Archive | January, 2009

Do $4 Generics Impact Mail Order and the PBM?

January 29, 2009 by George Van Antwerp 1 Comment

Some of you will remember that I wrote about this topic several months ago – The Brand Only PBM. As a follow-up to that article, I got interviewed by Neal Learner from Drug Benefit News about $4 generics. The interview got published today and is available here on page 6.

He asked about a few topics:
* How are PBMs and health plans reacting to the $4 generics programs?
* Are the programs used by people with insurance?
* How many generics could be offered at this price?
* Do they present a threat to the PBM?
* Will they impact the Rx Benefit?

BUT, what I find to be an interesting topic related to this is what happens if the USPS goes to 5-day a week mail service either closing on Saturdays or for some day during the week? How would this impact mail order and the PBM? I would think this would impact mail order by either delaying the distribution cycle or by forcing them to use FedEx or UPS which would be more costly. Another challenge to the primary profit driver?

Healthcare

7 e-Patient Conclusions

January 29, 2009 by George Van Antwerp 2 Comments

Thanks to e-patient Dave’s reminder on the e-Patient blog…

Here are 7 conclusions from the white paper that came out last year on this topic. Very important in diffusing some of the myths around the role of social networking in healthcare and the use of the Internet for information.

1. e-patients have become valuable contributors, and providers should recognize them as such.
“When clinicians acknowledge and support their patients’ role in self-management … they exhibit fewer symptoms, demonstrate better outcomes, and require less professional care.”

2. The art of empowering patients is trickier than we thought.
“We now know that empowering patients requires a change in their level of engagement, and in the absence of such changes, clinician-provided [information] has few, if any, positive effects.”

3. We have underestimated patients’ ability to provide useful online resources.
Fabulous story of the “best of the best” web sites for mental health, as determined by a doctor in that field, without knowing who runs them. Of the sixteen sites, it turned out that 10 were produced by patients, 5 by professionals, and 1 by a bunch of artists and researchers at Xerox PARC!

4. We have overestimated the hazards of imperfect online health information.
This one’s an eye-opener: in four years of looking for “death by googling,” even with a fifty-euro bounty for each reported death(!), researchers found only one possible case.

* “[But] the Institute of Medicine estimates the number of hospital deaths due to medical errors at 44,000 to 98,000 annually” … [and other researchers suggest more than twice as many]
* We can only conclude, tentatively, that adopting the traditional passive patient role … may be considerably more dangerous than attempting to learn about one’s medical condition on the Internet.” (emphasis added)

5. Whenever possible, healthcare should take place on the patient’s turf. (Don’t create a new platform they have to visit – take yourself wherever they’re already meeting online.)

6. Clinicians can no longer go it alone.

* Another eye-popper: “Over the past century, medical information has increased exponentially … but the capacity of the human brain has not. As Donald Lindberge, director of the National Library of Medicine, explains ‘If I read and memorized two medical journal articles every night, by the end of a year I’d be 400 years behind.”
* In contrast, when you or I have a desperate medical condition, we have all the time in the world to go deep and do every bit of research we can get our hands on. Think about that. What you expect of your doctor may shift – same for your interest in “participatory medicine.”

7. The most effective way to improve healthcare is to make it more collaborative.
“We cannot simply replace the old physician-centered model with a new patient-centered model… We must develop a new collaborative model that draws on the strengths of both systems. In the chapters that follow, we offer more suggestions on how we might accomplish this.”

Books / Articles, Consumerism, Healthcare, Innovation, Leadership, Marketing / Communications, Research, Technology, Value Propositions, Weblogs

Presentation Zen

January 29, 2009 by George Van Antwerp 0 Comments

presentation-zen-example
Have you read the book – Presentation Zen? If not, you can visit the blog to start to understand what Garr Reynolds talks about in his book. In general, one of the key points that I always try to relay to people is that slides are not your leave behind. Don’t put too much content on them. Don’t talk to them. Think about how to engage your audience in your story.

Take a look at a few of the slides he shares here. How does his presentation compare to your last presentations?

Books / Articles, General Business, Marketing / Communications, Value Propositions, Weblogs

Buyology: Teaser

January 28, 2009 by George Van Antwerp 0 Comments

I am just finishing up a book that has been a fascinating read…It’s called Buyology and is by Martin Lindstrom. I will post my notes shortly.

Books / Articles, Research

Improving Your Healthcare Communications

January 28, 2009 by George Van Antwerp 1 Comment

I put up a new page off the site that talks about HealthComm that many of you might find interesting.

Healthcare communications is a strategic opportunity for most healthcare entities. This framework should help you think about how to design solutions to drive behaviors within your membership.

Consumerism, Healthcare, Marketing / Communications, Methodology, Silverlink, Technology

Intense Workout

January 28, 2009 by George Van Antwerp 0 Comments

stairmasterI have to say that climbing stairs on this type of stairmaster is one of the best workouts I have ever done.  You do this for 30-minutes at a reasonable pace (say 10 minutes per mile or 6 stories per minute) and you will be feeling it.  You burn a ton of calories.  I think the key is that you are lifting your feet up to get to each stair.  There is no machine bounce to help you.

exercise

Did You “Catch” Your Obesity?

January 28, 2009 by George Van Antwerp 1 Comment

What if obesity were a virus that once you caught it you couldn’t manage it with simply diet and exercise?  That would be a very discouraging fact.

sneezeWell, some recent research is finding a link between a virus and obesity and claiming just that.  Of course, the primary issue is overeating especially with limited exercise, but this presents a new wrinkle in solving the obesity crisis.

So, to manage obesity, you need to sleep more and eat better.  Exercise has an impact, but it may not be the best way to try to lose weight (see article).

Books / Articles, exercise, Healthcare, Research

Gartner’s Predictions

January 27, 2009 by George Van Antwerp 0 Comments

Gartner put out there top 10 predictions.  Three of them stood out to me as relevant for what I like to discuss.

By 2012, successful enterprises will actively encourage and reward more failures in order to find the optimal approach they want more quickly.

By year end 2013, 40 percent of enterprise knowledge workers will have abandoned or removed their desk phone.

By the end of next year 2010, wireless operators will cease to offer unlimited (flat-rate) mobile data plans.

Rewarding failure…finally.  This is how healthcare will learn and improve.  As consumerism continues to dominate, it is going to be more and more important to test new ideas quickly realizing that many will fail before we “solve” the problem.  Everyone is always looking for the silver bullet which usually doesn’t exist.  AND, if it does, it’s often temporary as things change both with the patient’s condition and/or with the treatment options that they have.

The death of the desk phone is rapidly happening today.  I like to have one when I am in the office, but if I make 30 calls a month from my desk phone, I would be amazed.  I don’t even have voicemail set-up.  Any calls just get forwarded to my mobile phone.

No more unlimited plans…That would be unfortunate.  Talk about driving adoption and then taking away the incentive.  The convenience of the mobile devices blended with the low cost has created an “addicted” culture that loves their phones.  As the economy lags, I would see this trend having a negative impact or being completely met with negative reaction creating opportunity for new players.

Consumerism, General Business, Marketing / Communications

Where Are My Land Legs

January 27, 2009 by George Van Antwerp 2 Comments

I just got back from our “annual” Disney Cruise realizing that this vacation of 8 nights was the longest vacation I have ever taken.  Anyways, less that 24 hours later, I was back on a plane and jumping into meetings.  I still haven’t quite got my land legs  back.

But, I am anxious to share lots of things with you so hopefully, I will find some time this week to catch up on blogging.

A few things from vacation:

  1. It is amazing the redundancy and rigor that a company like Disney has.  We love the cruises.  I was amazed to learn that for the stage productions they put on on the boat that they have 2 microphones and 2 batteries for each actor.  And, if that’s not enough, they have their voices recorded for each part so they could lip synch if everything failed.  Why don’t we have that type of redundancy (without adding cost) in the healthcare system?
  2. I always lose faith in the healthcare system when I see the advertisement at the airport showing a physician signing the foot on which surgery is going to be performed.  Is that the best way we have of ensuring no mistakes are made?
  3. On the boat, you have to wash your hands before you enter any restaurant.  It would certainly take away from the ambiance, but should that be a more regular practice on land?
  4. They have a nice gym on board that I used 3 times.  They even run a 5K now at their island (on some not all cruises).  It made me wonder what percentage of the people on board worked out and whether that was a similar ratio to typical life and society.  If so, it reinforces one of our major challenges.
  5. How about some healthy food at airports?  I am surprised I haven’t ranted about this before.  It is getting better at a few airports where you can find a few things, but it is genuinely difficult to travel and eat healthy.
Events, exercise, General Thoughts, Healthcare

My Worse Healthcare Job

January 16, 2009 by George Van Antwerp 0 Comments

I was passing a hospital this morning and was reminded of my first healthcare related job. I was a young architect at the time and was given the project of validating the architectural blueprints of Henry Ford Hospital in detroit – about 1M square feet.

There were 4 of us interns assigned to do it. It was often overnight so we didn’t interfere with operations. We had to document door swings, plug locations, oxygen locations, etc.

Then we had to validate room size. It was painfully tedious.

General Thoughts

Walgreens Complete Care and Well-Being

January 15, 2009 by George Van Antwerp 0 Comments

Walgreens has just announced their offering to push into the on-site clinic market.  It is not completely new for them, but this is certainly a broader offering leveraging several assets they have acquired.

The program’s foundation is the pharmacy and health centers located on employer campuses or manufacturing facilities, along with Take Care’s in-store retail clinics and Walgreens nationwide pharmacies. Take Care’s employer health centers can offer complete pharmacy and health care services ranging from acute (e.g. strep throat) to primary care, occupational health, infusion services, specialty pharmacy, prescription mail services and disease management and are staffed by a combination of Walgreens clinicians including physicians, nurse practitioners, physician assistants, nurses, pharmacists and other health care professionals. Take Care Clinics, walk-in health care clinics open seven days a week and located at neighborhood Walgreens drugstores nationwide, are staffed by nurse practitioners and physician assistants who offer health care services built around a family’s needs.

I have always found this model to make a lot of sense, but it is hard to scale beyond massive employer sites.  In general, I think you have to have at least 1,000 people at one site to even begin to see this as a profitable investment (if I remember my analysis from years ago).

I am not really sure what the “all prices transparent to the employer” means in their press release.  Are they really going to reveal the acquisition cost of drugs?  The cost of their private label medications?  The cost of a clinic visit?  I am not sure that’s necessary.

Providing convenience without increasing costs should be enough.  Employees will love it.  Of course, I have heard that once you put it in that it is impossible to pull these out without very negative employee reaction.  And, I do believe that convenience (as it does with 90-day Rxs) can help improve adherence with mixed with the right education and counseling.

Books / Articles, Consumerism, Healthcare, PBM / Pharmacy, Value Propositions

Regence Quote On Pharma Studies

January 13, 2009 by George Van Antwerp 1 Comment

I always find some great nuggets in the AIS daily news.  I thought I would pass on this one from the head of pharmacy at RegenceRx.

“Unfortunately, we find that only 15% to 20% of pharmaceutical studies are reliable. Our findings are not unusual. For example, Pitkin, R. et al (JAMA. 1999; 281:1110-11) found that 18% to 68% of abstracts in six top-tier medical journals contained information not verifiable in the body of the article. To assure Regence doesn’t disregard valid studies, we request full study information from pharmaceutical manufacturers in addition to reviewed published information. Unfortunately, it’s rare for manufacturers to provide information beyond what’s in the published study.”

— Helen Sherman, Pharm.D., senior director of pharmacy services and chief pharmacy officer at The Regence Group, which operates BCBS plans in the Northwest, told AIS’s DRUG BENEFIT NEWS.

Books / Articles, Healthcare, PBM / Pharmacy, Research

Potentially Ridiculous Decision

January 11, 2009 by George Van Antwerp 3 Comments

I’m trapped in Boston waiting to get home due to the snow storm last night.  While I am waiting, the guy sitting a few chairs away from me was talking on the phone to a reporter.  If what he said is true, it’s a massive step backwards.

He said that CMS is no longer going to allow Medicare Part D plans to charge more for multi-source brands (MSBs).  These are brand drugs that have a generic equivalent (i.e., they are the same drugs based on active ingredients).  This would be a massive win for pharma since the manufacturers typically drive the price up after patent expiration so that they can make as much money as possible on the people that continue to use these drugs.

In most cases, these drugs are immediately moved to the 3rd tier of the formulary while the generic version is placed on the first tier.  This allows people to get them, but they have to pay more.  If CMS doesn’t allow this anymore, it will create lots of potential waste and be a big step backwards for all the progress we have made around generics.

sold-to-pharma

Healthcare, PBM / Pharmacy, Politics

Physician as Coach: Patient as Player

January 9, 2009 by George Van Antwerp 0 Comments

I really like this analogy.  Dr. Field talks about it in his blog.

It is easy for me to understand the role of my physician as providing me with the details about my disease.  They can tell me what to do.  They can motivate me to do it.  BUT, ultimately, it depends upon me as the patient to actually deal with the condition and improve it.

Consumerism, Healthcare, Weblogs

Walgreen’s President On Recession Impact

January 8, 2009 by George Van Antwerp 0 Comments

In case you didn’t see it, Gregory Wasson (President and COO) from Walgreens did an interview with The New York Times on how the economy is impacting them and answered a few other questions about their strategy.

Q. How is the slowdown affecting purchases of prescription drugs and health and beauty aids?

A. We certainly are seeing a slowdown in prescription drugs. In this economy, patients are not seeing their doctors as frequently. There may be some cases they are skipping doses of medications to control costs. As far as over-the-counter items, we see consumers definitely looking for value. We’re also seeing a big increase in private label product. The consumer is willing to buy down.

To read the rest of the interview…click here.

Books / Articles, Healthcare, Leadership, PBM / Pharmacy

Will Recession Kill Landlines

January 8, 2009 by George Van Antwerp 1 Comment

Every year there are more and more people who only use mobile phones.  A few months ago, you started seeing Sprint advertisements talking about how much you could save on their plan that gives you unlimited calls for $99 / mo.  Now, this morning on CNN’s new money segment, the recommendation was to ditch your landline.  They suggested that you could save $400+ per year doing this and who wouldn’t want that in today’s economy.

I think this is a great example of how the recession could fundamentally change our world by accelerating certain trends.

Consumerism, General Thoughts, Marketing / Communications

Follow-up On Physician’s Comments On PBMs

January 8, 2009 by George Van Antwerp 0 Comments

I talked about it in a few previous blog entries – Physicians versus PBMs and Physicians as Victims of System – and I am finally getting around to the source interview in AIS’s Drug Benefit News from October 31, 2008.

Here are a couple of additional thoughts after reading the entire interview with Toni Brayer:

  • She questions the value of PBMs (pharmacy benefit managers).
    • [It’s been well documented that PBMs can drive lower trend and have lowered prices.  This was well documented by third parties before PBMs were made central to the Medicare Part D benefit.  Additionally, reading any of the PBM trend reports will show you the money that can be saved by leveraging the trend programs that they offer.]
  • She talks about confusion between mail order pharmacies and PBMs.
    • [This is a good example of one thing that PBMs have driven which is mail order utilization which has driven down costs and allowed members to move from 30-day to 90-day prescriptions.  But, mail order is often a key component of the PBM offering.  People should think of them as two different entities – the PBM is focused on claims processing and the rules for benefit administration…the mail order is simply a pharmacy that uses automation to deliver medications to members from a centralized location.]
  • She says that PBMs contribute to the double digit increases in pharmacy costs that have occurred. 

    • [I think this has been disproven by many of the independent studies.  Additionally, the increases are driven by increased utilization, brand price increases, and new product introductions in most cases.  PBMs drive down reimbursement rates year-over-year, drive generic fill rates, and move members to lower cost channels such as mail order or specialty pharmacies.]
  • She talks about the hassle of PAs (prior authorizations).
    • [I completely understand the hassle here and am a little mixed in my opinion.  On the one hand, this is an effective trend management technique using evidence-based standards to manage inappropriate use of medications.  On the other hand, since in most cases, 95%+ of all PAs are approved (if the MD calls in), it does seem like an unnecessary burden.]
  • She also talks about confusion between brands and generics.
    • [This has become a bit of a challenge over the past few years as some branded products end up being cheaper than generics.  This has led to formulary tiers at a few companies reflecting more about drug price than brand versus generic.  And, I completely agree that physicians can’t be expected to understand formulary status…without electronic prescribing tools.]
  • She talks about pharmacies not automatically refilling prescriptions.
    • [I agree with her here with a few caveats.  Pharmacies should be reaching out to patients to remind them about refilling their medications.  They should be using a barrier survey to understand why they aren’t refilling and help them address these barriers or pushing them back to their physician when appropriate.  In my day job, this is definitely something that I talk with a lot of pharmacies (mail, retail, and specialty) about how to do this.]
  • She even talks about tamper-proof prescriptions being a hassle.
    • [In most cases, I think pharmacies offer patients either tamper-proof or standard prescription bottles as a choice.  Obviously the tamper-proof is to reduce the risk of children getting into medications and overdosing.  I don’t know the statistics, but I think it’s a legitimate concern.]
  • She compares pharmacies to the Department of Motor Vehicles.
    • [WOW!  I have certainly heard that some of the pharmacies in high density urban areas have ridiculous wait times, but I think this is a pretty bad slam.  The pharmacies that I go to take time to talk with the patients.  They are fairly quick on filling medications.  They use computer technology and automation to drive efficiencies.  We have a huge shortage of pharmacists in the US so there are some challenges.  That was one of the reasons I tried to go to market with a pharmacy kiosk solution.]
  • She says that she always considers cost when writing a prescription.
    • [This is great.  I know physicians generally do this for the medications they understand cost on…which are usually the outliers.  But, with over 10,000 medications on the market, I can’t imagine they can keep up with some of the idiocyncracies in the market.  Again, although I am not the biggest believer in electronic prescribing, this is one of the clear advantages here that it can show drug cost and member cost.]
  • She thinks that pharmacies are gouging patients by only dispensing 30-day supplies for chronic medications.
    • [This one I can talk about from several perspectives.  First, for new prescriptions, it is usually appropriate to only dispense 30-day prescriptions until the patient stabilizes on an Rx and strength.  Second, most patients have access to mail order where they can get a 90-day prescription…and some retailers offer this also.  Third, pharmacies generally make their money on the things people pick up while in the store…on many Rxs, pharmacy is a loss leader.  Fourth, to fix this issue, we would have to stabilize care so that only one insurer / employer paid since today people move around too much creating a disincentive to have one payor pay for a longer Rx only to have the patient leave before they use up their supply.  Fifth, since most people are non-compliant / non-adherent, there would be a lot of waste.]
  • She talks about hardly any medications costing under $40.
    • [Since most people have prescription drug coverage, this would only apply to 3rd tier drugs or specialty medications.  With all the $4 generics, patient assistance programs, and drug discount programs out there, patients don’t pay over $40 in many cases.  If she is talking about drug costs to the payor, then most brands certainly cost over $40 but that now represents just over 30% of all drugs dispensed.  I will let pharma make the arguement, but clearly the research required to bring a new drug to market justifies much of the cost.]
  • She suggests pricing brand drugs with no generic alternative lower.
    • [I am all for lowering healthcare costs and don’t think manufacturers should gouge patients, but in a capitalist society, why would I lower the cost of something that people need and have no alternative for?]

Sorry for the long rant, but there was soo much fun stuff to respond to in this interview…I never thought I would be a “defender” of the PBM model, but I really disagree with a lot of her comments.  PBMs do a lot of good things for clients and members even though they are in the “middle man” position.

Books / Articles, Healthcare, PBM / Pharmacy, Value Propositions

Texting Versus Raising Your Hand

January 7, 2009 by George Van Antwerp 1 Comment

I heard this story on CNN this morning about the smartboards that schools are using these days to replace chalkboards.  They talked about how easy it was for kids to respond and ask questions using text messaging versus raising their hands.

Is this a good thing?  I definitely feel a little torn.  On the one hand, this is great for the shy kids who might not otherwise participate in class.  On the other hand, these kids won’t survive in the real world without being able to speak up and talk in front of others.  They can’t sit in a meeting and just text their response.

Marketing / Communications, Technology

A Single View of the Member

January 7, 2009 by George Van Antwerp 0 Comments

Do you dream of being treated as one consistent individual across a company?  Wouldn’t it be nice if they knew every communication they sent to you – letters, calls, e-mails – and knew every communication touch you had with them – webpages visited, faxes, inbound calls, e-mails?  Unless someone can tell me different, this is still a dream world at most companies and maybe more than a dream at most healthcare companies.  (It’s even more complicated if you start thinking about all the touches by the health players – hospitals, clinics, MDs, disease management companies – and integrating them.)

All that data could help paint a much better picture of each individual if blended with outcomes data.  Who responded to what?  When did they respond?  What did they do?  How did it vary by condition?  How did it vary by gender?  By age?  What can you use to predict response rates? (I.e., the key here is having data transparency, easy to access data, and the ability to mine and analyze the information.)

There are so many variables that it can be overwhelming.  That’s why I found the discussion around Campaign Management 2020 by Elana Anderson and then commentary by James Taylor interesting.

“we can dream of technology that supports fully automated marketing processes and black box decisioning, tools that simplify marketing complexity and support collaborative, viral, and community marketing” (Elana’s blog entry)

This really gets at the heart of some of the fun projects we are working on these days at Silverlink Communications with our clients where we are bringing Decision Sciences to healthcare and helping clients optimize their engagement programs, retail-to-mail, brand-to-generic, HEDIS, and coordination-of-benefits (among dozens of other solutions).  Helping clients layout a strategy, define a process, develop a test plan, execute a program, and then partner with them to improve results is what makes my job so exciting.

As we go into the new year, I hope all of you are having fun at your jobs or quickly find a new job if your unemployed.

Business Tools, Healthcare, Innovation, Marketing / Communications, Silverlink, Software, Technology, Weblogs

Using Your FSA For Your Gym Membership

January 6, 2009 by George Van Antwerp 0 Comments

Maryland is working on a bill that will allow you to use your flexible spending account (i.e., pre-tax dollars) for things like gym memberships and sports equipment.  I am not sure I agree with the sports equipment since I could see a whole arbitrage opportunity of buying equipment with pre-tax dollars and then selling it on eBay.  But, I can see things like gym membership or even fees for a race qualifying.

I don’t have an opinion on the bill, but the concept sounds intriguing and sends the right message.

Books / Articles, Consumerism, exercise, Healthcare, Innovation, Value Propositions

Rx Spending Slows

January 6, 2009 by George Van Antwerp 0 Comments

In the USA Today, there was an article this morning about the slowing growth in the prescription drug market.  Growth was only 4.9% (in dollars) which is the lowest since 1963.  A lot of this is due to the increasing use of generics along with the trend toward $4 generics or even free generics.  They attribute some of it to safety warning which may have decreased utilization and certainly there have been multiple surveys talking about the dampening effect of the economy.

The article states that health care services overall rose 6.1% to $2.2 trillion in 2007 (or $7,421 per person) according to CMS’s Office of the Actuary.

They also state that generics now make up 67% of all prescriptions filled and that drug prices grew only 1.4% which was down from the 3.5% in 2006.

I was surprised by the statistic that the FDA issued at least 68 safety warnings in 2007.

In general, I didn’t agree with their observation that lower prescription drug cost increases contributed to holding overall health care spending increases down since prescriptions only make up about 10% of total healthcare costs.

Books / Articles, Healthcare, PBM / Pharmacy

Breaking Down The 2008 PBM Customer Satisfaction Report

January 6, 2009 by George Van Antwerp 1 Comment

PBMI (Pharmacy Benefit Management Institute) put out its 14th report on employer satisfaction with their PBMs. Here are some of the highlights from the report:

  • 275 employers representing 11.3M members responded.
  • The overall rating was an 8.0 out of 10.0. (up from 7.9 in 2007)
  • 6.7% of respondents perceived that their benefit costs were increasing more than others and ranked their PBMs lower. (perhaps a validation that trend management matters…hence the “battle” to show the lowest year-over-year trend to the street in the individual trend reports)
  • PBMs were ranked on three factors – overall service and performance, delivering promised savings, and delivering promised services.
  • For the overall score:
  • Aetna (6.6), Argus (4.8), Innoviant (8.7), MedImpact (8.0), NMHC (7.5), and Prime Therapeutics (9.0) also were part of the report but had limited profiles due to a lower number of surveys being received.
    • As far as I know, Prime doesn’t contract directly with employers but just through their BCBS owners. That would seem to disadvantage them in this survey.
  • Employers can contract directly with PBMs or thru a managed care entity or buying group. Those that contracted directly ranked their PBMs higher (8.2 versus 7.6) which makes sense since they are more involved and more likely to be actively managing trend and having lower costs.
  • This is validated by the fact that those with very aggressive intervention in benefit management rated their PBMs much higher (8.6 versus 7.1). About 33% considered themselves to be very aggressive.
  • PBMs were rated the worst (7.2) for their disease management programs.
  • When looking at factors that were correlated with satisfaction there were a few surprises and a few no-kidding variables:
    • I was surprised the member website, specialty pharmacy, and mail service pharmacy ranked low on the list of variables (i.e., less correlation).
    • I was not surprised that account management ranked high and retail pharmacy network was low. In many cases, the networks are pretty similar. I would be interested to see how large employers ranked PBMs versus smaller employers since they probably get different levels of service.
  • Looking at the overall scores from 2004-2008:
    • Caremark, Catalyst, Cigna, Express Scripts, and Medco all went up.
    • Walgreens and Wellpoint went down.

Looking at the ranking of key factors:

Highest Ranked Function(s)

Lowest Ranked Function(s)
Aetna Retail pharmacy network

ID card production

 Mail service pharmacy

Disease mgmt programs
Argus Retail pharmacy network

ID card production

 Formulary mgmt and rebates

Account mgmt
Catalyst Retail pharmacy network

Claims processing

 Disease mgmt programs

Mail service pharmacy
Cigna Account mgmt

Member services

 Delivering promised savings

Disease mgmt programs
CVS Caremark Retail pharmacy network

Claims processing

 Formulary mgmt and rebates

Disease mgmt programs
Envision Overall service and performance

Account mgmt

 Disease mgmt programs
Express Scripts Retail pharmacy network

ID card production

 Member services

Formulary mgmt and rebates

Disease mgmt programs
Innoviant Formulary mgmt and rebates

Delivering promised savings

 Utilization and benefit mgmt consulting

Member website
Medco Retail pharmacy network

ID card production

 Utilization and benefit mgmt consulting

Mgmt reports

Disease mgmt programs
MedImpact ID card production

Claims processing

Retail network

 Formulary mgmt and rebates

Drug utilization mgmt

Specialty pharmacy

Delivery promised services
NMHC Retail network

Plan implementation and changes

Specialty pharmacy

 Mail service pharmacy

Disease Mgmt programs
Prime Therapeutics ID card production

Retail network

 Disease Mgmt programs

Specialty pharmacy

Formulary mgmt and rebates
Walgreens Retail pharmacy network

Mail service pharmacy

 Mgmt reports

ID card production

Member website
Wellpoint Retail pharmacy network

Claims processing

 Acct mgmt

Disease mgmt programs

Mgmt reports

Utilization and benefit mgmt consulting

So…my overall assessment is that it is a good report. It is limited by response and limited by the fact that there aren’t major differences between PBM scores (with a few exceptions). But, it certainly would give me some clues on what to expect, where to push, and how I should evaluate my PBM.

Books / Articles, Healthcare, PBM / Pharmacy, Research

Taking My Insurance Out For a Test Drive

January 5, 2009 by George Van Antwerp 0 Comments

I heard a commercial this morning talking about a “test drive” for drivers insurance. It made me think that with data standards this would be a pretty easy thing in healthcare.

Imagine that every year for open enrollment you would simply create a file of all your claims from the prior 12 months and upload them at some website “TestMyHealthInsurance.com”. That website would show your employer sponsored options along with individual insurance options and show you what your total out of pocket costs would be under each scenario (assuming the same claims).

We had an application like this at Express Scripts called ExpressChoice which allowed members to compare their next year’s pharmacy plan options based on the prior year’s claims. It was a very cool tool. Of course, there are limitations, but it’s much better than most of us have.

So, why not extrapolate that to a bigger market play and include health and pharmacy. Given all the exclusions and other small print in our policies, it is always impossible to compare.

Now, if you really wanted to blow people away, guarantee that the costs per claim for the same drug, treatment, etc. won’t deviate from the forecasted price by more than 10% year-over-year. I think you would capture some attention here.

Consumerism, Healthcare, Managed Care, PBM / Pharmacy, Technology

Body Fat or Weight (BMI)

January 5, 2009 by George Van Antwerp 1 Comment

As we are all setting our goals this time of year, I was struck with a key question.

Do I focus on the traditional metric of weight which plays into my BMI (Body Mass Index)?

Or, do I use a body fat metric as a more appropriate metric to focus on?

I talked to a personal trainer who said to focus on body fat.  He gave me the following grid for men:

  • <14.1% low
  • 14.1-19.0 optimal
  • 19.1-24.0 moderate
  • 24.1-29.0 high
  • >29.0 very high

I was in the optimal, but I want to get to the low.

exercise, Healthcare

What’s Your “Age”?

January 2, 2009 by George Van Antwerp 0 Comments

We were talking about this the other night at a New Years Party. There are now several ways of assessing your “real age”. Of course, you have the actual calendar showing days, months, and years that have passed since your birthday, but is that a fair assessment of how your body is really aging.

fr-time

Without getting philosophical, I think these are some fun tools that assess your age that give you some directional indication. [Hint…It’s always better to be younger!]

1 – Your RealAge is a test that looks at 125 different factors to assess how you are aging. It takes into account diet, exercise, relationship, stress, and lots of other facts. It is an interesting test. (I was 3 years below my calendar age.)

2 – Your Wii Age is an assessment on the Nintendo Wii that looks at your flexibility and a few other factors based on how you respond to a test you can do each day. (I have taken it several times, but at best, I got to 14 years below my calendar age.)

3 – Your BrainAge is a game that provides exercise for your brain. It is made for the Nintendo DS. (I have never played this.)

4 – Your LifeTime Fitness Age is based on free assessment they provide members. I just did it the other day where they looked at my heartrate on the treadmill, a strength test, a flexibility test, and looked at my weight and body fat. (Happily, I was 6 years below my calendar age.)

Consumerism, exercise, Healthcare, Software