Enabling Healthy Decisions

I’m sure this is the politically incorrect way to look at this, but it’s how my mind immediately works. A new drug – Provenge – was approved by the FDA. It’s a vaccine for men with prostate cancer that gives them (on average) four additional months of live.

The drug costs $93,000 for the 3 shots. So, $93,000 for four months or $279,000 for a year [although you don’t really have that option].

I wonder what a life insurance company puts as value on a year of life? Or the courts?

Who should bear the costs of this drug? The insurance company? The individual? Medicare (taxpayers)?

Or, another complexity…I assume the drug doesn’t work if you don’t take all 3 shots. Of course, it’s going to have side effects – fevers, chills, and headaches. Will patients want to spend the last two years of their life with those side effects for the few additional months of life?

What if they get the first shot at $31,000 (1/3^rd of $93K) and decide not to get the additional shots? Assuming that makes the first shot a total waste of money, should they bear some responsibility for that? Could you make them pay $3,100 (10%) for the first shot and nothing for the future shots or some other way to make their costs front loaded?

I’m sure population health is one of those terms that means nothing to a consumer but is actively used within the healthcare system. Disease management is one of the old terms which is subsumed under this phrase. I think wellness is synonymous with it. But lots of older terms like case management fall under it. [In my humble opinion]

I had the chance to sit down with several leaders in the space and talk about their companies while I was in DC earlier this week.

I talked with Rob Webb (CEO of OptumHealth Care Solutions), Mike Tarino (President of DSM Personalized Nutrition), Stuart Slutzky (Chief Mktg Officer at The Vitality Group), and Calvin Schmidt (President of J&J’s Wellness and Prevention Group). There were some definite similarities in what they all were focused on and their thoughts about reform, but each of them certainly had a different perspective. Here’s a few of my takeaways from the conversations.

The Vitality Group:

• They are more of a start-up here in the US, but they have a lot of interesting experience from work in South Africa and the UK. [I’ll admit that while I liked some of their ideas a lot I’m a little more of a skeptic about the easy of leveraging learnings outside the US to our unique environment.]
• He talked about the fact that places like Europe have a greater awareness of the benefits of Wellness so the ROI / sales process is different.
• I liked the fact that in South Africa they developed a discount program with the largest grocery chain. For Vitality members, they get a 15% discount (or 20% if you have completed an HRA). I believe this is just limited to healthy foods which seems like a good motivator.
  • This reminds me of another company Linkwell which is doing some interesting programs here in the US. I talked with their CEO about using grocery data to identify what people buy and rather than trying to radically shift their buying patterns simply move them to a healthier alternative within the same category (e.g., frozen foods).
    
• They have a partnership to expand within China.
• In one of the countries, they have developed a link to life insurance so you get discounts for participation and staying active.
• They link incentives to outcomes based on 14 different risk factors and 30 different factors that they track.
• They’ve integrated with gyms like LifeTime Fitness to track your use of the gym. They’ve also integrated with several devices. The goal is to remove access barriers.
• We talked about the difference in the “value” of points between the US and South Africa. In SA, you earn discounts as your status increases (like an airline). In the US, you earn Vitality Bucks which you can cash in for free stuff.
• They don’t want to focus on certain fixed outcomes because people are different and they want to offer a non-discriminatory path to success.
• We talked a lot about corporate culture, using incentives appropriately, and developing a communication plan for how this is rolled out and engagement is sustained.
• This seems like a lot of work to finalize integrations especially as healthcare can be local in many cases. He said it only takes about 60-days.

DSM Personalized Nutrition:

• This is a newer group within a large global entity.
• They are looking at how to use nutrition to create health from disasters (i.e., Haiti) to Olympic athletes (e.g., faster recovery formula).
• They deliver employer solutions around wellness and how to most effectively drive lifestyle change.
• I asked him naively if nutrition equaled diet. He pointed out that it was broader than that. It was what you eat, how much you eat, when you eat, and the supplements you take.
• As I’ve talked about before, this is a personal area for me. We digressed several times to talk about the challenge of changing diet versus exercising more. (Only about 2% of people can lose weight without changing what they eat…something I learned a few months ago.)
• I asked him who they competed with which is a broad area since there are a lot of companies out there now competing for wellness dollars.
• I asked him about Jenny Craig and Weight Watchers who seem to be moving into the employer space. He said that they were focused on performance not just on weight loss, but he did talk about the Biggest Loser type competitions and challenges that are part of a cultural change.
• One of the most interesting stats was when he asked me what the average calorie intake difference was between someone who was of a healthy weight and overweight…I would have thought about 500 calories. What do you think? (See bottom for the answer)
• I asked him what they do to gain insight into the health today and in the future:
  • Assessments (web)
  • Screenings (in-person)
  • Coaching (phone, in-person)
• He talked about using teachable moments to get commitment to a goal.
• He felt that incentives often create false motivation and therefore create a short-term return, but don’t create sustainable change. He used the term Intrinsic Motivation several times.
• We talked about the BlueZones research about people living long lives.

OptumHealth Care Solutions:

• I first met Rob at this conference a few years ago where I interviewed him.
• I now know a lot more about what they do and we had a good dialogue about several things.
• We talked about their recent partnership with American Well to leverage their technology.
• I asked him how that played into their traditional model of the health coaches and nurses. He described the need to match up the patient with the right physician and make sure to keep them in the care delivery system. This tele-health strategy allows them to do that.
• I hadn’t seen the American Well presentation yet so I immediately jumped to the value of getting a second opinion using this (or bringing a specialist into the dialogue…which is even better). He agreed and talked about how they’ve been able to lower the transplant rate in their population from 16 per 1,000 (which is the norm) to 11 per 1,000.
• We talked about the measurement and payment challenges in the industry where there’s no clear definition of engagement (or more importantly sustained engagement). It’s too easy to manage to an opt-out list or simply send people a letter saying that you didn’t get them on the phone and check the box that they’ve been “engaged”.
• We talked about incentives for a while and the challenge with them. He (like many I talked to at the conference) was quick to point out that they can often be used to cover up the problem of people not being engaged for the right reasons.
• We talked about back surgery and the fact that if you talk to a surgeon about it then you are 17x more likely to get back surgery than if you talk to a chiropractor about it. (Or 5x more likely if you talk to a PCP about it.) We also talked about the fact that most back pain lasts about 5-6 weeks so if you get someone in a stretching program (for example) that last six weeks then the pain will be gone before their done.
• We talked about a Center of Excellence (COE) concept which many people have been discussing both at hospitals along with call centers (e.g., Medco’s Therapeutic Resource Centers).
• Then we had a really interesting discussion on geography and how consumers are so focused on geography which is something they have access to versus quality and affordability which are harder to access and understand. For example:
  • There are >200,000 physician offices in the US
  • There are about 100,000 gas stations in the US
  • There are about 60,000 pharmacies in the US
  • I often think there are too many gas stations so…
• We ran out of time to talk about their eSync platform, but I find this to be an interesting concept.

Johnson & Johnson Health & Wellness Division:

• They have bought a few companies (e.g., HealthMedia) to get into this space and at one point were looking to build a stand-alone $20B company.
• They seem very focused on the employer and creating custom solutions for them that blend technology, science, and engagement.
• He described it as a “holistic, multi-dimensional consumer approach” and talked about creating a seamless experience.
• I liked his five “pillars” that he categorized as important – leadership and communications, programs, policies and practices, marketing communications, and outcomes.
• We talked about ROI and the two areas to be analyzed – productivity and cost reduction.
• We also talked about incentives and looking at carrots versus sticks and how to use carrots to drive participation.
• They’ve developed 1.3M individual plans for consumers to improve their health.
• I asked him whether HealthMedia was one leg in their stool or the platform upon which to build. Interestingly, he said it wasn’t binary that HealthMedia provided them with both a set of solutions along with a platform to build upon.
• I asked him for some insights into consumers. One that I noted was that they found binge eaters were more willing to talk with or interact with a system than with an agent. [This is similar to what we’ve found at Silverlink where consumers with some specialty conditions are more willing to provide information to an automated call than to the nurse…they don’t want to feel like their being judged.]
  
• We talked about health as a strategic imperative and the need to create a top-down leadership culture to effectively change behavior and environmental factors.

[Answer from above…It’s only a 100-calorie a day difference between being healthy and being overweight.]

For the third year, I’ve been able to come to the WHCC big spring event in DC. I would say this is one of the best conferences in terms of total attendance, level of speakers, and level of attendees.

Between recovering from vacation, work (no…the blog doesn’t pay the bills), and interviewing people, I only made it to a few sessions. My notes from them are here.

Kathleen Sebelius (Secretary of Health and Human Services) talked about:

• Reform is not a gov’t takeover but providing an operating framework (paraphrased).
• Some of the immediate changes – no more pre-existing conditions. Moving coverage of dependants to age 26.
• Medicare spends over $1B per day.
• Preventative care incentives…great example on comparing the costs of amputation for a diabetic versus the costs of preventing it. (want to run this model in more detail later)
• There are $56B in uncompensated healthcare costs (to hospitals) which leads to $1,000 in insurance premiums for all of us that are covered.
• She quoted someone saying that healthcare costs are the tapeworm that is eating into American competitiveness in the global marketplace.

Dr. Mehmood Khan (SVP, Pepsi) talked about:

• How a food company can contribute to the health discussion and change in health (e.g., taking full calorie sodas out of the schools).
• The research and work they do internally.
• The fact that we are now seeing both overfeeding and under-nurishment co-existing in the same geography.

Andy Webber (CEO, National Business Coalition on Health) talked about:

• Challenges that employers see:
  • Improving health
  • Transforming the delivery system to focus on outcomes
  • Controlling expenditures
• The healthcare delivery system is a small input into the overall outcomes. He says that jobs and income are the #1 driver in determining outcomes. [Good for pitching a focus on economic growth, but I don’t buy it.]
• Improving population health is a team sport focused on the local level.

Dr. Reed Tuckson (EVP, UHG) talked about:

• Chronic disease is a tsunami to our delivery system.
• We need to understand what is killing people locally and how to solve it.

Nathan Estruth (VP/GM of FutureWorks at P&G) talked about:

• The innovation strategy at P&G (see detailed paper here)
• The Connect & Develop strategy they use where P&G brings the consumer to the table.
• Some of their investments including MDVIP and Navigenics.
• The power of “and” (try to find solutions that do A and B not just optimizing around one component)
• I think the most telling message was that they clearly did not subscribe to the “Not Invented Here” innovation challenge that many companies do. He said they focus on >50% of their innovation coming from outside the company.

Roy Schoenberg (CEO of American Well) talked about:

• The issues around healthcare in the US – access, MD income, PCP shortage, specialty care access, ER abuse, and systems agility.
• Work they are doing with pharmacies, payers, OptumHealth, Ascension (hospital), and the military.
• A very interesting point about retired MDs coming back into the system since they can work on their schedule and without having to have an office.
• Another cool point about the ability to coordinate visit between a PCP and a specialist. They also enable easier referrals. (I think this could be game changing.)
• They can also project care where needed – e.g., Haiti.

General Observations:

• Lots of talk about creating a culture of health and innovation.
• Lots of talk about wellness.
• Most of the people I talked to from the wellness companies were very skeptical of incentives.
• Lots of people trying new things and trying to innovate.

I guess that’s the best way to explain my comedy of issues today.

Issue One: Phone

I was driving from Boston to a meeting in Connecticut. While I hate to drive, I don’t mind it if I can return lots of calls during that time and schedule conference calls during that time. [My first lesson was that early morning in the East Coast is a hard time to call people in other time zones.] About halfway thru my drive, my phone gave me the equivalent of the blue screen of death. It just showed a spinning clock.

So, I pulled the battery out and tried to reset it…over and over again. Nothing. At this point, I’m missing a conference call and thinking about the fact that in today’s day and age no one is going to believe that I was totally off the grid on a day while I’m working. So, 25 minutes later, I pull off the highway to look for a pay phone. (Yes…I’m not even sure they still exist.) I found one and figured I could call someone to send out a message to 4 or 5 people and let them know that my phone was down.

Well, the pay phone didn’t work. So then I spot an AT&T store (which is not my provider). I go in and ask them about a pre-paid phone. They tell me $30 plus pennies per minute. I’m thinking that’s perfect. BUT, the phone comes with no battery life and it’s another $30 for a car charger. No need to be too needy. Fortunately, before I run over my phone with the car, it comes back to life.

Issue Two: Outlook

Even with the delay, I get to my meeting early and decide to stop at a Starbucks and send off a proposal that someone is waiting for. It seems like a great idea, but right after I sit down, I get a call asking where I am. Apparently, I’m still having an Outlook issue with Daylight Savings Time. While I think I’m an hour earlier, I’m actually late (by the time I get back from Starbucks to their office).

Issue Three: Outlook

Now, I get out of the meeting and have too many emails to answer. I scan for a few urgent ones and go to respond. Well, no big surprise…my e-mail is full. I can’t send any e-mails. So, I jump in the car and drive to the airport.

Issue Four: Power

As I look to jump on another conference call, I realize my Bluetooth headset and my phone are low on power. Not a big deal, I just need to find an exit off the highway with some store where I can squat and plug in. Ideally with a wireless network also. I have no idea where I stopped, but I found a Borders which worked. (I’m sure I looked funny with my Bluetooth headset plugged in and in use and trading plugs between my phone and my laptop.)

Issue Five: Wireless

Now, I finally have a chance to get online and save down enough files to send an e-mail. Great…but I can’t connect. Something is wrong with my wireless card (which worked the day before). [I must admit I’m starting to go a little crazy at this point.] So, I call our IT people, but I have to be on conference calls so I can’t take their call and can’t get e-mail. I get enough battery life to make it the rest of the trip and leave for the airport. Once there, I connect with the IT people and fix the wireless card.

Issue Six: Details

This one might simply be called stupidity, but in the rush to get my e-mail downloaded at the airport and find a plug, I looked at the departure time thinking it was the boarding time. So, after moving around some chairs to an abandoned gate with a plug, I hear “last call for George Van Antwerp”.

What a day! I’m glad the 90-minute client meeting was a good one. Now only one more hour before the last leg of my trip…a short flight home from Chicago.