see if it helps me with my friends. It’s hard to compare since it’s a different game and different population.

In summary, I think there are a few more takeaways for healthcare communications:

  • Like my “tell”, you have to know what your brand perception is in the marketplace and how to use that or change that to drive trust in the messaging you send out.
  • Participation in programs is based on making it easy. You need to understand what the hurdles are to participation and do what you can to minimize those. (For example, getting a patient to move to a generic or to split a pill may involve faxing their physician for them. Do it!)
  • You need to continually improve your programs to be better than your competition. Whether it’s improving HEDIS scores, improving retention of your members, or improving mail order penetration, communications is strategic and you need to treat it that way.
  • Don’t be complacent and miss out on new approaches and solutions.
  • Don’t be myopic and forget to see the big picture by focusing on the wrong metrics.
  • Take action. You have to play to learn.
  • Understand your core asset (operations, web site, clinical data) and make sure it’s solid so that you can leverage it with your membership.
  • Communications requires lots of coordination such as:
    • Across channels (letter, calls, call center agents, web, e-mail, text messaging, faxes)
    • Messaging variation across segments
    • Timing relative to events
    • Sequencing – letter than call or call then letter (for example)
    • Data integration
  • You need to know the rules and the “odds” to predict behavior.

Customer Experience Matters

I found this new blog (Customer Experience Matters) and thought I would share it.  It is written by Bruce Temkin who works for Forrester Research.

To get you started, here are a few posts I think you would enjoy:

Brand or Generic – Whose Paying?

I spoke about this months ago, but a Medco study provided good real data on this.

It’s different when you are spending your own money versus someone else’s money.

Medco found that seniors on Medicare chose branded drugs when covered, generic drugs during the donut hole (i.e., paying out of pocket), and many chose branded drugs again when they got through the donut hole.

This was consistent with a point I have talked about where consumers believe they are getting a better “deal” on the branded drugs.

Would I rather pay $20 for a $100 product or $10 for a $30 product? In one case, I am saving 80% and in the other I am saving 66%. That’s one of the challenges in our healthcare system.

Imagine applying that to a surgery…would I rather pay $2,000 for a $10,000 surgery or $1,000 for a $3,000 surgery.

Prescription Growth Trends

I am on the plane reading the Adler’s Drug Store Counter which Meredith Adler and team put out for Barclay’s Capital. This is a monthly report which focuses primarily on the large chains – Walgreens, CVS, Rite-Aid, and Longs. It has some nice snapshots of historical prescription growth trends that I included below which are based on data from IMS and their analysis.

Clinical Train Wrecks and Hangnail Underwriting

In reading this article about health insurance in the LA Times called “An eroding model for health insurance“, it reminded me a lot of the movie Sicko. It is a scary reflection on some of the issues with our healthcare market although I think it does a good job of bringing some interesting perspectives forward.

When people are rejected for coverage, a logical question that someone would ask is why wouldn’t any insurer cover them. The article talks about the fact that if one changed their underwriting rules without the industry doing it then they would get flooded with the sickest patients. Since it’s not a charity model (or a government model), that’s understandable (but very frustrating).

A few things from the article:

  • A story about a baby born to a couple that had coverage but the baby was refused coverage due to a temporary condition. The baby was covered 6 months later when the condition went away. [I guess I always assumed a child born to a couple with coverage would be covered…foolish me.]

“Insurers can reject applicants for even mild preexisting conditions. People have been turned down for individual policies because they have hay fever, have suffered from jock itch or use common medicines such as cholesterol-lowering drugs, records and interviews show. Even those lucky enough to have insurance are uncertain they can keep it or count on it in a crisis.”

  • A story about a woman who couldn’t get coverage because she took Prevacid. [Would she have been better off taking an Over-The-Counter (OTC) medication like PrilosecOTC or an older medication?]
  • Stories about companies auditing individuals trying to find reasons to terminate their plans.

BTW – The title is from two terms used in the article.

Here’s to figuring this out at some time in the near future. The stories are a sad reflection on our country.

Prescribing Placebos

I found this entry on the WSJ Health Blog and all the comments very interesting.  At the core, the issue is that if a physician prescribes a placebo (sugar pill, vitamin, OTC, antibiotic) to make the patient feel better even though it medically won’t (but may mentally)…is there something wrong with that.

Obviously, if it drives a financial burden for the patient, that would be wrong, but I don’t see physicians doing that.

If it prescribed a medication that had serious side effects, that would be wrong, but I don’t see physicians doing that.

If it was a simple remedy (e.g., take B12), that doesn’t seem harmful.  There have been plenty of arguements about medications like antidepressants and whether they work, but they still get prescribed quite a bit.

Pharmacy Musical Chairs

Remember back in the 90s when AT&T, Sprint, and all the other companies kept offering you incentives to move to their service?  I had an uncle who just kept moving around and getting $50-$100 checks.  I thought he was crazy, but he never had an issue.

Given the economy and the incentives being offered in pharmacy, I wonder why a consumer wouldn’t do the same.  I saw a $25 gift card offer at Walgreens yesterday.  I know Target has had a $10 gift card offer for a while.  Some of the mail pharmacies occassionally offer coupons or copay waivers.

So, if I was a consumer with a maintenance drug that I have used for a while and don’t need consultation on, why wouldn’t I move my prescription every month to a different pharmacy and get these gift cards.  I think I would.  I don’t know all the terms, but if I had a generic, I might actually make money on my prescription.

I am sure this will be a short-term phenomena.

Drug Prices Go Up

A recent report by AARP which is talked about on the WSJ Health Blog reveals the following:

“Last year, the wholesale price of specialty drugs rose 8.7%, three times the rate of inflation. The price of non-specialty, branded drugs rose 7.4%, while the price of generic drugs fell by 9.6%.”

Are we surprised?  Generics have tons of competition so prices will go down over time unless they get too low and people jump out of the market.  Brand drug utilization keeps going down so they are going to raise prices.  And, specialty drugs have a limited market so their prices are going to continue to go up.

Is this right?  I could debate this forever.  But, it is a free market.  This is what happens with supply and demand.  We all want the drugs to extend our lives and make us feel better even when we have chronic illnesses.  But, it isn’t cheap to do research and trial and error to find out what works (at least it’s not cheap without testing on humans in an uncontrolled environment…which I don’t think we want).

Tough Times To Start A Company

After trying my own venture a few years ago, I have greater empathy for this challenge. I have watched a few friends and neighbors doing this. I have the ultimate respect for them.

Even so, most business experts conform to a theory of “thirds”: Of all the new business startups, 1/3 eventually turn a profit, 1/3 break even, and 1/3 never leave a negative earnings scenario. According to a study by the U.S. Small Business Association, only 2/3 of all small business startups survive the first two years and less than half make it to four years.  (source)

A few comments I have heard from friends:

  • A physician who wanted to go out on his own to open his practice (a time honored tradition) could not get a loan and even putting up his house didn’t work since the house was worth less than he owed.
  • A friend who does small business loans told me that the criteria to approve loans made it difficult for her to give small companies money.
  • I talked to a VC on my plane this morning who said they can’t raise funds in this economy and that valuations are down since there is less money chasing deals.

Then in USA Today, they had an article about venture capitalists losing their nerve.

  • US venture capital for the 3rd quarter dropped to $7.4B (down 7% from last year).
  • There were only 270 information technology deals done in the 3rd quarter which is the lowest quarterly amount since 1st quarter of 1996.
  • The Silicon Valley venture capitalist confidence index hit 2.9 (lowest in 5-year history of the index).
  • Tesla Motors, Redfin, Zillow, and AdBrite (promising start-ups) have all announced layoffs.
  • People are looking to sell their holdings in venture funds to companies like Industry Ventures that buys holdings at a discount.
  • The exceptions are biotech and clean tech which continue to grow funds.

46% Want Universal Health Care

In a survey of 45,180 workers, the American Payroll Association found that 46% of Americans were for Universal Health Care. 26% didn’t know and 28% were against.

So, what is Universal Health Care…basically, it is healthcare coverage for all citizens which is funded by the government through taxes. [in my words]

There are lots of arguments pro and con for universal healthcare that I won’t go into here.

Health 2.0 Conference

From the outside looking in, it looks like the Health 2.0 Conference is going to be a big hit this week with almost 900 people attending.  Rather than going to back-to-back conferences, I opted to go to a pharmacy conference over this one which has several of our executives attending.

It promises to be an interesting session, and it looks like the press coverage of the event continues to go up.

To learn more about the conference – click here.

To official conference blog is here, but I expect there will be lots of bloggers adding their notes.  They also pointed to Twitter for information (use #health2con or #health 2.0).

Some of the companies sponsoring the conference include:

Kaiser Permanente

Johnson and Johnson

Cisco

A.D.A.M.

American Well

Connextions Health

Community for Connected Health

Destination Rx

Edelman

ICW

ICW

Sage Software

Sermo

Eliza

Microsoft HealthVault

Myca

PhysiciansWellnessNetwork

RightHealth

Silverlink

TelaDoc

Athena Health

Physic Ventures

Safe-Med

Cisco

Locate-A-Doc

OptumHealth

SharpBrains

PrivateAccess

BeWell

BodyMaps

Invest Northern Ireland

healthcare

phreesia

olive tech

gene ed

Conecto

Within3

Navigenics

Praxeon

Relay Health

PharmaSurveyor

icyou

Medical Marketing and Media

MHS

MHS

The Treadmill Desk

I think this is one of the coolest ideas that I have seen in a long time.  Attaching a desk to a treadmill and walking while you work.  It has lots of benefits including losing weight.  I also agree with a comment from one company doing it that it would help people think differently.

The company featured on CNN has treadmills that go up to 2 miles per hour and even has a conference room with treadmills around the table.

In doing some research on the topic, I found the following:

Gambling With Your Health

It’s a continuous message these days…people are avoiding care (preventative and necessary) due to cost.  Here is an article in the Washington Post about it.

Though the burden is especially heavy for uninsured Americans, even those who have coverage are feeling the pinch as employers shift higher deductibles and co-payments onto employees.

“The reason why health care was immune [to recessions] in the past was because most people were covered under good insurance plans,” said Jean Mitchell, a professor of public policy at Georgetown University. Now, “people are realizing, ‘Oh my gosh, I have to pay for this out of pocket.’ ”

Median US Income – $32,000

As we talk about the economy and its effects on healthcare, it begs the question of what the average US family makes per year.  Averages are what we typically see versus median.  Median means that 1/2 of the families make more and 1/2 of the families make less.  The averages are often skewed by populations at the ends of the spectrum (i.e., the people making millions). This article says that according to IRS data that 50% of the US makes below $32,000.

New statistics from the Internal Revenue Service show that the highest-earning 1% of taxpayers in America make 22.06% of all income reported to the government. That’s almost twice the 12.51% of total income earned collectively by the lowest-earning 50% of workers. Yes, 1.4 million taxpayers claim 22% of income earned while 68 million share just 12.5%.

But get this: When it comes to taxes paid, an even wider discrepancy shows itself, in reverse. Those earners in the top 1% pay 39.89% of all federal individual income taxes. The bottom 50% of earners pay just 2.99% of those taxes. (Source article)

Article On Silverlink Communications

The October 2008 issue of ADVANCE for Health Information Executives contains a nice article about Silverlink Communications by Robert Mitchell. Here are a few items from the article:

  • It focuses on our Adaptive HealthComm Science approach which brings decision sciences to the area of driving healthcare behaviors. [This is what leading consumer companies, credit card companies, and gaming companies use to understand consumers.]
    • “Adaptive HealthComm Science looks at microsegments of the member population to try different interventions with different populations — all standing against control groups and measurements of what works best. It then adapts, learns and tries again. “The communication system continually learns and automates its processes so that it is capturing new data and learning along the way from those interactions. It is consistent and can be measured.”
      • It is amazing to see how much programs can be improved over relatively short periods of time by rapidly testing isolated variables to find the right solution for each microsegment of the population.
    • One of my favorite examples from my past was simply using stamps turned at an angle on a letter to improve the rate at which direct mail was opened. It looked more like a human had hand licked each stamp rather than a machine which put the stamp on perfectly each time.
  • It talks about the ability to do on the call calculations and dynamic pathing on the core automated calling platform.
    • On-the-call calculations: If you have 3 drugs to refill, but you only choose two of them then it can tell you what your copay is. Or, if you tell the caller your weight, it can calculate the difference from a prior weight it had collected.
    • Dynamic pathing: Based on answers you give, the call is intelligent enough to serve up different content to the member and/or route you to a different group of live agents based on rules.

“We’ve invested heavily in people, technology, processes and a methodology that continuously improves to maximize the effectiveness of health care communications,” Stan Nowak, CEO and co-founder of Silverlink, said. “Over the next few years, changes in the way health care stakeholders communicate with patients and health plan members will be one of the keys to lowering health care costs while driving consumer affinity.”

“To the consumer, health plan products are largely undifferentiated on the basis of benefits or network, and consumers experience their health plan almost exclusively through the communications they receive from the plan,” Nowak continued. “Health care organizations have an opportunity to clearly differentiate themselves through proactive and personalized communications, improving their members’ experiences with each interaction, and earning consumer trust and affinity. In essence, for health plans, communications is their product.”

Bush on small business and healthcare

A good quote from the daily AIS news several days ago…

“If you listen to anybody who owns a small business, they will tell you that the rising cost of health care is troubling not only to their balance sheet, but also to their soul because they want their employees to have the best. Small-business owners really do care a lot about their employees.”

President Bush, who was talking about HSAs [Health Savings Accounts] at a Sept. 12 forum of women business owners and lawmakers in Oklahoma City.

Tight Rx Market

I am sitting at the airport doing some blogging on my blackberry. Here is a quote about the prescription market:

“We are facing a continuation of the slowest-growing prescription drug market in 47 years, according to IMS Health. We believe the biggest impact has been the very tough economy.”

— Jeff Rein, chairman and CEO of Walgreen Co., where prescription sales actually climbed 7.9% in the latest quarter. Rein was addressing a Sept. 30 investors’ conference call on the company’s financial results for the quarter that ended August 31.

Stress Up: Health Down

I would have loved to have the time to do this research myself, but fortunately it was nicely bundled up The USA Today in a piece by Marc Siegel who is an associate professor of medicine at New York University School of Medicine.  Here are a few of the facts from his article:

  • A survey by the American Psychological Association indicated that financial concerns “topped the list of stressors for at least 80% of those surveyed”.  More than half reported the most common symptoms being anger, fatigue, and an inability to sleep.  Close to half reported over-eating or eating poorly.
  • After the 1929 Wall Street crash, millions turned to drinking and smoking which led to heart attacks, strokes, bleeding ulcers, and clinical depression.
  • Research on people laid off from a plant in Pennsylvania over 17 years shows that they were 15% more likely to die of any cause.
  • In NY, calls to the Hopeline network for people with depression or suicidal thoughts increased 75% in the 11 months ending July (before the worse of the economic situation).
  • UnitedHealth Group reports that hospital admissions for psychiatric services are up 10% this year.
  • A 1% increase in unemployment is projected to cause as many as 47,000 more deaths over the next two years – 1,200 suicides and 26,000 additional heart attacks.
  • Cumulative stress causes depression, suicide, heart disease, stroke, predisposition to infection, and certain kinds of cancer.

He does offer a few pieces of advice that are always hard to focus on when you think about all the negatives:

  • Eat healthy food
  • Sleep right
  • Do yoga, meditate or exercise regularly
  • Touch in the form of massage, hugging, and kissing decreases stress hormones

Where’s Your Raise…It’s In Your HC Benefits

According to Hewitt Associates, healthcare premiums and out-of-pocket costs will go up 8.9% next year.  This is at the same time as many people are hurting from the economy and seeing gas and food prices go up.  I can guess that the average raise next year won’t be near enough to make up for this with most people.

In an article by Sandra Block at The USA Today, she suggests several things on controlling costs.  None of them are new, but perhaps they are worth reiterating:

  • Use generic drugs whenever possible.  [You should ask your physician or pharmacist if there is a generic alternative available.  You should also not be afraid to ask for samples for new prescriptions from your physician.]
  • Sign up for mail-order.

“Unless you have a crush on your pharmacist, there’s really no reason to go to the drugstore every 30 days to pick up your blood pressure pills.”

  • Contribute to a flexible spending account so you use pre-tax dollars to pay for out-of-pocket costs [but be aware of the use-it-or-lose-it rules].

With more and more companies pushing more cost to the employee or even dropping benefits, you might have to start recognizing the value of having a good coverage plan as part of your total compensation.

HRA Feedback Request

In one of my LinkedIn groups, a company (HealthSphere) is asking for feedback on their Predictive Health Analysis tool which is an HRA (Health Risk Assessment).  I figure from the website that they are open to general consumer feedback.  The LinkedIn group will likely just get them people in the industry which have a certain bias. My observations:

  1. First section is a questionaire on lots of personal traits – body type, dreams, physical characteristics.  It was a fairly easy to use system, but I didn’t understand a lot of the answers and was skeptical of why I was giving them all this information.  It made me go back to ready the disclosure statement beofre continuing.
  2. From those questions, it gives you a report.  The report talks about:
  • Primary physical systems
  • Primary emotional systems
  • Potential Risks / Weaknesses
  • Dietary recommendations
  • Dietary supplements
  • Herbal supplements
  • Homeopathic remedies

It was interesting, but way too much information.  And, it seemed hard for me to believe that my answers would lead to this much information.  I also become skeptical when I see things like supplements and remedies which make me think that this is a funded site just to drive product sales (which it may or may not be).  Anyways, interested in your thoughts…

11.5% of Budget on Junk Food

Given that Minneapolis is both a health city and has a large amount of healthcare companies, I found it very interesting that they spend almost 11.5% of their income on junk food according to Catalina Marketing.

Survived The Chicago Marathon

I guess it wasn’t quite as hot as last year (only 84 degrees!), but it felt hotter than any long run I have ever done.  I guess only 33,000 of the 46,000 people that registered even showed up to run in the heat and only 31,000 finished.  I can only imagine how frustrating that is to start and not finish.  I saw lots of people sitting in aid tents and fortunately they had lots of water and gatorade all over the course including lots of people using their hoses to spray down the runners.

Not my best run (4:46), but I was glad to finish and not be sick.  I appreciate all the crowds that showed up and all the volunteers – Thanks.  Now, back to work.

Proof Communication Matters

The reason we communicate with patients and members in healthcare is that we want to drive them to action or inform them of information.  Whichever party you like, I think the TV commercials and the debate make this point very clear.

  • You either like scare tactics or not.  Some portion of the population will respond to those.  (I personally see this as desparate and don’t care…especially when some of them are such a stretch.)
    • Should you point out to people that they should stay adherent or risk serious side effects or hospitalization?
  • People want clear messaging.  I thought Obama was the one being too high level early on.  In the debate, John McCain was the one that didn’t seem to answer the question.  At least Palin said she was going to talk about another topic not give a glossy answer in the VP debate.
    • We got this feedback from MDs at Express Scripts that said just to tell them what we needed and stop with lots of general messaging.

Think about how you motivate your kids or your employees.  It’s all the same.  This is what you want from your health provider or your insurer.

(I must admit to being frustrated with the politicians as I am sure anyone who works in communications is.  To have Palin (the relative newcomer) being the best presenter (not so great in interviews) is surprising.)

60% Think We Are Headed To A Depression

You wonder how bad it is economically or where we are headed…look no further than the CNN poll out this morning showing that 60% of Americans think it is likely that we will go into a depression.  Not a recession, but a depression like many of us read about in the history book or saw in the movies.

Do people really know what the depression meant – 25% unemployment (for example).  So, if that’s the perception out there, imagine the impact on health behavior.  People will continue to look for savings opportunities – skipping pills, splitting pills, moving to generics, trying over-the-counter medications, moving to mail order.  They will likely be less likely to act preventatively – e.g., getting a flu shot.  They may be more willing to ride out bad symptoms at home rather than rush to the clinic.

This makes me think about an article I saw the other day that said that people don’t have any solutions to manage trend.  I think that’s BS.  The fact is people are afraid of the solutions to manage trend.  They don’t want to tell employees what to do or limit their choice.  In a tight labor market, companies want to keep the employees happy.  So, as the labor market opens up (i.e., higher unemployment) and healthcare costs go up, will companies finally embrace some of these tools.

For example, on the pharmacy side, we used to see a spike in call center volume of 1,000%+ on some of the aggressive programs – mandatory mail, step therapy, limited formulary, limited retail network.  That scared a lot of clients.  Maybe that attitude will change.  Granted pharmacy is 10% of medical spend so the bigger problem is on that side, but maybe companies will finally be willing to link out-of-pocket costs to controllable medical activities – weight, exercise, blood sugar, cholesterol, preventative testing.

If I were a insurer or a PBM, I would be focused on showing my value right now.  I would be delivering cost savings messages to all my members and help them understand how to minimize their out-of-pocket spend in this economy.

Some Items From Drug Store News

Just finished reading the most recent Drug Store News (Sept 2008).  A few things caught my eye that I thought I would share:

  • NACDS calls this the “make-or-break time” for retail pharmacy.
  • Giant Foods launched a new pharmacy program giving customers 5% off their next grocery order whenever they purchase five prescriptions using their Giant BonusCard.
  • HealthExtras acquired Discount Drug Mart’s PBM – Immediate Pharmaceutical Services.
  • Rite Aid introduced their Fill Up and Fuel Up program in June which offers a $30 gift card and a chance to win a year’s worth of free gasoline.
  • Rite Aid also is piloting a program to deliver prescriptions to the house of patients being discharged from the hospital.
  • In early 2007, there were 3,904 open pharmacy positions which continues to push up pharmacist salaries which according to Mercer are:
    • $118,000 for a pharmacy team manager
    • $108,700 for a staff pharmacist at retail
    • $105,200 for a staff pharmacist at a hospital
    • $105,000 for a clinical pharmacist
    • $23,000 for a pharmacy technician

(Think about the fact that the person you interface with at the pharmacy – the technician – makes $23,000 a year compared with a person who works in the tool booth in MA that makes $70,000 a year.  Does that seem right?)

Kaiser Family Foundation on Healthcare

The Kaiser Family Foundation has two things relative to the election that you might find interesting:

  1. A side-by-side comparison of policies for the two candidates; and
  2. Lots of videos and podcasts on healthcare.

Since this is the number two topic (after the economy) that people care about, it is important to know how they feel.

The Tough Economy is Impacting Health (and Potentially HEDIS)

A WSJ article of last week provides a glimpse into the many ways our strained economy is adversely impacting the healthcare-seeking behavior of individuals (see article here). It cites a D2Hawkeye analysis of medical service and pharmaceutical utilization (in a study performed before the most recent Wall Street and Main Street turmoil) and shows widespread impact across many healthcare categories. Consumers are cutting back on everything from mammograms to drugs to physician visits.

These findings should be a big stimulus for health plans, population health companies and PBMs to work more creatively on plan designs and communications strategies to support prevention and medication adherence.

Certainly, many individuals are feeling the pinch of health care costs to a greater extent than ever—with higher co-pays, bigger deductibles and for some Medicare members, the “coverage gap,” all contributing to choices people making. The D2 Hawkeye analysis of several Mid-Atlantic health plans looked at preventive and non-acute health services received between March 2007 and March 2008…

It shows pap smears are down 6% and antidepresssant medication fills declined by 19%

…despite the fact that for most of these members (in the study population) the cost-sharing changes year-to-year were minimal. So, the broader economic reality appears to be forcing consumers into making hard choices – trading off health care for other goods and services, whose prices are simultaneously rising.

NCQA is about to release its 2008 State of Healthcare Quality Report (tomorrow, October 2nd) which is its comprehensive summary of how plans across the nation are performing across the full range of HEDIS indicators . The data will reflect the healthcare services received by members in 2007, levels which from the D2Hawkeye study and other industry sources suggest we’ve declined. ….the time is now for innovation that spurs positive member behavior –in areas ranging from diabetes care to flu shots to colon cancer screening—to take center stage as an antidote to all the negatives the economy is now inflicting.

Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service. (source)

This posting was written by Margot Walthall, Population Health Market Leader for Silverlink Communications. Margot has previously worked in director level roles in strategy, member communications and product management/marketing for three health plans and also in product marketing for a population health software and services company.

Margot’s work for Silverlink is focused on multi-channel communications solutions that enable campaigns in the areas of health engagement, health risk appraisals, health education in support of gaps in care/HEDIS, adherence programs, virtual coaching and health program satisfaction measurement. Margot has a master’s degree in health administration, as well as an MBA in marketing.

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