Archive | August, 2009

Phone Calls Improve Quality of Life

“Asking nurses to reach out to people who have advanced cancer – even if only by phone – can improve patients’ mood and quality of life” – Study in Journal of the American Medical Association

This program used nurses trained in palliative care and compared people with regular follow-up care with those that received these phone based interventions.  The nurses discussed issues such as coping, communication with their MD, finding support, managing symptoms, and planning for the end-of-life.

Again, a great reinforcement of the value of communications in healthcare.

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My Healthcare Strategy For Obama

So, this is getting messy quickly.  Support is waning.  The public is confused.  It’s time to do something.

If I put myself in your shoes [President Obama] here’s how I would have proceeded:

  1. Make 2009 about the uninsured.  Focus on one problem which is achievable – coverage for all.  You would have people rallying around you.  And, if the numbers that I have seen are right, the net costs to the insured population would be the same.  Right now, they pay for the uninsured through higher bills from the providers who ultimately have to cover their bad debt. 
    • Challenge – getting the providers to agree to lower their rates once their bad debt dropped.
    • Financing – short-term coverage of the 12-18 month lag between coverage and rates dropping.  long-term mandate with costs covered by taxes for those who can’t pay.
  2. In 2010-2011, I would take on the issue of evidence-based medicine, comparative effectiveness, and health IT.  I would save health reform for my second term (if I got one). 

    Everyone knows the system is broken.  BUT, I would stop talking about a trillion dollars in cost to fix the system.  Think like when we stretched to put a man on the moon. 

    Set a goal of “designing a healthcare system in which the total cost per individual is no more in 2020 than it is in 2010.” 

    Now, you can get people to rally around your efforts to save a trillion dollars and get us out of debt as a country. 

    The goal of keeping everyone happy and taxing the rich plays well on TV, but it’s not reality.  People can’t have their cake and eat it to.  People are going to have to give up some of the luxuries in the healthcare system.  We can’t have defensive medicine.  We have to have some limits on litigation.  We have to have health IT to push evidence-based medicine.  We have to reward people for actively managing their health. 

One of the winning strategies for you in the campaign was a simple focus on change.  You can’t change everything at once.  People have limited capacity.  Think like a program manager – phased implementations; goals people call rally around; simple wins.  People don’t understand what a trillion dollars is.  People can’t focus on 10 year plans. 

Healthcare is complex.  Focus on making it simplier:

  • Get universal coverage.
  • Establish standards of care which are driven by technology.
  • Hold costs flat.

New Words For New Times – “Recession-ese”

I always find new words interesting so I found the article “Do You Speak Recession-ese?” by Jill Becker in the American Way (8/1/09) interesting.  Here’s a few of the words she introduces with their definitions (paraphrased):

  • Bankster – combined form of banker and gangster.
  • Boomeranger – adult child who’s been forced to move back in with their parents.
  • The Chewbacca – the hair style that results when you skip a haircut or two to save money.
  • Duppie – depressed urban professional or downwardly mobile urban professional.
  • Frugalista – someone that is frugal and fashionable.

Pavlovian Caller ID

When the phone rings, what the first thing you do?

caller ID

You look at the caller ID (or at least most people do).  A lot of people won’t answer the phone if they don’t recognize the caller or if there’s no caller ID.

Recently, I thought about how I was using caller ID at home.

  1. In one case, I used to use a service for my dry cleaning.  They would pick it up once a week and drop it off 48 hours later at my house.  The key was making sure I put it outside for them to pick it up.  It got to a point where I never even answered the phone.  I just looked at the caller ID and saw that they were calling.  That was enough to remind me to put the clothes out.
  2. In another case, I could tell how important it was for someone to reach me based on the number of attempts that they made to contact me and the frequency of their number on the caller ID.
  3. In a third case, I realized that I often called the caller ID on the phone rather than bothering to listen to the caller ID that was left in the message.

Certainly, these lessons apply across other channels (e.g., direct mail, e-mail).  The question is how do you incorporate them into your communication strategy and understand the magnitude to which they happen and influence results.

How to communicate with your members on flu 2010?

With H1N1 and the regular flu vaccines this fall, who really knows what to do?  Consumers are going to be looking for information and calling many of their providers and insurance carriers to ask the question.  Combine that management issue with the fact that only 40% of those that should get flu shots typically do, and you have a dilemna.  To hear more from Silverlink’s Chief Medical Officer (Dr. Jan Berger) and our lead for our Population Health solutions (Margot Walthall), clients and potential clients can attend our upcoming webinar on the topic.

Flu Program

How You Ask The Question Matters – Pre-Existing Conditions

All of those in the communications space realize that linguistics do matter especially in certain healthcare situations.  I think this is a great example of how politics and healthcare are playing out.  No one really understands everything.  They understand and get excited (pro or con) based on the soundbite.

Covering_Those_With_Prior_Illness

Consumers Fear Gov’t Involvement More Than Insurers

This was a pleasant surprise since I completely agree.  Based on this Kaiser survey, consumers worry more about the gov’t being involved in health care decisions than healthcare insurers.  Considering we always worry about consumer awareness and trust in healthcare entities, I think this is a positive.

Whose_Meddling_is_Worse_Govt_or_Insurance_Companies

22:1 ROI on Specialty Refills / Adherence

I always get very skeptical when an ROI goes above 3:1 so I was a little shocked to do some retrospective analysis with one of our Specialty Pharmacy clients at Silverlink and come up with an ROI that was 22:1 (or 2,200% ROI).  And, this was based on a pretty simple application.  (Of course it helps that specialty drugs are expensive and have a reasonable margin in some cases.)

But, for those of you interested, here are a few factoids:

  • A simple refill reminder program saved $12K per month in agents by automating the process
  • The program accelerated the refill timing within a 30-day period leading to less gaps-in-care
  • The program had almost a 20 percentage point jump in refill rates (a proxy for adherence)

It also validated a few things for us and the client:

  • As observed nationally, adherence has gone down over time (even on specialty medications) during this recession.
  • “I forgot” is still a common issue around adherence and solutions to address that should be the first thing that companies do.

Of course, the work doesn’t stop there.  We obviously want to continue our work on longitudinal analysis to look at MPR (Medication Possession Ratio) over time.  We also are working with them on addressing the other barriers on these medications (e.g., cost, side effects) by customizing communications by condition and based on the individual patient attributes.

If you’re interested in hearing more about how Silverlink works with clients on adherence (or tactically on refill automation), please feel free to reach out to me.

Time To Kill The “Clean Plate Club”

Dirty Dish

I always thought this was something that only my parents talked about until recently when I heard a few friends use the same term – “clean plate club”.  So, maybe more of you are familiar with these words:

“You have to finish what you were served.  Don’t you want to be part of the clean plate club?  People are starving around the world while you have all this food.”

I just assumed that my dad who was one of eleven kids who grew up in the Depression had this as a reality of limited food.  It took me years to realize that this framework was a recipe for disaster in today’s age.  When you go to restaurants that serve you huge plates of food and apply this mental framework, you are bound to over-eat site.

This is a great example of how something framed early in life can drive behavior.  That’s one of the key concepts when planning healthcare communications is understanding the frameworks that consumers / members / patients have about their physician, their health insurer, their pharmacist, generic drugs, mail order, and a variety of other healthcare topics.

Nature’s Rules For Healthcare

I found this article – Nature’s 10 Simple Rules for Survival – on biomechanics and biomimicry interesting (Fast Company article).  It looks at how nature has survived all these years and translates that to lessons for business.  This is worth more pondering, but my Saturday morning thoughts on applying this to healthcare are in brackets.

  1. Diversify across generations.  [We need different strategies for different segments.  One size will not fit all.]
  2. Adapt to the changing environment — and specialize.  [We need a US centric healthcare model not a model from Canada or the UK.]
  3. Celebrate transparency. Every species knows which species will eat it and which will not.  [Be clear on incentives and roles.  Set up a win-win not a win-lose.  Don’t try to get government to run an efficient business which it never has.]
  4. Plan and execute systematically, not compartmentally. Every part of a plant contributes to its growth.  [A technology infrastructure and shared decision making across a care continuum is important.  The medical home concept has merit.]
  5. Form groups and protect the young. Most animals travel in flocks, gaggles, and prides. Packs offer strength and efficacy.  [Social networking and leveraging peer-to-peer education and support will improve health outcomes.]
  6. Integrate metrics. Nature brings the right information to the right place at the right time. When a tree needs water, the leaves curl; when there is rain, the curled leaves move more water to the root system.  [We need home monitoring and predictive metrics for preventative care.  Using genomics and other measures should save lives by allowing us to act early.]
  7. Improve with each cycle. Evolution is a strategy for long-term survival.  [Big bang improvement to the system won’t work.  Pick one problem at a time – e.g., un-insured – and solve for it.]
  8. Right-size regularly, rather than downsize occasionally. If an organism grows too big to support itself, it collapses; if it withers, it is eaten.  [Healthcare is inherently local.]
  9. Foster longevity, not immediate gratification. Nature does not buy on credit and uses resources only to the level that they can be renewed.  [We need to address the issue of hyperbolic discounting.  People want immediate value, but lots of healthcare improvements take time personally and systemically.]
  10. Waste nothing, recycle everything. Some of the greatest opportunities in the 21st century will be turning waste — including inefficiency and underutilization — into profit.  [Don’t overcomplicate the solution.  Sometimes the obvious can improve the difficult.]

Electronic Device Evolution – What’s Next

The question of ubiquity around consumer electronics is an interesting one.  Will the Kindle replace the laptop?  Will home computers and TVs combine with gaming systems?

While you’re thinking about that, you might enjoy this evolutionary chart which was in the latest Fast Company (July/Aug 2009).  It’s a nice history reminder although you could add a lot more on any path and really have a very interesting discussion.  The funny thing is that I can remember most of these things, but I bet there are kids today that have no idea of a 8-track tape, a walkman, the Commodore 64 (or PC Jr), or the big mobile phone bags.


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