Archive | March, 2010

National Stress Awareness Month

April is National Stress Awareness Month.  [It seems like there are a lot of these type of month / day “designations” lately.]  Here are some statistics from a Fast Company (April 2010) article

  • There are two types of stress – Distress and Eustress.  [Eustress – positive stress; Distress – negative stress…oversimplified]
  • A study of monkeys showed those suffering from more social stress held more abdominal fat (a precursor of heart disease).
  • 3 out of 5 global doctor visits are stress related.
  • $22.8B is spent on anxiety-related healthcare each year.
  • More than 275,000,000 working days are lost in the US each year due to absenteeism from stress.
  • Anxiety and mental-health issues are 5x more common today (2007) among high school and college students than they were at the end of the great depression (1938).
  • 2/3rds of spoken curse words are a result of stress.
  • 1 in 4 Americans admit to taking a “mental-health day” to cope with stress.  The cost to employers is $602 per worker per year.
  • 62% of Americans are stressed about work.
  • Stress fighting products and services are a $14B business in the US.

Voice Personality Is A Powerful Lever To Motivate Health Behavior

This article appeared in HealthLeaders (3/3/10) by two of my co-workers based on some very interesting work they’ve been doing.  

It’s not what you say, but how you say it that matters. The “how” includes a number of specific voice attributes, such as inflection, rate of speech, and intonation—all of which contribute to an overall perceived “voice personality.” 

Voice is a powerful lever in the ability to effectively communicate your message to ultimately motivate behavior. Would you be more apt to trust the voice of James Earl Jones or the voice of your local car dealer? How do you perceive these voices overall? Which voice personality most effectively delivers a message? The answers, of course, depend on the listener, what is being communicated, and the behavior you’re trying to motivate. 

In healthcare, individuals are educated and supported in the decisions they make about their health through communications. This article highlights a recent study of the impact of voice in healthcare communications and how individuals perceive voice as it relates to health messaging. 

Specifically, this research analyzes voice selection for interactive automated calls, an effective outreach channel widely used in healthcare to reach and motivate individuals. 

Subjectivity in Voice Selection
If you put a small group of people in a room and ask them to describe the voice they hear, the answers will be wildly different: “This voice sounds too perky.” “That one sounds robotic.” “This voice sounds friendly and cheerful.” Reaching a final conclusion about which voice is “best” often is a highly subjective process. 

While we don’t consciously listen to an individual’s voice attributes, we do subconsciously assess the voice’s characteristics and create inferences about the speaker. Over the telephone or on the radio, when voice is the focus, we paint a picture of how someone looks, what kind of person they are, their age, gender, and generally whether or not you trust them. 

We’re sometimes surprised in the end at how different the person is when we meet him or her face-to-face. By itself, voice impacts our perceptions, which affect how well we understand a particular message. 

In healthcare, it is a common belief that people prefer a female voice when receiving messages about their health. Perhaps this is because female voices are perceived as more nurturing and caring; and women are often the caregivers in the home. 

But is a female voice equally effective when communicating to all people, of every age, in every region, and for every type of health related behavior? For instance, is a female voice as effective for people of poor health status hearing a message about an important health screening? What about seniors hearing a reminder to take their cholesterol-lowering medications? 

Voice Research
To answer these questions, we created a framework to map specific voice attributes with voice personality. We conducted an attitudinal study to learn how people of different age, gender, and region perceive and respond to different voices. We surveyed 3,000 people across the country, in a statistically representative sample of the commercially insured U.S. population. 

Participants heard the same short informational wellness message spoken by several different voices representing a variety of ages, gender, and unique voice characteristics. Survey responders were asked to provide their opinions on the following: 

  • Is the voice perceived negatively or positively overall?
  • Which attributes do people generally use to describe a particular voice? (e.g., rate, volume, and age)
  • Is the voice perceived as introverted, extroverted, formal, or conversational?
  • Is the voice perceived as coming from someone who is more caring and sincere, or someone who is trying to sell something?
  • Do people believe and trust the voice?

The survey results provide a powerful depiction of how different voices are perceived by different segments of a population. 

What’s in a Voice?
High trust and care/sincerity ratings are important factors when trying to motivate healthcare behaviors. Medication adherence, for example, is associated with the quality of relationship between the patient and the physician. When people trust the voice they hear, and feel that the person speaking to them is sincere, they are more likely to change their behavior. 

There are many interesting attitudinal findings from our study including: 

  • Both men and women across all age groups preferred a male voice to a female voice overall.
  • Voices described as fast paced, young, highly extroverted, perky, and animated rated poorly in the trustworthy and caring categories.
  • Voices described as moderately paced, middle-aged, and well-spoken/educated, were rated most trustworthy and caring.
  • Seniors (those 65+ years old) aren’t as sensitive to voice age as other groups and don’t perceive older voices as necessarily older sounding. By contrast, younger groups perceive “older” voices more negatively.
  • Seniors aren’t as sensitive to the rate of speech as younger populations; therefore, slowing the pace may not be as impactful as was once thought for older populations.
  • Younger people (18- to 34-year-olds) are significantly more sensitive to voice age and rate of speech, which means very careful selection of voices for young audiences is important to drive behavior.,/li>
  • Young people showed stronger opinions overall between men and women when rating the voice gender they prefer. In other age groups, there is general agreement on voice gender preferences. Gender selection is therefore a more important factor for the 18-to-34-year-old age group.

The use of voice to motivate health decisions
The results of this study provide us insight into how people of varying gender, age, region, and health status perceive the voices they hear. Our goal is to validate how specific voices can be used as a lever to change behavior. 

Voice, like other communications levers, such as messages and timing, can be selected based on the demographics, purpose, tone, and intent of communication, as well as how voice supports brand identity. By validating attitudinal voice responses against behavioral activity, voice can ultimately become a measurable behavioral best practice in healthcare communications. 

While the bulk of our experience supports the conventional wisdom that a woman’s voice is more effective for healthcare communications, our voice research suggests that there are opportunities to use a male voice to measurably move health behavior. A recent outreach program to educate individuals about the importance of colorectal cancer screenings supports our attitudinal research. 

The outreach asked if the individual had received a screening during the past two years, and if they planned to schedule a consultation with their doctor. The same message was delivered by a male and a female voice. All population segments, including men, women, Caucasians, Hispanics, and Asians, answered the survey at a higher rate when a male voice was used versus when a female voice was used. 

By applying science and measurement, we can determine the voice qualities that are the most impactful for a specific health behavior and for a group of people. There are measurable patterns in overall voice preference. Communications programs aimed at driving individual behavior should include voice analysis. 

By measuring and understanding perceived voice personality, our research sheds light on an objective way to effectively apply voice in healthcare communications to ultimately impacts behavior change. 

Jack Newsom, ScD, is vice president of analytics at Silverlink Communications, and Ryan Robbins is voice production manager at Silverlink Communications.

Are You Pouring On The Pounds?

Now here’s an example of an ad campaign from NY that my change the way you think about soda.

And, from a recent article in Fast Company:

  • Drinking one can of soda per day can add as much as 10 pounds to your weight in a single year
  • People do not eat less food when the drink more calories…these are just more calories.
  • For every glass of sugared beverage consumed per day, the likelihood of a child become obese increases by 60%

“Snickers is a nutritional wonderland compared to a Coke.”

As someone who has evolved from a 12-pack of Mountain Dew per day in college to 7 Diet Cokes per day until a few years ago to 1-2 Cokes per day now, this may finally push me over the edge.  [Although I did go to zero per day for a year, and my weight didn’t change at all.]

World’s Most Admired Companies

Fortune published their annual list of most admired companies.  Only one of the top 50 is a healthcare company – Johnson & Johnson. 

The top 10…

  1. Apple
  2. Google
  3. Berkshire Hathaway
  4. Johnson & Johnson
  6. Procter & Gamble [some healthcare business but still primarily consumer products]
  7. Toyota Motor [survey was before all the recent issues]
  8. Goldman Sachs Group
  9. Wal-Mart Stores [some healthcare business]
  10. Coca-Cola

But, let’s look at some of the subgroups.

Insurance and Managed Care:

  1. Aetna
  2. United Health Group
  3. Wellpoint
  4. Humana
  5. Amerigroup

Pharmacy and Other Services:

  1. Medco Health Services
  2. US Oncology Holdings
  3. Quest Diagnostics
  4. Catalyst Health Solutions
  5. IMS Health


  1. Abbott Laboratories
  2. Johnson & Johnson
  3. Novartis
  4. Roche Group
  5. GlaxoSmithKline
  6. AstraZeneca
  7. Amgen

Food & Drug Stores:

  1. CVS Caremark
  2. Publix Super Markets
  3. Tesco
  4. Kroger
  5. Safeway
  6. Walgreen
  7. J. Sainsbury
  8. Carrefour


  1. McKesson
  2. Owens & Minor
  3. Cardinal Health
  4. Henry Schein

Healthy Habits In US Aren’t Good

A few stats from the National Health Interview Survey:

  1. 61% of adults drink alcohol.  [Seems low to me…plus I thought some data showed red wine to be good for you]
  2. Only 31% get enough physical activity
  3. 40% do no leisure physical activity
  4. 20% smoke (and 21% are former smokers)

The report has shown no improvement in physical activity since 1997.

The data did show that education makes a difference.  More educated people were less likely to be smoking, more active, less likely to be obese, and less likely to have slept 6 hours or less in the past 24 hours.  And, it showed that married adults are more likely to have healthier behaviors than people who are divorced, widowed, or separated.

Health Reform And The PBMs

I’ve been getting a lot of questions about how health reform will affect the PBMs. While I will admit that I haven’t had the time to read all the tweaks and nuances of what was passed and realize it may change, my take is as follows:

  1. Assuming the PBMs stay part of any government type of solution, this will provide new covered lives for them to manage thereby growing business.
  2. Retail profits for combined entities like CVS Caremark may be negatively affected as cash patients are processed under negotiated contracts, but in so much as they can increase share at their stores, the ability to manage the distribution location (i.e., Maintenance Choice) may negate this.
  3. Generic biologics will be accelerated which will be a very positive play for the specialty business as generics have been for the PBMs. This will also allow the PBMs to use utilization management tools (e.g., step therapy) and formulary management tools which will drive savings and keep them as an essential entity.
  4. Financial disclosure may have a slightly negative effect by creating new reporting and auditing burdens and may ultimately affect client savings as deal parity becomes more normal versus allowing firms with better leverage and negotiating power to drive deeper deals. But, most PBMs are providing transparency today at a client level so this isn’t anything dramatically different.
  5. The focus on preventative services and wellness programs may actually create an expanded role for PBMs to step into the disease management void (which favors CVS Caremark’s model with clinics, retail, and PBM and Medco with their Therapeutic Resource Centers) and provide more services around critical conditions like diabetes and increase the focus on consumer engagement and adherence.
  6. The reduction in the donut hole and funding by pharma will negatively impact PBMs as it will encourage seniors to stay on brand drugs which are less profitable than generic drugs but it will increase adherence during the donut hole which will alleviate some of this downside.
  7. Overall, health reform should be a net positive for the PBMs allowing them to continue to be part of the strategy in reducing health care costs.

More thoughts from Adam Fein on his blog.

Walgreen’s Auto Refill Advertisement

I saw this while I was looking something up on mapquest.

Diabetes Alert Day

Tomorrow (March 23rd) is Diabetes Alert Day. Here is some information that CMS shared around diabetes.

Medicare provides coverage of the following diabetes-related services for qualified Medicare beneficiaries:
• Diabetes screening tests,
• Diabetes self-management training (DSMT),
• Medical nutrition therapy (MNT),
• Glaucoma screening (e.g. dilated eye exam with an intraocular pressure (IOP) measurement), and
• Diabetes supplies (e.g. glucose monitoring equipment and therapeutic shoes) and other services (e.g. foot care).

What Can You Do?
As a trusted source of health care information, your patients rely on your recommendations. CMS requests your help to ensure that all of your eligible patients take advantage of diabetes-related preventive services covered by Medicare.

For More Information
The Medicare Learning Network® (MLN) has developed several educational products related to diabetes-related preventive services covered by Medicare:

o The Guide to Medicare Preventive Services for Physicians, Providers, Suppliers, and Other Health Care Professionals ~ this comprehensive resource provides coverage and coding information on the array of preventive services and screenings that Medicare covers, including diabetes-related services.
o The MLN Preventive Services Educational Products Web Page ~ This website provides descriptions and ordering information for MLN preventive services educational products and resources, including diabetes-related services.
o Quick Reference Information: Medicare Preventive Services ~ this chart provides coverage and coding information on Medicare-covered preventive services, including diabetes-related services.
o Diabetes-Related Services Brochure ~ This brochure provides an overview of Medicare’s coverage of diabetes screening tests, diabetes self-management training, medical nutrition therapy, and supplies and other services for Medicare beneficiaries with diabetes.
o Glaucoma Screening Brochure ~ This brochure provides an overview of Medicare’s coverage of glaucoma screening tests, including the dilated eye exam with an IOP measurement.

To order hardcopies of available Medicare Preventive Services products, including the brochures mentioned above, click on “MLN Product Ordering” in the “Related Links Inside CMS” section of the MLN Preventive Services Educational Products Web Page listed above.

Additional Resources
National Diabetes Education Program (NDEP) ~ This website offers numerous resources to help your patients delay or prevent the development of type 2 diabetes, as well as resources to help your patients manage diabetes to prevent serious complications. Check out “Your GAME PLAN to Prevent Type 2 Diabetes: Information for Patients,” a 3-page booklet to help people assess their risk for developing diabetes and take steps to prevent diabetes. For patients with diabetes, “The Power to Control Diabetes is in Your Hands”, contains information about diabetes and related Medicare benefits. ~ This website contains information for employers to help them reduce health care costs and improve productivity by keeping employees healthy
American Diabetes Association ~ This website contains a wealth of information about diabetes, treatment, and prevention.

Gender Bias Of Statins

Statins are cholesterol lowering drugs (i.e., Lipitor, Crestor, Zocor). Millions of people take them and they account for about 10% of drug spend.

There is now some discussion of whether they work equally in men and women. I guess genomics would make you believe that it’s unlikely, but I’ve never heard anything about this discussion before the recent article in Time Magazine.

I don’t have the time to read all the research in depth and there appears to still be some debate so let me simply pull a few interesting things from the story:

* There is little evidence that statins prevent heart disease in women.
* There is evidence that women are more likely to experience the serious side effects of statins than men are. Those include memory loss, muscle pain, and diabetes.
* The data suggests that statins can reduce heart-related deaths but not deaths overall.
* For females to prevent one event (e.g., heart attack), 36 women would have to take Crestor for five years (from Jupiter study).

Google Health And SureScripts

I’m just catching up with this announcement from a few weeks ago. Google Health has added Surescripts to their partner list. This is interesting to me on a few fronts.

1 – Can this solve the portability issue? Today, if you change employers, your prescription history gets reset. If your employer changes health plans or PBMs, your prescription history gets reset. While this isn’t always a major issue, that history is important both for a DUR (i.e., drug-drug interaction) perspective but also from a research perspective (e.g., Medication Possession Ratio).

2 – Google is going to message users about potential DUR issues. That is a big value proposition of the PBMs. Given the other threats to their business model ($4 generics, direct-to-consumer mail order, claims administrators, legislation, pharmacy to employer contracting), is this another issue?

The “Toyota Effect”

While I’m not an expert, all these stories about Toyota get me thinking about prescriptions. Is the rapid acceleration caused by the car or the driver? Is the perception that it could happen contributing to it happening?

From an outside perspective, it seems to be a mix of correlation, causation, and the placebo effect. Here are some definitions from

Correlation = the degree to which two or more attributes or measurements on the same group of elements show a tendency to vary together.

Placebo Effect = The beneficial effect in a patient following a particular treatment that arises from the patient’s expectations concerning the treatment rather than from the treatment itself.

In the medical world, it’s important to understand the differences between these three. Let’s say you start taking a new medication and feel sick to your stomach. Is it caused by the medication? Does it happen every time you take the medication but not related? Or did you expect to feel sick and therefore do?

People often don’t pause to think about this and test the hypothesis.

[See older post on price and placebo effect.]

Causation = anything that produces an effect.

AHIP On Health Care Reform Legislation

America’s Health Insurance Plans (AHIP) President and CEO Karen Ignagni released the following statement on proposed health care reform legislation:

“For health care reform to work, everyone needs to be covered and the growth in health care costs must be brought under control. Health care reform legislation that does not address underlying medical costs cannot be sustained. Unfortunately, this legislation will drive up health care costs by adding billions in new health care taxes and encouraging people to wait until they are sick before getting insurance.”

Areas of Concern within the Bill

Lack of Cost Containment:

– Does Not Bend the Cost Curve – Health reform legislation that does not address underlying medical costs cannot be sustained. Unfortunately, this legislation lacks a system-wide approach that would actually bend the cost curve downward.

– Pilot Programs – The legislation takes a very timid and limited approach to addressing ways to control costs and improve quality. The legislation needs to take bolder steps by implementing throughout the entire health care system innovative payment and delivery system models that will help move the nation away from reliance on a fee-for-service payment structure and incentivize performance improvement across the board.

– IMAC – The legislation will not provide the comprehensive oversight needed because it would exempt Medicare payments for hospitals, physicians, and other key services from review during the first five years.

– Medical Malpractice Reform – The legislation needs to protect doctors who follow established best practices and implement safe, accountable care models based on the latest scientific evidence.

– Comparative Effectiveness – Comparative effectiveness research needs to look at both the clinical and cost effectiveness of tests, treatments, procedures, and prescription drugs so that patients and their doctors can make the most informed health care decisions.

Premium Tax:

– The legislation imposes a new $70 billion premium tax that the Congressional Budget Office (CBO) has said will be passed on directly to patients. This will raise the cost of coverage for individuals, families, and employers.

Market Reforms:

– Weak Coverage Requirement – The legislation will encourage people to wait to purchase coverage until they are sick, which unfairly penalizes those who currently have coverage. According to CBO, 23 million Americans will remain uninsured once this bill is fully implemented.

– Age Rating – The new age rating requirements will cause premiums to increase for people under the age of 30 by more than 50 percent.

Medicare Advantage:

– Massive Medicare Advantage Cuts – The legislation imposes $200 billion in cuts to Medicare Advantage that will cause massive disruption for the more than 10 million seniors enrolled in the program. If these cuts are enacted, millions of seniors in Medicare Advantage will lose their coverage, and millions more will face higher premiums and reduced benefits.

(See for what AHIP is promoting as a solution.)

Walgreens Continues Acquisitions

I remember probably five years ago observing that Walgreens didn’t typically grow by acquisition. Well, a lot has changed. They’ve continued to grow by acquisition since then recently adding Duane Reade in NY and now USA Drug Stores in Memphis. I keep thinking they’ll either go on the acquisition path around the PBM or divest of their PBM. So far, I’ve been wrong.

With continued rumors of Aetna’s PBM being on the market, Walgreens would seem an unlikely but potential buyer. I suspect that they’re waiting to see if anything ever becomes of the pressure on the CVS Caremark merger and/or whether that can successfully be leveraged to drive significant multiples. I think CVS has shown that the merger can drive retail business especially with their Maintenance Choice offering.

The other question would be who to sell their PBM to, and one has to wonder if the recent reorganization means anything in this area. [Per Dave Snow’s (CEO of Medco) comments, I think they would be the most active potential buyer right now.] All of the non-retail business which previously reported up thru the Walgreens Health Services group is now reporting up thru the retail business. I personally doubt it, but I’ve always been a big believer in the GE model of wanting to be #1 or #2 in a market or trying to clean up my business to sell it.

I personally have always thought a Prime Therapeutics / Walgreens relationship would seem pretty interesting. They both have decent size books of business and together could probably capture lots of efficiencies.

Can’t Wait For My Augmented Reality Glasses

With Droid and other technologies, the augmented reality concept is becoming real. Never heard of it. Here’s a definition from Wikipedia:

Augmented reality (AR) is a term for a live direct or indirect view of a physical real-world environment whose elements are augmented by virtual computer-generated imagery. It is related to a more general concept called mediated reality in which a view of reality is modified (possibly even diminished rather than augmented) by a computer.

In the case of Augmented Reality, The augmentation is conventionally in real-time and in semantic context with environmental elements, such as sports scores on TV during a match. With the help of advanced AR technology (e.g. adding computer vision and object recognition) the information about the surrounding real world of the user becomes interactive and digitally usable. Artificial information about the environment and the objects in it can be stored and retrieved as an information layer on top of the real world view.

The simple examples that many of us may be familiar with are the simulated first down line in football or the line of the hockey puck. They are graphics that are applied in real-time to a reality.

Here’s a couple of cool examples:

Dialing using your hand.

Yelp via Monocle on your iPhone. (Just look thru your camera phone)

Travel Guide using Wikitude. (Just look thru your camera phone.)

First off, the geeky side of me finds this fascinating. Practically speaking, as someone who struggles with names especially at large social events, this would be great in my glasses. If I had pictures of everyone I knew and had ever met and that could pop up into my view in my glasses with some basic information on them (John, works at X company, went to University of Michigan, has two kids, last spoke on April 09).

Maybe at some point this becomes the Matrix meets SecondLife meets Wall-E where everyone’s obese and the only thing you see of them is their Avatar as they move thru some augmented reality.

The Stress Of The Healthcare Vote

I don’t spend a lot of time around politicians, but I had the chance this week to spend some time with lobbyists and people working with the lobbyists. One of the interesting things I heard about the healthcare vote is that politicians (especially the Democrats) were unusually stressed out about having to vote.

Basically, they’ve been told that they’ll be blackballed and unable to get any of their own initiatives pushed thru if they don’t vote for the bill.

And, many of them are seeing numbers that show only 50% of their constituents (at best) support the bill.

Therefore, it’s a lose-lose proposition. You’ve been elected to represent the people so you should do what they want. At the same time, we know that consumers are swayed by all the propaganda by both parties and multiple other groups. Do you know better?

It’s a great question. I haven’t been a big supporter of this reform while I 100% agree that our system is messed up. My recommendation continues to be to parse it up. First, solve coverage for the uninsured. Second, begin to address things like previous conditions. Third, focus on prevention and the payment / incentive systems.

And, I’m in the industry and don’t have time to keep up with all the changes and nuances to the legislation. I had finally resolved myself to reform and thought the bill(s) on the table right before the MA vote were probably ok (not great). But, I don’t know what’s changed since then and the meaning of those changes.

I saw some article about all the pork being put back in to the bills to get the vote. That makes me annoyed as a taxpayer.

Addressing Hospital Readmission Rates

High hospital readmission rates are a real source of concern for health plans, from both a quality and cost perspective. With 20% of Medicare patients being readmitted within 30 days of discharge, health plans and their partners have a significant opportunity to reduce readmission rates across all populations. Even just a half-point drop in readmissions for a Medicare plan with 1 million members can yield $10 to $15 million in annual medical cost savings.

In a new podcast, Dr. Jan Berger, Silverlink’s Chief Medical Officer, discusses how health plans can address this costly, growing issue affecting our healthcare system. Dr. Berger offers best practices for reducing readmissions such as:
• Expanding outreach to entire discharged population
• Reaching out within 24-72 hours of discharge
• Coordinating communications among members, physicians and care managers
• Identifying members at risk for readmissions

Download this podcast and visit our new Post Hospital Discharge Microsite to access other valuable resources on this important healthcare topic.

CVS Caremark Employer Survey

CVS Caremark recently published the results of their 2010 employer survey.

  • 94% will seek opportunities to improve savings more WHILE looking for ways to improve the overall member experience
  • They ranked the following as key priorities in their PBM procurement strategy:
    • 86% price
    • 86% customer service
    • 84% trust and reliability
    • 46% consumer engagement capabilities
  • 48% were considering implementing a step therapy program (generic before a brand)
  • 56% were considering a copay waiver to drive adoption of generic drugs

As a consultant and vendor in the consumer engagement space, this is great. Let’s look at these incrementally:

  • Price is the standard competitive space. This is already playing out and potentially accelerating with the direct to employer approach of Wal-Mart and Walgreens.
  • Customer service is a critical foundation item for both the PBM call center and mail order operations. And, consumer engagement can impact customer service as PBMs learn to predict behavior and proactively engage consumers using segmentation, personalization, and preference-based marketing.

That leaves consumer engagement as a key opportunity for differentiation. And, it plays well to the overall comment about improving savings while improving the member experience. Consumers don’t understand their plan designs. They don’t understand when to act. They don’t understand the importance of adherence.

So, this creates a big opportunity. PBMs can engage consumers to improve 90-day utilization (retail or mail), shift patients to designated pharmacies (retail, mail, specialty), improve generic fill rate (e.g., copay waiver), improve adherence, and allow employers to be more aggressive in their plan design (e.g., step therapy).

In general, the survey was a good reinforcement, but it doesn’t show much in terms of changes in client’s interests. The one thing that did surprise me was that last year 74% said reducing costs was their number one measure of success and this year it was only 66%.

Why Do We Need Healthcare Reform?

This was made a few months ago, but I think it does a good job of addressing some of the core issues.

Insanity Workout

I must admit that I generally go out of my way to not promote products, but I started this new workout routine (Insanity by BeachBody) a few weeks ago and am impressed. Very difficult. I think in the first two weeks that I’ve only made it thru the warm-up twice without stopping. I’ve checked with a few others so I know I’m not crazy. It’s hard.

For me, I needed one that I could travel with (i.e., no equipment needed) and would push me. I’m trying to work on the better eating concept, but that is always my achilles heel.

Light and Sneezing

I’d never heard of this until the other day but apparently 18-35% of the population has something called Photic Sneeze Reflex. A friend first brought this up when she mentioned that she sneezes when going from darkness to light. Apparently, the nerve that controls sneezing is very close to the nerve that controls visual impulses to the brain.

In one story about it, it says it is an inherited trait so kids have a 50/50 chance of having it. Not surprisingly based on when this came up in a meeting this week, some of the people thought this was normal (since they do it) and others thought it was crazy (since they’d never experienced it).

The other thing I learned was that some people with it use bright light to trigger a sneeze which is on the verge but not happening.

DBN On Mandatory Mail

I’ve talked a few times about mandatory mail on the blog and after talking with Drug Benefit News (DBN), a few of my comments appeared in today’s publication.  One of the hypotheses in the article is that mandatory mail is growing (which doesn’t surprise me in this tough economy), and Ken Malley from Medco is quoted several times in there talking about their growth in the program.  He says they have 11M lives in the program which I believe would be more than anyone else.  I also think the Medco program with RiteAid which is described is probably something that clients would like a lot and similar to the Maintenance Choice product that CVS Caremark is offering. 

My comments in the article are mostly about the importance of communications which can ease the transition to mail.  The article also quotes Claire Marie Burchill from Cigna about communications and branding.  They called mandatory mail the “pharmacy of choice” which is not unusual.  When I was at Express Scripts, my team changed it to “Exclusive Home Delivery” and Medco calls it “Retail Refill Allowance”.  [This is the whole concept of framing which is core to communications.]  

The fact is that once members start using mail pharmacy, the overwhelming majority of them like it, “but the challenge is more the inertia of getting them started,” Van Antwerp says. “They need a good boarding experience at mail around first fill, and then it becomes more automatic.” Depending on the payer, mail-order customer retention rates vary from 75% to 95%. 

He adds that if more plans start implementing mandatory programs, “initially you’re going to get some disruption, because people push back against change.” However, once patients realize that they can receive 24/7 support and save money, “most people will be pretty happy,” Van Antwerp says. 


All of this plays into the other benefits of mail order – faster generic substitution, adherence, convenience, and savings.  The other key is aligning pricing and plan design to drive mail order which remains a challenge across the industry but is critical.  

The one thing we didn’t get into in the DBN article was the science of communications and how important it is to understand consumers and what motivates them.  I think this is the future of pharmacy.  A good segmentation and targeting strategy allows you to personalize communications and deliver the right message at the right time to the right person using the right channel with the right message to motivate them.  It’s not that easy to do, but it can be done.

One Way That Mail Order Pharmacies Are Disadvantaged

All I ever hear is complaints from retail pharmacies about the advantages of the mail order pharmacy since they are owned by the PBMs.  Let’s spend a minute on one of the ways they are disadvantaged (which as a consumer is really annoying).

If a retail pharmacy wants to call a patient for a refill reminder or enroll a patient in an automated refill program or talk to a patient about their condition, they can do that.  There’s no limitations put on their pharmacy-patient relationship.

When the mail order pharmacy tries to do the same thing (which by the way I believe is good patient care), they have to get approval from the PBM clients. Why?  If it’s part of the standard practice of pharmacy and the retailers can do it, why can’t the mail order pharmacies?

And, yes…I had an incident yesterday that annoyed me.  I tried to sign up for the auto-refill program at the mail order pharmacy that is owned by the PBM that contracts with the managed care company that the broker who serves my employer selected.

But, when I tried to sign up, they couldn’t do it.  Apparently, the managed care company doesn’t believe in auto-refill (a point which I will be raising with their mgmt team shortly).  I’m sure the argument is that it creates waste.  I could argue against that, but I’ll save that for another time.  Let’s say I concede that may be an issue.  Great, then don’t push auto-refill.  But, why can’t I sign up for it?  It should help me be compliant.  (Note that my MPR is well above 90%…but I’d like to be at 100%.)

But, the bigger issue here is why is mail disadvantaged by their PBM ownership?  Their a network pharmacy with a requirement to manage me as a patient.  Let them do that.

CVS Caremark, Behavioral Economics, Social Media, and Adherence

Yesterday, CVS Caremark announced an expansion on their research partnership with Harvard to include three people focused on behavioral economics and social media.  The focus of both these efforts is around prescription compliance (an almost $300B problem).

The work is going to be focused on three areas:

  • Providing Appropriate Incentives: Research how appropriate financial incentives – in the form of lower copays and immediate up-front rewards – motivate consumer decisions to help improve health care behavior.
  • Developing education tools: Determine how education materials and programs targeting consumers can be applied to persuade positive behavior that will affect meaningful change for patients.
  • Tailoring Communications: Studying how specific messages resonate with individuals to promote improved health outcomes, adherence and personal care.

TED Talk On “Last Mile” in Healthcare

Sendhil Mullainathan, a Harvard professor of economics, on matching intentions with action. The struggle we all have.

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