Archive | April, 2010

$300K for an additional year of life?

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 (1/3rd 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?

How Does Adherence Fall Off?

This is a nice simple graphic from a new Medco document that’s out – Case For Smarter Medicine.  We all know adherence is an issue especially in the first 3 months (for those that ever fill even their drugs one time), but this gives us a good picture of how it drops off over the first 12 months. 

Depression Infographic

I just came upon this infographic based on information from almost 1,000 people in the depression community on CureTogether.

The Best Healthcare Conference

In today’s budget conscious economy, people are constantly evaluating where to spend their time and money from a conference perspective.  Some conferences are good networking events.  Some of requirements to work in an industry.  Some are educational.  Some give you new ideas on how to run your business.  Some are in great fun locations with fun events.  Very few fit all of those.

I think our Silverlink Communications client event called RESULTS2010 does all of those.  [Hint – the conference is called RESULTS since that’s what we focus on with our customers.]  It takes on all the key issues we see in the market.  It brings in industry experts and clients to talk about what they are doing to address these issues.  Those problems are framed out by our industry experts that have line experience with these roles.  [Our leadership team comes from places such as Express Scripts, CVS Caremark, Gorman, and HCSC and our team includes people from McKesson, Humana, United Healthcare, IMS, DigitasHealth, Medco, and WebMD.  I challenge anyone to find a more knowledgeable vendor team.]  It gives people a chance to network and talk to their peers.  And, there’s some fun mixed in there.

This year’s event is focused on THE HEALTH CONSUMER.  I’m pretty sure it’s the only conference focused on communicating with consumers in healthcare.  The objective is to provide clients with ideas about how to educate, support, and motivate consumers to take actions which support health outcomes. 

Honestly, it was the original event that convinced me to come to Silverlink.  I was a consultant at my first event working with the company.  I met 75 users who were passionate about the company and had great first hand experience using the technology to make a difference in their companies.  I was able to ask them about the competition and understand why they choose Silverlink for their member communication partner.

So, what does this year’s event have in store:

  1. An amazing list of external speakers including Mark McClellan, David Wennberg, Don Kemper, Jack Mahoney, and Janice Young.
  2. A long list of client case studies – 14 so far.
  3. Specific tracks to cover our different client groups and allow for smaller discussion versus formal presentations – Pharmacy, Population Health, Medicare, and Managed Care.
  4. Industy experts on key topics such as consumer engagement, use of data in healthcare, consumer data, behavior change models and incentives, pharmacy economics, pharmacogenomics, medicare market dynamics, and the evolving retail healthcare model.
  5. Adherence experts such as Dr. Will Shrank from Harvard and Valerie Fleishman who led the NEHI adherence study that is widely quoted.
  6. Several fun events including golf, morning runs, and a few special sports related surprises.

There are several more speakers who you would know and I’m very excited to have come and speak…BUT, I want to leave something inside the package for you to want to rip it open and learn more.

How much does it cost?  Nothing (as long as you’re a Silverlink client).

Where is it?  Boston (a great city).

How do I learn more?  Well…if you work for a large managed care company, a population health company, or a pharmacy / PBM, you may already be a client.  We have over 80 clients today.  So, if you’re not on our invite list, think you might be a client, and want to learn more, let me know.  I’m at gvanantwerp at silverlink dot com.  [spelling it out avoids spam]

This year’s event is in late May so I hope to see many of you there!

Would You Like Some Food With Your Salt?

This is a good example of too much of a “good thing”.  The recommended daily salt maximum is 2,300 milligrams.  But, men consume 4,300 mg per day and women consume 3,003 per day (National Health and Nutrition Examination Survey).

What’s the problem?  Excessive sodium can lead to high blood pressure which is associated with strokes, kidney damage, and congestive heart failure.  The Institute of Medicine estimated that reducing sodium intake could prevent 100,000 deaths a year and save $18B in medical costs.

And, salt also contributes to the obesity crisis by creating a brain response that craves more and causes people to drink more soft drinks and alcoholic beverages.  Some big claims.

Express Scripts’ Slides From Barclay’s Conference

I was reviewing the latest presentation from Express Scripts (ESI) and thought I would share a few of the slides here.

The first one is ESI’s new focus on Waste as a way of driving focus.

The second is a chart that everyone’s been using lately on behavior as the biggest impact on health outcomes.

The third is two charts on adherence.  The first is the one everyone is showing on mail adherence being better than retail.  The second one shows how few people actually have optimal adherence which they define as 90% medication possession ratio (most people I know would use 80%).

Prescription Growth Trends March 2010

These charts from IMS and Barclays Capital show 0.9% script growth for 2010 YTD. Retail continues to grow while mail continues to decrease volume.

So, I guess the question is what to make of this.  Is it right? 

  • IMS doesn’t get all the data (e.g., Wal-Mart and I think some mail order data).
  • The independent pharmacies all complain about the PBM’s taking business away.  This would say that’s not true. 

Let’s just take Express Scripts as an example.  In 2004, Express Scripts filled 39.1M mail Rxs out of 437.8M total claims.  In 2009 (after the Curascript, Priority, and MSC acquisitions), Express Scripts filled 41.8M mail and specialty claims out of a total of 530.6M total claims.  So, over 5 years and with lots of effort, the number of mail claims has grown slower than the total claims growth.  Some of this is due to client mix and plan design.  Some of this is due to things like the $4 generic programs at Wal-Mart.  But, how does this gel with the IMS data and the independent pharmacy complaints?

Or, is this due to the increased growth and focus on 90-day retail?

Sugar and Cholesterol

If you have high cholesterol, drink water NOT soda, juices, lemonade, sweetened teas, etc!  That’s my quick summary of the article I read

Of course we all know that sugar intake is linked to obesity which is linked with high blood pressure and heart disease.  I think logically many of us would know that sugar is tied to cholesterol but generally the focus is on reducing fat intake.  I simplistically think of it as the primary driver of my tricyceride levels. 

Based on the study just published looking at over 6,100 adults:

  • Participants consumed an average of 21.4 teaspoons of added sugars a day.
  • 16% of participants total calorie intake was from added sugars (compared with 11% in 1977-78).
  • People with higher levels of sugar intake were more likely to have low HDL and high triglycerides (blood fat).

The American Heart Association says that women should consume no more than 6.5 teaspoons of sugar a day and men no more than 9.5 teaspoons a day.  [A Coke has 16.5 teaspoons in a 20 oz bottle or 10 teaspoons in a 12 oz can.]

HealthEngagement Barometer 2010

Edelman recently published the results of a survey of over 15,000 people across 11 countries.

The study is interesting in terms of people’s opinions. Here’s a few highlights.

  • More than 50% of people believe businesses are doing a poor job of engaging in health.
  • 73% say it’s as important to protect the public’s health as it is to protect the environment.
  • 61% believe they need to do a better job of taking charge of their own and their family’s health.
  • Only the UK reads and shares less information than the US. 41% of people read health information weekly and 33% share health information weekly.

So, what do people mean by how businesses should engage?

One of the things that interested me was the slide about what motivates people to get active in their health.

While 58% of people use some form of digital media to research health, the majority use Google or some search engine. 34% of them (globally) use health company websites. [If this were limited to health plan or PBM websites in the US, that would seem high.]

I wasn’t surprised that fighting cancer was the most important issue, but I was surprised that privacy of information was the least important.

Express Scripts Drug Trend Report 2010

I knew the new report must be out when I had about 40 hits this morning on my blog based on Google searches for it.  Here’s the banner showing some segmentation.  I haven’t had the chance to read it and comment, but I will in the next 2 weeks.  You can search my blog to see my comments on all the PBM drug trend reports from the past few years.

[added later…my comments are now posted here.]

The Adherence Estimator by Merck

Merck did research that was published last year showing that their 3-question Adherence Estimator (TM) was 86% accurate in identifying patients at risk for nonadherence.  Pretty impressive. 

A copy of the questions are below and were on the Tuft’s website which also shows the scoring mechanism.  This is something patients can take to determine their risk or plans, PBMs, pharmacies, MDs, disease management companies, or others could use. 

Nice Adherence Summary Graphic

I was doing some research this morning and came across this.  I thought it provided a nice visual summary.

Dialogues From WHCC About Population Health

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.]

World Health Care Congress 2010 Notes (#WHCC10)

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.

Largest PBMs by Claims Processed

I saw this in Drug Benefit News today and thought some of you would be interested.  I think Humana’s claims are represented under Argus

Ingrid Lindberg, Chief Experience Officer, Cigna

This was definitely my favorite and most interesting presentation and discussion from the World Health Care Congress in DCIngrid presented and subsequently spent some time talking with me.  She has what I would consider one of the coolest jobs – transforming a large company to be consumer centric and radically changing the way they think, speak, and act. 

From her presentation, here were a few notes:

  • There are 337 languages spoken in the US today. (health literacy issue?)
  • Only 23% of people understand what their health insurance policy means.
  • Most patients appear to be unaware of their lack of understanding in physician instructions and are inappropriately confident.
  • 35% of consumers spend less than 30 minutes reading their health benefit information.
  • Only 7% of people trust their insurer.
  • Trust translates to loyalty and satisfaction.
  • It’s a mix of quantitative and qualitative research.
  • They spent time monitoring sites like –  (do you?)
  • Their senior staff has to spend time listening to member calls each week.
  • They spent lots of time on ethographic research and identified 6 personas that they use for defining products – Busy Mom, Skeptic, CareGiver, Controller, Athlete, and Bargain Shopper.
  • They identified the #1 dissatisfier was language.  Plans talk to them in a language they don’t understand.  (For example, consumers think of providers as the insurer not a physician.)
  • Consumers didn’t want to be called members since it’s not a health club.  They didn’t want anyone other than their physician to call them patient.  They’ve elected to go with “customer”.
  • She talked a lot about how they’ve changed their EOB (explanation of benefits) and their plan overview to address things like what’s not covered.  She talked about how customers think of the EOB as the “this is not a bill form”.
  • They identified 10,000 separate letters that could go out to a customer.  They’ve re-written 9,000 of them. 
  • She talked about changing their call centers to 24/7 and the fact that they’ve now taken their 1M call in what used to be considered “after hours”.
  • She talked about re-designing their IVR to offer you a self-service option (press 1) or a talk to agent option.
  • She talked about their website and YouTube channel –
  • She talked about their understanding level being around 70% while the industry average is around 15% [of communications sent out].
  • This was in a 15 minute presentation and summarized only 2 years of work. 
  • She also shared some metrics that they use and improvements such as a 8 point improvement in one year of “values me as a customer”. 

And, they’ve shared some of this information in their press kit.  There is also an IBM white paper about some of the technology they’ve implemented.

I think the following slide from her deck sums it up well.

Then I sat down with Ingrid to talk with her.  I had a thousand questions which I limited to about 10.  This is a topic I love and is why I love what I do – work with companies to help them develop consumer communication strategies and implement those strategies to improve the consumer experience and drive better health outcomes

  1. How long did it take?  This is about a 3-5 year effort which is complicated by the fact that people in these types of roles typically only last about 28 months.
  2. Did you do it all internally?  No.  They worked with Peppers & Rogers on a Touchpoint Map and used an IBM tool called Moment of Truth.  They also worked with IBM on a new desktop solution.  BUT, she was quick to talk about the fact that those were enablers while the majority of work had to be done by internal change agents since this is a cultural change.  She said that now almost 80% of Cigna people are using their recommended language and are aware of the changes made by her group.
  3. Why haven’t others followed?  It’s hard work. 
  4. How do you deal with consumer preferences?  This is one of my favorite topics to debate.  Should you offer consumers options on how you communicate even if you know that they might not pick one that is the most effective.  For example, I might say to send me an e-mail, but they get lost, they can’t contain PHI, etc.  She said that you have to ask but you have to navigate the path.  She seemed to agree with me that there are some communications where you want to ask (e.g., order status at mail) and others where you want the right to contact them (e.g., drug-drug interaction).  She talked about the fact that it’s all in the framing (e.g., if we have a message for you that could affect your safety, is it okay if we ignore your do not call request?).
  5. Are you changing Cigna’s physician communications also?  Yes.  The changes have become the “language of Cigna”.  Physicians are people, and they are also trying to educate physicians on what they’ve learned about how to communicate with customers.  She mentioned that the most difficult groups to change were the people that were knee deep in this healthcare language – internal people and consultants. 
  6. Based on my discussion with Andy Webber, I asked her if she thought that today’s fragmented environment would allow for a coordinated consumer experience.  She agreed that it’s difficult and that the consumer sees everything as their benefit.  They don’t see the piecemeal parts.  She mentioned that one of their clients had held a “vendor fair” to kickoff the plan year where she presented their learnings and all the vendors were told to use them immediately.  [Maybe that’s part of the solution.]

We then bounced around on a couple of interesting topics:

  • We talked about the fact that lots of companies are hiring non-healthcare people to help them better understand the consumer.  These include consultants, database people, marketing people, and innovators.  My personal opinion is that you need people that have worked in or around healthcare AND outside healthcare.  They also need to have consulting and line management experience.
  • She talked about their war room (she used another term) where they had a current state and future state (of patient experience) and showed all the 10,000 current communications as a waterfall. 
  • We talked a little about some of the things we’d done at Express Scripts when I was there including changing the way we referred to members at the call center to patients and the impact that had. 
  • I shared with her that our biggest difficulty was making web changes at Express Scripts which I thought would be the easiest to do.  She shared that changes on the web were one area where they were lagging and is difficult. 
  • She talked about trying to get innovation from customers by understanding what they want and giving it to them.

BOB vs. ERP Concept For Patient Experience

I had a quick dialogue with Andrew Webber (President and CEO of the National Business Coalition on Health) earlier today at the WHCC (see #whcc10 twitter feed).  I wanted to talk with him about how we create a unified consumer experience in today’s healthcare environment. 

Today, a consumer gets messages from their employer, their physician, their pharmacy, their PBM, their managed care company, their hospital, their disease management company, healthcare sites such as WebMD, and probably several other places.  Very little of that is coordinated, and it’s certainly not always consistent in messaging and direction.

Mr. Webber explained that the employers need a “supply chain management” solution to share data across vendors and develop a consistent message.  We talked about how the Accountable Care Organization (ACO) concept will try to get us back to some type of solution where there is a primary “owner” of the relationship and that this would be with the trusted key in the solution – the MD. 

We talked about the fact that the employers have created this system which pushed the BOB (best-of-breed) over a consolidated, centralized solution.  And, we discussed the fact that employers continue to love these “boutique solutions” that develop niche plays (think Health 2.0 companies) which address an acute need.  They create great case studies but are often difficult to scale.

It made me think of some old IT models I worked on where clients had to decided whether to pick an ERP system like SAP or go with the best-of-breed and manage the infrastructure to connect them.  I think the current employer based system even went a step past this.  In the IT world, the company had to manage a connected infrastructure (think enterprise data warehouse and service oriented architecture).  BUT, in healthcare (or benefits), that infrastructure doesn’t exist.  Each entity owns their piece of it completely with limited interaction and connectivity.

This was the first time where I could see the point of a “employee centric model” versus an “employer centric model”.  I’m not sure I believe it could effectively be done, but it reminded me of a company that was trying to create a web-application that was a type of next generation PHR (personal health record) where the member could consolidate communications, designate preferences, and would adapt general (vanilla) communications to the consumer based on behavior, preferences, demographics, etc.

New And Easier Version of

Got this from CMS…(looks better to me, but it’s been a while since I was there)

Today, the Centers for Medicare & Medicaid Services posted a new and easier to use version of, the Medicare consumer-focused Web site.  The updated Web site is part of the steps Medicare is taking to make using easier for seniors and people who care for them to find the information they need about Medicare. The improved Web site provides users with a summary of Medicare benefits, coverage options, rights and protections, and answers to the most frequently asked questions about Medicare.

The updated Web site reflects Web 2.0 design principles and concepts.  The new design was focus tested with seniors, caregivers and operators at Medicare’s helpline, 1-800-MEDICARE, some of the most frequent users of  The new design gives Medicare more flexibility to quickly update information that is important to users, especially people with Medicare and family members who care for them. 

Take a tour of the new online face of Medicare by clicking on

Accenture Study: Global Perceptions On Health

I’m at the WHCC 2010 in Washington DC, and I got to sit down with Greg  Parston from the Institute for Health & Public Service Value from Accenture.  They just released the results of their global study – Accenture Citizen Experience Study: Measuring People’s Impressions of Health Care

How do citizens rate the quality of health care in their countries?  How do they view government’s role in supporting – and improving – health and health care?  What actions do individuals consider important to making improvements, and how do they rate government’s performance in supporting these actions?

They looked at Australia, Brazil, Canada, France, Germany, Hong Kong, India, Ireland, Italy, Japan, Mexico, Norway, Singapore, Spain, UK, and the US. 

Some of the takeaways from the survey:

  • People around the world want government to address health disparities – access for people with difficulties and fair and equal access.
  • Accountability is a big issue.
  • Access to information is essential or very important (although only one of the top three actions for government in India).
  • Taking prompt, effective actions to resolve problems or difficulties had the largest gap between expectations and performance…75% rated this as essential or very important with only 26% believing that government performs this well.

But, you can read the study…My value here is the conversation with Greg.  Some of the things we discussed were:

  1. Will the US perceptions and expectations of government shift post-reform?  I hope they do the same survey again in a few years for comparitive purposes.  In the US, 62% (at time of survey) wanted government to improve healthcare but only 41% trusted the government to do a good job. 
  2. Men have a higher regard for US quality than women.  (The US was the only country more focused on cost than quality.) 
  3. The elderly (who have more frequent use) have a higher regard for the quality of the US system than younger people…so, where do the low utilizers form their opinions.
  4. People feel disengaged and are relatively uninformed in the US.  (But, how can this be given all the data that’s out there.  And, if the data was available, would people access it and use it?)  He believes that people are inquisitive and would use it.  The difference between other countries and the US is that there isn’t an integrated system for data.  Consumers would have to go to multiple systems to find data.  [I’m honestly more of a skeptic here in that the engaged people would soak up more data, BUT the people who drive costs today and in the future (e.g., pre-diabetics) who don’t engage today will still fall thru the cracks.]
  5. Today, conditional type data (i.e., diabetes 101) is better in the US than abroad, but localized data (MD 1 has better outcomes than MD 2) is worse.
  6. What would you do if you were the “Chief Experience Officer” at a plan?  He talked about focusing on transparency and pushing data out to the members which would build trust and loyalty.  [The question is how to value this and whether it’s relevant in a group market versus an individual market.]
  7. I told him I’d love to see politicians views (or healthcare workers views) versus the general public.  He said they’ve done some of that research in other areas and generally the issue is that politicians are looking for the short-term wins while the consumers have longer thresholds than we given them credit for.
  8. We talked about generation divides on expectations and technology.  The example he used was around EMRs where in general 58% of MDs expect to adopt the technology in the next 24 months, but it jumps up to 80% if you exclude the senior MDs that were surveyed.  (On the flipside, 65% of patients want MDs to have EMRs.)
  9. We talked about the value of metrics and scorecards and the need to publish this data.  The risk is making sure they stay useful, get used for decision making, and aren’t dropped randomly in the future. 

From the US survey:

Pediatricians To Discourage Teen Drinking?

I was reading the USA Today earlier (now that I’m back from vacation) and it has this whole article about “pediatricians need to work hard to discourage children and teens from drinking alcohol.”  Really?

That seems like a role for people other than the pediatrician.  Unresponsible drinking is certainly a problem:

  • Major contributor to the leading causes of teen deaths – accidents, homicide, suicide.
  • Increases the chances that teens engage in other risky behaviors.
  • Affects developing brains and general health.

Their statistics are:

  • >90% of high school seniors and 60% of 8th graders say alcohol is easy to get.
  • 29% of high school students report riding in a car 1+ times in the past month with someone who had been drinking.
  • 10.5% had driven a car in the past month after they had been drinking.

I always thought the most effective way to discourage drinking and driving was to park that crashed up car in front of the schools to serve as a visual reminder.  Probably today, you could create a virtual reality drinking experience that shows how bad your responses are and your likelihood to impact your life.

But, I can’t see pediatricians having enough access to students in their influential years (which I would consider grade 6 and above) and making a convincing arguement by taking about the damage to the developing brain. 

This is an issue which requires parential guidance and is massively impacted by social norms.  Do their friends drink?  Do their parents drink?  When?  How much?  Why?  Are they allowed to drink responsibly at home (like Europeans for example)? 

We have to culturally teach our kids the right view of alcohol.  If we paint it in the wrong light, it will be abused. 

Now, if you’re interested in why many of the facts about drinking are overstated and the agenda behind that, you can go to or[Note: I’ve only skimmed these pages which seem someone opinionated and counter to much of what I’ve seen.  I did see a few points I agreed with, but I’m only presenting a counter-opinion.]

Sleep, Work Hours, and Career Choices

I know there are limits on how many hours a trucker can drive per day and limits on how many hours an airline pilot can fly per day.  I even think there are some limits on hours that a resident can work in a day.  These are all within the past decade.

It struck me as interesting earlier today when I thought about the fact that it is the jobs to which we trust our lives and/or have the highest likelihood of harming us where people are most likely to have worked the most hours and slept the least.  Given all the research on the impact of sleep on our health and our decision making ability, shouldn’t this be a bigger concern for us?

  1. People with weapons – police and military – are highly likely to work in stressful positions with long days.
  2. People in the healthcare field – pharmacists, nurses, physicians – are highly likely to work in stressful positions with long days.
  3. People who provide transportation – taxi drivers, bus drivers, airline drivers, truckers – are highly likely to work long hours (at least historically).  [I assume these may be stressful jobs, but I don’t know.]

I’m sure there are more, but these were the 3 buckets that jumped out at me.

A Few Recent Posts Worth Reading

Trying to keep up with newspapers, magazines, blogs, and everything else can be a fulltime job.  So, I took a quick skim of some of the blogs I follow.  Here are a few entries worth reading:

  1. Genetic Test Reduces Hospitalization For Users Of Warfarin
  2. Copays – When 95% Savings Isn’t Enough
  3. Chilmark on WebMD’s Social Media Launch
  4. Health Reform To Squeeze MCO Profits
  5. Micro-Obstacles to Health and Wellness
  6. DiabetesMine (always great)
  7. Pharmacy’s MTM Challenge (one of my favorite bloggers)
  8. Rating MDs on Cost
  9. The Power of FREE
  10. Medicine is Human

There are lots more, but that’s all I have time to share right now.

Why Are Copay Waivers So Popular?

It seems like whenever I talk to companies about adherence one of first things they want to discuss is copay relief.  It’s a solution I’ve used before so it’s certainly rationale.  But, let’s not forget that cost is not the primary reason for non-adherence.  Forgetfulness and lack of health literacy are often big drivers of non-adherence with medications.  This is easily validated when comparing lift in medication possession ratio (or more tactically refill rate) by looking at copay waiver type program (value-based design) versus communication programs.

Given that copay waivers often require $10+ per month and other programs can be conducted for much less, I question the ROI.  I’d love to see a head-to-head test.  Try education and refill reminders versus copay waivers to see which yielded a greater MPR improvement.

My Technology Pulls April Fools On Me

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.

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