Archive | June, 2009

So Much Confusion Over Generics

In reading the article about generic drugs and the subsequent comments, I am amazed at how much mis-information and confusion exists.

Let’s start with a few facts:

  • Generics are approved by the FDA and have to have the same manufacturing standards.
  • Generics receive a rating (e.g., A-B) and are chemically equivalent to the brand drug upon whose patent they are based.
  • Chemically equivalent drugs have the same active ingredients but different inactive ingredients.
  • Generics cost less since there is no research and no sales and marketing activity to support.
  • A high percentage of generic drugs are made by the brand drug manufacturers.
  • Consumers save money on generics.  Pharmacies and PBMs make money on generics.  Plan sponsors (i.e., employers) save money on generics.  Everybody wins!
  • The variance in active ingredients is no different on generics than it is on brands.

There is definitely plenty of misinformation out there.  I would suggest sticking with sites like the FDA’s site on what’s real.

As the study by Prescription Solutions (United Healthcare) shows, there is confusion in the market.

  • Nearly 1/3rd of Americans don’t know or believe that generics are identical to brand drugs.  (They’re not identical, but the active ingredients are.  I would have asked the question differently.)
  • 2/3rds of respondents didn’t know that generics typically cost 50-70% less than brands.  (That surprises me.)

Jacqueline Kosecoff, Ph.D., chief executive officer of Prescription Solutions, said, “Using generics helps make health care more affordable without compromising results. Many Americans erroneously believe that the most expensive drug is always the most effective drug, so by helping to change perceptions, we can help people save money and still get the best treatment available.”

New CMO – Dr. Jan Berger

I’ve had the chance to read Dr. Berger’s research over the years when she was at CVS Caremark. After having a chance to spend some time with her on a few topics, I am very excited that she is coming on board at Silverlink Communications as our Chief Medical Officer.

From the press release:


June 23, 2009

Burlington, MA – Silverlink Communications® Inc., the leader in healthcare consumer communications, today announced that Dr. Jan Berger, former Senior Vice President and Chief Clinical Officer for CVS Caremark, joins Silverlink as Chief Medical Officer. In her role, Dr. Berger will focus on setting the company’s overall vision and strategy for population health and clinical communications programs within the managed care, population health, and pharmacy benefit management space.

Dr. Berger brings more than 25 years of business and clinical expertise in healthcare, including more than 15 years as a medical director at both a health plan and a major regional hospital. She is actively involved in quality initiatives, participating in numerous committees for National Committee for Quality Assurance (NCQA); medication safety, participating in steering committees at National Quality Forum (NQF); and population health management through her Executive Board position at DMAA. She also serves on several influential editorial and healthcare company boards, including Editor in Chief of American Journal of Pharmacy Benefit. Her expertise expands Silverlink’s focus in population health and clinical outreach – specifically related to engaging and connecting with healthcare consumers in a variety of lifestyle management, disease management and preventive health activities.

“Jan is clearly one of the leading innovators in healthcare, with tremendous clinical acumen and an ongoing track record of business execution in programs that drive down healthcare costs and improve health outcomes,” said Stan Nowak, Silverlink’s co-founder and CEO. “We are extremely proud to have her join our executive team at a time when behavior change is critical to our national healthcare reform process.”

“Silverlink is at the forefront of using communications and analytics as strategic assets to help consumers make more effective healthcare decisions,” said Dr. Jan Berger. “With the consumer at the center of our healthcare cost equation, we have the opportunity to improve the health of our country and eliminate hundreds of billions of dollars that relate to preventable conditions. This is a complex but solvable problem and I’m passionate to be part of a team that is already making an impact.”

Gov’t Reduce HC Costs: Rx Decisions Say No

I have nothing against the pharmaceutical companies.  We need medications.  Development of medications costs money.  There are lots of failures to find one that works.  They deserve to make money.

That being said…they are smart and apparently the administration is inappropriately (IMHO) paying attention to what they suggest is right.

  • For Medicare PDP, the plans can no longer require the member to pay more when they choose a brand drug which is available as a generic.  WHY NOT?  It’s the same drug.  There may be a few exceptions called Narrow Therapeutic Index (NTI) drugs, but just make them exceptions.  This was a bad decision which will cost us taxpayers money.  (See prior posts – Potentially Ridiculous Decision and Uproar Over “Reference-Based”…)
  • Now, they jump on the savings that are offered for members who hit the “donut hole” and stay on the brand medication.  Why not just require MDs to give out samples?  Of course this will effect behavior and drive brand utilization.  Pharma is not stupid.  This is another decision which will cost us taxpayers money.

On the one decision where they go against pharma – drug reimportation, they make a bad decision.  Why import drugs?  Why not implement a therapeutic MAC (maximum allowable cost)?  This will definitely impact drug costs AND generic drugs (which make up almost 70% of the claims filled) are cheaper in the US.

This is the government that we want to manage the costs of our healthcare system when they can’t even make the logical decisions that anyone close the business could make.  Come on!

[IMHO = In My Humble Opinion]

Sold to Pharma

Could / Should Healthcare Follow The Car Dealer

Healthcare is one of the few industries where more supply equals more demand.  (Maybe the only one.)

So, as we look at the healthcare shortage of PCPs, RN, and RPhs, should there be more discussion of closing locations?  Should we pursue the tact of the car manufacturers in closing dealerships to have less locations?  This would fly in the face of the MinuteClinic type of strategy.

Or, I guess the better question is whether there are certain points in the process where more access points are needed, but there are other points in the process where less access points are needed.  For example, do we really need 6x,000 retail pharmacies in the US.  Certainly, in some urban and suburban locations where the average person passes more than 3 pharmacies to get to the one they use, the answer is no.  In some rural locations, there is no option other than the one pharmacy that is 20 miles away.

Would this change our behavior?  I believe analysis would show that less testing facilities and more difficult access to certain tests would certainly change their use.  Would this address the problem or simply create more services that were being done outside the system (i.e., cash businesses)?

I don’t know the answer, but I haven’t heard anyone talking about what seems like a logical discussion.

Social Norm – E-mail, Voicemail, SMS

Are there social norms around responsiveness to communications?  I was reading this quote and realized that I am obviously not fitting the norm.

“The social norm is that you should respond [to e-mail] within a couple of hours, if not immediately,” said David E. Meyer, a professor of psychology at the University of Michigan. “If you don’t, it is assumed you are out to lunch mentally, out of it socially, or don’t like the person who sent the e-mail.” (source)

There are many days when between travel, client meetings, conference calls, hundreds of e-mails, and trying to read all the things I get that I barely respond to anything but critical e-mails.  Add a few conferences or a day off here and there, and it’s literally impossible to keep up.  So, if the expectation is immediate due to blackberry’s and other smart phones, I guess I’m in trouble.

What Would A Public Healthcare Company Give Us?

I’ll admit upfront that I’m well behind in all my policy reading, but as a citizen and someone who works in healthcare, I have to wonder why this makes sense.

  1. Is it to lower administrative costs as Kathleen Sebelius said on TV this morning?  Since they only represent ~10% of the total healthcare costs, that’s not going to make a big difference.
  2. Is it to provide coverage for the uninsured?  This seems like a fundamentally good cause but how is that population defined.  Why can’t that happen in the existing system with the right incentives / mandates?
  3. Is it to provide competition for the current insurers?  This seems like a bad path.  Government competing with industry…will the playing field be even?
  4. Is it to provide a government subsidy to those that can’t be profitably insured?  Again…this is probably in the social interest of the country.  Can it be done w/o simply overspending?
  5. Is it to drive a long term investment in preventative care?  Now, this seems like an interesting perspective.  We know one of the issues with long-term investments in patient care is that members churn.  If I invest today in a member that I won’t have, I don’t get my money back.

I think my point here is that a public system (IMHO – In My Humble Opinion) isn’t the right question.  We have systemic challenges around incentives, payment structure, long-term care, supply and demand, health literacy, etc. that have to be addressed.

From what I’ve seen in Medicare Part D (PDP), I have no faith that a public system would manage trend.  They won’t even push people to chemically equivalent generics.  They blindly pursue re-importation.  They don’t have a very limited formulary.  They don’t have aggressive utilization management programs (e.g., step therapy).

Someone needs to set an aggressive goal of keeping trend to 0% for the next decade and then work toward that.

“Web 2.0” – Millionth Word in Language w/ Most Words

I guess I never really thought of English as a complicated language because it had so many words.  I always thought things like the fact that we had so many homophones or words that sound similar.

I found all the recent discussion about adding the millionth word to the English language interesting.  I’m not sure I consider “Web 2.0” as a word.  For example, the fact that Chinese is the language with the second highest number of words at 450,000 is interesting.  The way in which words become “official” is interesting.

This is why the study of linguistics becomes so interesting (see good context at Wikipedia).  This is also part of our broader health literacy issue in this country.

Finding A New Name

I have received notice that I can no longer use the “Patient Centric” term.  Apparently, it’s a Trademarked name.

As I am looking at new names, I have come across a new series of blogs and sites.

1. I first looked at “The Engaged Consumer”

2. I looked at “Healthcare Communications”

3. I looked at “Health Engagement”

4. I looked at “Member Engagement” which is open, but I’m not sure it’s the right terminology.

I welcome any thoughts.  I am working on a few more right now.

New Clinical Webinars – HEDIS, Adherence, Engagement

In June, we are offering three complimentary webinars to our clients and prospects on key topics of discussion.

Increasing the Effectiveness of Population Health Program Engagement
June 16th | 1:00 PM ET

Getting consumers to take charge of their healthcare behaviors and choices is critical to controlling costs and improving outcomes. Successfully welcoming and engaging consumers in DM and health management programs can be the toughest road for health plans and population health organizations. Strategies that motivate participatory engagement are key – but it takes more than a friendly voice and the right script.

Join Silverlink for a complimentary webinar where we will discuss the challenges of moving health behaviors and effective strategies organizations can implement to get ahead of the behavior change curve.

In addition, learn how to:

  • Leverage tailored messaging to drive high engagement rates
  • Enable continued engagement over time
  • Maximize buy-in and acceptance of health coaching
  • Combine multichannel approaches to elicit engagement and re-engagement
  • Optimize engagement campaigns through predictive analytics to drive results

Drive Positive Health Behaviors and Improve HEDIS Results

June 23rd | 1:00 PM ET

Whether your focus is on the HEDIS measures for women’s health, the diabetes metrics or a broad range of effectiveness of care measures, Silverlink can design communications strategies that increase your reach, motivate member action and improve HEDIS results.

With the backdrop of the economic slowdown, communicating with members about the importance of key preventive screenings is more critical than ever. Explore the many routes to break through health prevention challenges by tailoring communications interventions that work for your populations.

Join Silverlink for a complimentary webinar where we will present the results and lessons learned over several years in supporting HEDIS screenings including a recent campaign aimed at reducing health disparirities in African American and Hispanic populations related to colorectal cancer screenings.

In addition, learn how to:

  • Use a flexible framework that supports national teams in delivering effective outreach in local markets
  • Drive performance on high-profile HEDIS measures where plan performance has hit a plateau
  • Segment your membership to deliver highly personal messages using multiple levers
  • Design and target messages to help reduce health disparities
  • Combine multiple messages to support members with more than one gap
  • Leverage multichannel campaigns to maximize reach and action

Rethinking Medication Adherence

June 30th | 1:00 PM ET

More than 50% of consumers become nonadherent around their maintenance medications within the first 12 months of therapy. And, today’s economy is putting even more pressure on people to make economic tradeoffs that threaten their health. Several studies have shown that more people are skipping doses or not refilling medications. Non-adherence leads to $177B in direct and indirect costs to the healthcare system per year.

Silverlink provides a comprehensive suite of communications services to drive medication adherence from targeting and messaging to multi-channel campaign management and execution. Join Silverlink where we will discuss some of the common myths around and key strategies related to medication adherence.

In addition, you will learn about:

  • Critical success factors in designing adherence solutions
  • Important conditions to focus on for adherence
  • Success metrics and key measurements
  • Comprehensive solutions for all phases of the patient’s therapy from initiation through long term maintenance

Expanding the Role of the Clinic

I think the fact that Walgreen’s and CVS Caremark are expanding the role that the clinics can play in healthcare is a positive thing.  There will be lots of debates about how much can be handled at the clinics versus the physician’s office, but I think the key point should be that today’s model doesn’t work.  Chronic diseases are not managed.  We provide sick care not well care.

Launched over the last four years to care for such simple ailments as ear and sinus infections, strep throat or pinkeye, retail clinic operators now are training nurses to do specialized injections for such chronic conditions as osteoporosis and asthma.

In addition, they are offering treatments for advanced skin conditions that include removal of warts and skin tags or closing minor wounds. Care for minor “sprains and strains” also is being offered at some retailers, and pilot projects are underway for breathing treatments and special infusions of drugs derived from biotechnology.

We need to figure out how to lower the costs, make the system more accessible, get patients engaged, and drive people to preventative care.  I don’t know if the clinics can do this, but if they can, we should embrace them.  I think both companies are very well positioned to drive change with their breadth of services.  They touch the consumer on a regular basis and have the ability to use data, technology, and localized care to engage patients.

Should MDs Make Less Since Work Is Fulfilling?

It’s an interesting question, and one I had never thought about.  But, this is how I would summarize Penelope Trunk’s post.

Why do doctors need to make so much money? The non-financial rewards for being a doctor are larger than almost any other profession. Except teaching.

Can’t I have a good job that I like; make a difference in society; AND make a lot of money.  Is that too much to ask?

I guess it’s like saying why can’t I balance work and family AND make a lot of money.  It can happen, but it’s rare and hard. 

I’m not sure I buy her hypothesis about lowering standards to create more MDs which would drive down costs, but it’s an interesting perspective.

Facts, Ideas, and Thought Provoking Discussions

We had our client event a few weeks ago (and I am finally digging out). Additionally, I had the privilege to attend one of our client’s big internal events last week. They both gave me lots to think about. I am grouping them all together here to share.

  • Payors are becoming more interested in BPO (business process outsourcing) today. (Is that an economic reality or a competitive need?) Disease Mgmt is the exception here as plans are moving it back in-house.
  • Even thought over 30% of payors have more than 4 backend systems, some of them are looking for new claims systems for their individual business.
  • Marketing is the #1 investment area for 2009 (and hasn’t been in the top 10 for the past decade).
  • One plan out there has 72 different business intelligence tools they are using.
  • 67% of members haven’t been contacted by their plan in the past 18 months. (Is that good or bad?)
  • 80% of members get information from general healthcare sites not the health plan website.
  • Payors are starting to get into (or investigate) the social media world.
  • Reducing 3 risk factors (e.g., smoking) would reduce 80% of diabetes and 40% of cancers.
  • Safeway has kept their healthcare costs flat for 4 years by using incentives.
  • Over 80% of Americans are on 3-tier plans.
  • Only 10% of MDs aware of the cost of a drug to the patient…
    • And most think it’s the RPh’s job to address this
    • But 70% of patients don’t know the cost before it’s adjudicated
    • And 60% of patients w/o coverage don’t talk to MDs about cost
  • Just following guidelines would improve care and costs dramatically (e.g., hypertension by 25%)
  • Starting patients on generics increases their likelihood of reaching an MPR > 80%
  • For the same location, Marriott makes 8% more revenue than competitors based on personalization and use of data
  • The Royal Bank of Canada is beginning to use the value of your social network in determining things like your interest rate (e.g., John has a high net worth cousin that we want to retain).
  • Your IQ score plus your credit score can explain 95% of your success as an employee
  • At NetFlix, they found that people like their recommendations better than the movies people chose themselves
  • High performing companies are 5x more likely to consider analytics a key part of their strategy
  • One CEO is so focused on analytics that they talk about firing people for not using a control group.
  • Analysis is not an ideal but a truism. You have to both have the data and the intelligence to interpret it.
  • Healthcare is just realizing that consumers can be “convinced” to use specific products or services.
    • Behavorial economics (fear) versus inspiration (love).
  • There are more fast food restaurants in states with higher obesity – vicious cycle.
  • You have to engage consumers on their terms.
  • Do consumers really know what they want? If you ask them about receiving health care communications, what would they say? Can you honor those preferences? When do you override them?
  • Is communications and member insights really the only way to differentiate versus competition?
  • Your brain takes in more information than it can process…this is why sleep, exercise, relaxation, etc. is necessary for your brain to process all of it. (If true, do you forget more if you don’t do those things?)
  • You have to have both the Hedgehog (people that dig deep on data) and the Fox (people that connect the dots) to be successful. (Good to Great)
  • Personalization and pro-active communications are key.
  • 65% of healthcare products will be personalized in the next 5 years. (What are you doing to get there?)
  • BWM offers a great example of customization:
    • You could name your mini-Cooper
    • Your personalized key fob would activate billboards that showed a personal message (Hi Herbie!)
  • Interesting discussion on using automated member satisfaction solutions versus live agents. Do you get different outcomes? Which is more accurate?
  • Do members want to be “treated like a friend”? Wouldn’t some view this as too intrusive / presumptive?
  • Can you really motivate your employees if you have no personal relationship with them? I was surprised to hear some people say yes.
  • The most difficult thing is to stop doing what we’ve been doing.
  • Do you want to be part of a corporation or a movement?
  • 65% of employees are looking for another job (even in today’s economy).
  • 80% of employees don’t look forward to Monday (and heart attacks and strokes are higher on Monday mornings).
  • 25% of big company CEOs would meet the clinical guidelines to be defined as a psychopath.

Hopefully, like me, these give you a few things to think about and chew on.

Introverts versus Extraverts

I thought this was a nice summary in the American Way magazine (5/1/09).  It also talks about Jennifer Kahnweiler’s book “The Introverted Leader: Building on Your Quiet Strength“.


I think understanding this about your team and peers is critical.  It’s also important just to understand that recepients of your messaging may analyze the information very differently.  From a quick scan on Google, I found that 25% of the overall population is considered introverted.

Retail Clinics Scarce in Poorer Areas

Just like there are less grocery stores in poorer areas, less retail clinics are being built in those areas.  This systemic challenge makes health changes hard to overcome.  From USA Today (5/27/09):

Walk-in retail clinics in grocery and drugstore chains were designed primarily for convenience but also can help the uninsured find health care, proponents say. But a new study suggests most retail clinics aren’t in the poorest neighborhoods — they are in more affluent areas already well-served by other medical resources. A study by University of Pennsylvania researchers in Monday’s Archives of Internal Medicine mapped 930 retail clinics operating last year, then used U.S. Census data to describe the income and racial makeup of the neighborhoods. Only 123 clinics were located in areas defined by the federal government as medically underserved. Census tracts with clinics had lower percentages of black and Hispanic residents, lower rates of poverty, higher rates of home ownership and higher median incomes.

Top Wealth Centers

Since we know health disparities exist and we know (for example) that higher income and higher educated people are more likely to use generics, I think it’s important to understand some of the ways areas are evaluated and ranked by 3rd parties on their “wealth”.

Reading the St. Louis Business Journal last week, they showed the IL and MO cities and how they ranked.  The metrics were interesting:

  • Median household income
  • Households with incomes above $200K
  • Median home value
  • Households with 4+ vehicles (really?)
  • Adults with bachelors degrees

McLean, VA was the top ranked city:

  • $156,292 median household income (vs. $50,007 nationally)
  • 36% of households have an income above $200k (vs. 3.7% nationally)
  • 79% of adults hold bachelors degrees (vs. 27% nationally)

Lake Forest, IL was the second ranked city and has 5% of households with an annual income of more than $1.15M and 7.4% of households had 4+ vehicles.

(This analysis that they did was based on US Census Bureau’s 2005-2007 American Community Survey.)

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