Archive | April, 2009

Why Do People Miss The Easy Stuff?

I got an e-mail about the World Health Care Congress (WHCC) which made me wonder why people miss some of the simplest stuff in communications.  As you can see in the picture below, they were re-using a message but instead of replacing my name, they crossed out the other name.

And, to make it worse, they use the acroynm WHC instead of WHCC which is the one used by the conference.  Simple mistakes that give a lack of credibility to the message.


Are You Going To The WHCC in DC Next Week?

Just figured I would post to see if any of you are going to the 6th Annual World Health Care Congress in DC next week?  It looks like it has a great list of speakers and topics.  Drop me a note if you are there and want to connect.

Sprint: What’s Happening Now

I am not sure how this helps Sprint sell more phones and/or services, but I enjoyed the advertisement. The concept of leveraging data to understand consumer behavior is essential. This is a topic we [Silverlink] are constantly working with our healthcare clients to address.

  • How do you know what members or patients are doing?
  • Do you understand their preferences?
  • What have they historically done?
  • Can you predict how they will act in the future?
  • What data is needed to do analysis and create a predictive algorithm?
  • How do you leverage that to create interactive and compelling communications?
  • How do you study their behavior change?  (e.g., did they get a flu shot after being reminded)

X-Ray Vision Carrots

Behavioral economics can apply in many instances.  It is the “hot” discussion topic in healthcare about how to understand how members (consumers / patients) make decisions and what factors influence their decisions.

In this article in Newsweek about getting kids to eat healthy, they talk about three things:

  1. Verbal encouragement
  2. Descriptive labels
  3. Improved access

Rather than calling them carrots, they talk about calling them “x-ray vision carrots”.  These 3 “principles” are relevant to a lot of communications.  You have to be proactive and provide encouragement to members to get a flu shot or do other preventative health actions.  You then need to find a way to describe the action in a way that is compelling.  And, finally, you have to make the action easy.

Flaspohler PBM Survey

I was not familiar with this survey and stumbled across it the other day – 2008 Flaspohler PBM Survey. For those of you that follow the space, it has some interesting data in it. Here were a few of my notes:

  • It was a survey of 259 executives from MCOs (health plans), self-insured employers (SIs), third party administrators, and consultants.
  • This is the 2008 survey, but it has been conducted annually since 2000.
  • 70% of MCOs and 90% of SIs were either somewhat or very satisfied with their PBM.
  • 86% of the MCOs had been with their PBM for more than 2 years.
  • 75% of the MCOs cover OTC (over-the-counter) drugs compared to only 25% of SIs.
  • Both MCOs and SIs reported “relationship oriented” being the most important factor in selecting a PBM. (Really? It seems like price is always how the decision gets made.)
  • They rate the highest PBMs by a bunch of factors:
    • Attractive pricing
    • Relationship oriented
    • Effectively uses technology
    • Effective tools to manage drug benefit costs
    • Flexibility
    • Mgmt reporting
    • No “conflict of interest”
    • Unique programs and services
    • Superior specialty pharmacy
  • They gave the top 5 in each of those categories. What stuck out to me is that Express Scripts only appeared once out of the 18 possible boxes (9 categories ranked by both MCOs and SIs). That surprises me given my familiarity with them.
    • Later, in the rankings by consultants, they did appear more which says they are doing a better job there of getting the word out and education.
    • Several other companies appeared only once which was surprising (Aetna and UHC), but they were unlikely to be ranked by other MCOs.
  • It also surprised me that Medco only appeared 3 times and Cigna 4 times.
  • The other companies that appeared were Argus, Catalyst, MedImpact, SXC, Wellpoint Next Rx, Prime Therapeutics, CVS Caremark, Humana, NMHC (now SXC), UnitedHealthcare, Walgreens, Partners Rx, and Prescription Solutions.
  • Only 10% of SIs but 27% of MCOs have an exclusive specialty pharmacy provider.
  • They then looked at the specialty pharmacies across 5 categories:
    • Use and have an exclusive relationship with
    • Would consider using
    • Know little or nothing about
    • Use but not exclusively
    • Know but would not consider using
  • The three categories that interested me were exclusive relationships, ones that the MCOs know little or nothing about and those they would not consider using.
    • Exclusive relationships were with CVS Caremark, BioScrip, and Express Scripts (CuraScript) primarily.
    • Of the biggest names, it was surprising that people knew little about PrecisionRx (Wellpoint) and Wal-Mart.
    • Of those they would not consider using, two were in excess of 30% – Walgreens and Accredo (Medco).

Big Month For Vasectomies

Based on several articles over the past year, this should be a big month for vasectomies.

Last year, Forbes pointed out that the scheduling of vasectomies jumps dramatically before big sports events – The Masters, Final Four, Football.  Apparently, people want to get “snipped” on the Friday and have a good reason to sit around all weekend and recover while they watch their favorite sport.  Talk about planning.

And, last month, there was an article about the spike in vasectomies due to the economy.  No hard data about why, but the article hypothesizes that people are concerned about the additional costs of children and want to get the procedure done while they have health insurance.

Impact of Rising Health Care Costs

These are straight from the National Coalition on Health Care (NCHC), but they represent a sobering view of the impact of our rising costs. For the broader list of facts, you can go to their website.

  • In 2008, health care spending in the United States reached $2.4 trillion, and was projected to reach $3.1 trillion in 2012.1 Health care spending is projected to reach $4.3 trillion by 2016.1
  • Premiums for employer-based health insurance rose by 5.0 percent in 2008. In 2007, small employers saw their premiums, on average, increase 5.5 percent. Firms with less than 24 workers, experienced an increase of 6.8 percent.2
  • Health care spending is 4.3 times the amount spent on national defense.3
  • Health insurance expenses are the fastest growing cost component for employers. Unless something changes dramatically, health insurance costs will overtake profits by the end of 2008.4
  • The percentage of Americans under age 65 whose family-level, out-of-pocket spending for health care, including health insurance, that exceeds $2,000 a year, rose from 37.3 percent in 1996 to 43.1 percent in 2003 – a 16 percent increase.5
  • A recent study by Harvard University researchers found that the average out-of-pocket medical debt for those who filed for bankruptcy was $12,000. The study noted that 68 percent of those who filed for bankruptcy had health insurance. In addition, the study found that 50 percent of all bankruptcy filings were partly the result of medical expenses.6 Every 30 seconds in the United States someone files for bankruptcy in the aftermath of a serious health problem.
  • A new survey shows that more than 25 percent said that housing problems resulted from medical debt, including the inability to make rent or mortgage payments and the development of bad credit ratings.7
  • About 1.5 million families lose their homes to foreclosure every year due to unaffordable medical costs. 8
  • A survey of Iowa consumers found that in order to cope with rising health insurance costs, 86 percent said they had cut back on how much they could save, and 44 percent said that they have cut back on food and heating expenses.9


  1. Keehan, S. et al. “Health Spending Projections Through 2017, Health Affairs Web Exclusive W146: 21 February 2008.
  2. The Henry J. Kaiser Family Foundation. Employee Health Benefits: 2008 Annual Survey. September 2008.
  3. California Health Care Foundation. Health Care Costs 101 — 2005. 02 March 2005.
  4. McKinsey and Company. The McKinsey Quarterly Chart Focus Newsletter, “Will Health Benefit Costs Eclipse Profits,” September, 2004.
  5. Agency for Heathcare Research and Quality. Out-of-Pocket Expenditures on Health Care and Insurance Premiums Among the Non-elderly Population, 2003, March 2006.
  6. Himmelstein, D, E. Warren, D. Thorne, and S. Woolhander, “Illness and Injury as Contributors to Bankruptcy, ” Health Affairs Web Exclusive W5-63, 02 February , 2005.
  7. The Access Project. Home Sick: How Medical Debt Undermines Housing Security. Boston, MA, November 2005.
  8. Robertson, C.T., et al. “Get Sick, Get Out: The Medical Causes of Home Mortgage Foreclosures,” Health Matrix, 2008
  9. Selzer and Company Inc. Department of Public Health 2005 Survey of Iowa Consumers, September 2005.

Kaiser Family Foundation Health Care Data

The Kaiser Family Foundation always has some great data points on health surveys, data trends, and other topics. In some cases, they have made these into slides that you can download and re-use.

I grabbed a bunch of them which you can see below. To download them yourself, go to their website.

The Connected Consumer – Razorfish

This was also an interesting look at online consumers and their influence versus brands.

Getting Kids Active

In today’s computer world, this is as much a challenge for some kids as it is for us adults to find the time. But, it’s important to start the practice early. I liked Dr. Dolgoff’s blog entry on this. It’s pretty straightforward but a good reminder for all of us.

Step One: Let your children see you enjoying exercise.

Step Two: When your child is old enough (around age 3), allow them to participate in very small amounts. You don’t want to overwhelm them.

Step Three: Don’t say no!

Step Four: Step it up!

Step Five: Keep it up!

Finally Digging Out

As someone who is semi-compulsive about e-mails, I finally reached a point where I knew I was way too far behind.

When an e-mail comes in, I read it and either delete it, respond to it, file it, or leave it in the inbox for further reading before responding. Ideally, the e-mails in my inbox are less than 50 even when I get a few hundred a day.

The other day, I hit 500 in my inbox which was too much. It was stress inducing. Finally, I am back down below 250. I hope I can get below 100 before Monday. I would feel so much better.

The Inbound Only Landline

I heard about an interesting service today which is being offered by one of the telecommunication companies. They are rolling out a landline for $5 a month that receives inbound calls, but you can only call 911 for outbound calls. Very interesting.


OTC Equivalents to Prescription Drugs

In some cases, there are OTCs (over-the-counter) medications which a consumer can choose to use in place of a prescription drug. Financially, it’s a question of what your copay is versus the cost of the OTC medication.

The biggest drugs in the past few years to go OTC have been Claritin and Prilosec which are now both available as brands and generics over-the-counter.

I found this list that BCBS of TN had put out which I thought I would post as a link. It does a good job of creating a clean wall chart of some of the alternatives.

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