Archive | October, 2011

Flu Shots, Myths, Appointments, and Public Health

I talked about Flu Shots last week, but I came across a few other things when I was following up on the post.  One is a site called Faces Of Influenza by the American Lung Association.  It does a good job of making this public health concern personal by highlighting lots of personal stories.

They also provide a list of myths and address those.

The other thing that this got me thinking of is whether people want appointments.  In general, flu shots have become a walk-in, adhoc business.  Which is nice from a consumer perspective (as long as there’s not a wait), but I have to imagine it’s difficult for the pharmacy to plan their data around.

I know that CVS is now offering apointments as an option for flu shots.  It would be interesting to see what percentage of people choose this option and their demographic attributes.

Will Drought Eventually Push Us To Drink Toilet Water?

Not a hot topic! But, I think we all have seen the issues in Texas and other areas of the US this year around lack of water. Water is rapidly becoming a critical resource with McKinsey estimating that by 2030, the global water supplies will meet just 60% of demand. Basically, water supplies don’t go up while demand does due to population and new uses for land.

There is an interesting article called Droughtbusters by Anita Hamilton. One of the more disgusting but yet practical solutions in there is recycling toilet water which is being done in Namibia. I won’t pull you through the technology, but if Orange County, CA can begin treating sewage water and pouring it into its underground aquifiers than it’s not that far fetched.

To read more about water scarcity, you could go to

Have You “Roasted” Your Products Lately?

We all are looking for better ways to innovate and improve our product offerings. I found an example from 37signals in Inc Magazine (October 2011) to give an interesting example.

They put a cross-functional group together and walked through one of their software products. Everyone was encouraged to rip on the product in roast style. From this article, it sounds like they were able to accomplish this with no hard feelings and coming up with some productive next steps.

It made me wonder:

  • How would your adherence product survive a review?
  • What would people say about your benefit materials?
  • What about mail order or 90-day retail? How would people think about these offerings?

Of course, if you went down this path, I would suggest getting some clients (e.g., employers, payers) and some consumers involved. You need to create a “safe” place for them to criticize without people being defensive.

It makes me think of one adherence product I saw lately. I stopped by a company booth at a conference. I asked them how they addressed adherence. They showed me this pad of forms. They explained how patients could self-administer the form after picking it up in the physician’s office. They could then share it with the physician for which they had prepared a book on how to interpret the results. They shared some research with me to support the findings. I was dumbfounded.

  • I asked them if it was online…No.
  • I asked them if they called patients to administer it using automated calls…No.
  • I asked them if they really thought patients and physicians used this…Yes.

Somehow, I doubt it.

Why Should Pharmacies Disclose Profit?

In a resurgent of an old discussion, there are talks under Medicare of requiring the PBMs to disclose their spread made on pharmacy claims.

Let’s look at this in two different ways:

  1. PBM spread on non-owned pharmacies. PBMs create network contracts for their clients. They contract with pharmacies to dispense drugs at agreed upon rates. In many cases, they make spread (profit) on these transactions. They may charge Medicare $40 for a drug and pay the pharmacy $39 leading to $1 in spread. (The pharmacy is then making profit on the drug based on their payment by the PBM versus their acquisition cost of the drug.) Should the PBM profit be disclosed? IMHO…no. But, I could see disclosing average profit made from the network (which I think is disclosed in the PBM financials if you look at COGS).
  2. PBM spread at owned pharmacies. In the majority of cases, PBMs own mail order and specialty pharmacies that consumers are encouraged to use through plan design or other educational campaigns. They may charge Medicare $40 for the drug and buy the drug for $35 dollars leading to $5 in spread (profit). But, in these cases, the PBM is acting like the pharmacy. Rather than showing the $1 in spread from scenario one above, they are making that plus the difference in acquisition cost. Should the PBM profit relative to acquisition cost be disclosed? IMHO…no way! Is CMS asking every retail pharmacy to share their acquisition costs?

This gets to the heart of the American business model. People should be able to make money (yes…even in healthcare). Should government have the right (or any other buyer) to understand the costs for raw materials? I don’t see the government asking Ford to disclose the costs of each car component when they buy a police car to understand Ford’s profit. I don’t see the government requiring hospitals to disclose physician’s salaries when looking at the costs associated with billing codes.

Looking at averages and understanding the basic market dynamics is fine. But, requiring PBMs or pharmacies or any other entity to provide full transparency around their acquisition costs of raw materials is ridiculous to me.

I guess ultimately the PBMs could create separate “businesses” to have a wall between them and their owned pharmacies so that each business unit made its own profit, but I’m not sure if that would get around this.

Diabetes And Medicare Star Ratings

Do you know what the Medicare Star Ratings are?  If not, you might want to review the Kaiser Family Foundation brief from last year.

Basically, the star ratings provide individuals with a quality rating across numerous dimension on a Medicare plan.  And, they are helping to drive the pay-for-performance (P4P) focus across healthcare.  This year’s changes include several adherence metrics and have brought the total diabetes measures up to 7.  And, if you happen to be one of the few 5-star Medicare plans, you will be able to have open enrollment all year not simply during the AEP period from 10/15-12/7.

Here’s a quick summary of the seven (lots of opportunities to work with communications to improve ratings and outcomes):

Measure Summary
Cholesterol Screening Percentage of diabetics with an LDL  test
Eye Exam Percentage of diabetics with an eye exam
Kidney Disease Monitoring Percentage of diabetics with a kidney function test
Blood Sugar Controlled Percentage of diabetics with an A1c test showing their blood
sugar under control
Cholesterol Controlled Percentage of diabetics with an acceptable LDL value in their cholesterol test
Treatment Percentage of diabetics with both a diabetic medication and a hypertension medication that are getting an ACEI or an ARB
Adherence to Oral Rxs An average Proportion of Days Covered (PDC) greater than 80%

We all know the statistics on diabetes so hopefully this will help to improve outcomes.  If you’re interested in how Silverlink helps plans with Star Ratings – go here.

Do Medicare Participants Know Open Enrollment Period Has Changed? No.

A recent study showed that only 37% of Medicare participants knew that the AEP (Annual Enrollment Period) had changed. It now closes on 12/7 not 12/31. That could cost people money if they don’t review their ANOCs (Annual Notification of Changes) and take action.

Another article in US News & World report emphasizes that with some comments from Silverlink’s Chief Medical Officer (Dr. Jan Berger):

Berger breaks down the Medicare coverage decision into five steps, all of which are addressed in the annual statement:

1. What are the primary financial implications of your plan for 2012, including the premium, annual deductible, and co-pays?

2. How well does the plan accommodate your preferred medical providers? Are your doctors participating in the plan? Your preferred hospital?

3. What are the costs and availability of your medications in the plan?

4. How convenient is the plan in geographic terms? Are the participating doctors, medical facilities, and pharmacies nearby and easy for you to get to?

5. What is the star rating of your health plan, and how does it compare with other plans offered in your service area? Quality ratings of health plans ranging from one star (worst) to five stars (best) are relatively new. Medicare has been emphasizing them, and the health reform law has provisions that will penalize plans for substandard rankings. The current star rating process will go live on Medicare’s website on October 12, an agency spokesman says.

Here Come The Pharmacy Co-Branded MA/PDP Plans

In the past few days, I’ve seen two new announcements:

  1. Aetna partnering with CVS to launch a co-branded Medicare plan
  2. Coventry partnering with Walmart, Walgreens, and Target

I think we’re all familiar with the success that Humana has had in their Medicare offering with Walmart.

I think one could also say that the PBMs (i.e., mail order) getting into the Medicare business was also an effort to co-brand Medicare offerings between payers and pharmacies.

I wonder if we’ll see an NCPA offering.  I would think in certain regions that that would play well.


Could An Onsite Clinic Be In Your Future?

Traditionally, I think of on-site medical clinics as something reserved for large employers who have centralized campuses. This morning, I read about one for an employer with 100 employees. And, the numbers shared in the article in Inc Magazine (Oct 2011) were compelling looking at the year before and after they put the clinic on-site in 2009:




Employees covered



Annual Healthcare Costs



Annual Healthcare Costs per Employee



Annual Prescription Drug Costs per Employee



Costs of Emergency Claims




So, what did the clinic look like:

  1. The clinic was part-time (2 days per week).
  1. The clinic had a pharmacy, an MD, and a staff of 4 nurses and PAs.
  2. Visits , prescriptions, and lab work had no cost to the employees.
  3. The clinic cost the company $144K / year through WeCare TLC Onsite Clinics.
  4. Employees pay $50-$100 a week for coverage; copays for visits outside the clinic are $25; and copays for Rxs outside the clinic are $60.

BUT, ultimately, the key was soliciting other groups to co-share the clinic. They initially did it with the city and are now looking at another company.

Talk about leveraging a big-company idea for a small company. Assuming this approach could be duplicated, could this create a new model for physicians where they are splitting their time between multiple onsite facilities? Or would this type of model just exasperate the physician shortage?

Ultimately, one thing is for sure…this type of model will require better connectivity and access to information across multiple sites. But, it should leverage personalization and engagement and ultimately could be a huge opportunity for addressing preventative care.

The Lipstick Index; Health / Wealth; And Connectedness

Have you ever heard of the “lipstick index”? It was coined by Leonard Lauder from Estee Lauder about a decade ago. It points to a phenomenon that lipstick sales go up when the economy declines. It happened in 2001 and right now lipstick sales are up 14% in 2011. Perhaps, more disturbingly, nail polish is up 54% this year. (Of course, further proof showed this not to be a true indicator but interesting anyways.)

But, why would it matter?

Apparently, makeup is a cheap thrill for penny-pincher shoppers. People cut back on many things, but they still need some luxury in their life. (at least that’s what the article in Time on 10/10/11 says)

I find this whole line of research really interesting given the Health and Wealth overlap. Another point in the same article was looking at whether money buys us happiness. Apparently, according to the article, happiness peaks at $75,000. I think one of the points made which many people realized post 9/11 is about the difference in happiness based on materialism versus experiences.

Interestingly, that plays into a broader discussion topic in healthcare around connectivity. Apparently, spending on travel and experiences with friends and family help enhance feelings of social connectedness (leading to a 25% increase in recreation spending from 2007-2011). Interestingly, as we’ve become more thrifty, what we define as splurges have changed. Connectivity (i.e., cell phones and Internet) have not been impacted by the recession at all.

“Connectivity has joined food, shelter and sex as a necessity.” (Paco Underhill, consumer behavior expert, Time, 10/10/11)

Sandwiches and Caregivers During AEP

October 1st marked the beginning of the Medicare marketing period leading into the enrollment period known at AEP (Annual Enrollment Period) which begins on 10/15. [For more on how Silverlink is helping clients with AEP – click here.] More to come on this topic, but for right now, I was just reading an article about the sandwich generation which made me think about this.

Traditionally, we think of sandwich generation as those that have young kids and parents to care for. Increasingly, that “young kids” age is getting stretched out as kids move back in post-college or even as they lose their jobs later in their career.

Perhaps, some of this will be good as we go through more integration of multiple generations into single households as other cultures experience, but it certainly is creating financial stress for the baby boomers. As you think about your marketing, this is just another wrinkle.

For example, according to Strategic Business Insights’ MacroMonitor, 39% of households headed by 60-64 year olds had primary mortgages compared with 22% in 1994. And, as we know, it’s often harder to get out of those houses these days as many people are unwater or can’t sell their homes.

How does this change our caregiver strategy as a healthcare provider? (assuming you even have a caregiver strategy)

On this caregiver point, here are some statistics from the National Family Caregivers Association:

More than 65 million people, 29% of the U.S. population, provide care for a chronically ill, disabled or aged family member or friend during any given year and spend an average of 20 hours per week providing care for their loved one.
Caregiving in the United States;
National Alliance for Caregiving in collaboration with AARP; November 2009
The value of the services family caregivers provide for “free,” when caring for older adults, is estimated to be $375 billion a year. That is almost twice as much as is actually spent on homecare and nursing home services combined ($158 billion).
Evercare Survey of the Economic Downturn and Its Impact on Family Caregiving;
National Alliance for Caregiving and Evercare. March 2009
The typical family caregiver is a 49-year-old woman caring for her widowed 69-year-old mother who does not live with her. She is married and employed. Approximately 66% of family caregivers are women. More than 37% have children or grandchildren under 18 years old living with them.
Caregiving in the United States;
National Alliance for Caregiving in collaboration with AARP. November 2009
1.4 million children ages 8 to 18 provide care for an adult relative; 72% are caring for a parent or grandparent; and 64% live in the same household as their care recipient. Fortunately, most are not the sole caregiver.
National Alliance for Caregiving and the United Hospital Fund, Young Caregivers in the U.S., 2005.
51% of care recipients live in their own home, 29% live with their family caregiver, and 4% live in nursing homes and assisted living.
Caregiving in the United States;
National Alliance for Caregiving in collaboration with AARP. November 2009
36% of family caregivers care for a parent and 7 out of 10 caregivers are caring for loved ones over 50 years old.
Caregiving in the United States;
National Alliance for Caregiving in collaboration with AARP. November 2009

Do You Have A Communications Waterfall?

For those of us that have ever worked in IT, the idea of a waterfall based design always implies a less than optimal strategy.  But, I’m beginning to see an applicability of this framework for communications.

Let’s look at a scenario for a prescription refill where you’re trying to optimize for the lowest cost intervention.

  • Identify targets for an intervention
  • First push a message to all those that have downloaded your mobile application (~10%)
  • Second push a message to all those that have opted into your SMS reminder system (~6% with some overlap)
  • Third push a reminder to those that you have an e-mail address on file
  • Fourth send a reminder using an automated outbound call with the option to refill during the call
  • Fifth (maybe) use agents to reach out to the patient
As you go through this “communications waterfall”, there are several things to think about:
  1. How do you leverage permission-based or preference-based marketing here?
  2. How do you integrate your channels so that if you send an e-mail which isn’t opened after 48 hours (and the message is important) that it automatically escalates to the next channel?
  3. How do you cross-promote across channels to drive greater use of the self-service channel?
  4. What permissions do you need to use each channel?
  5. What are the HIPAA / PHI limitations within each channel?
  6. What is the correlation between preferences and behavior?
  7. If you know that certain segmentation and messaging increase the likelihood of action, how do those insights manifest themselves in each channel and does that change your interest in using a particular channel?
  8. What data do you want and can you get from each channel to understand the response curves?
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