Archive | January, 2012

Will Patient Reported Data Augment Claims Based Models?

On the one hand, it seems fairly obvious that patient reported data (use of OTCs, exercise, food intake) is important in understanding their healthcare.  On the other hand, the historical bias has been to use historical claims to predict future costs.  At a minimum, I think that studies around tools like PAM (Patient Activation Measure) have shown that patient reported information is important in understanding their literacy and attitudes on healthcare.  This data is critical in designing effective healthcare engagement programs.  [One of the reasons that Silverlink has stressed our focus on using data for segmentation and personalization for years.] 

That’s why I found one of the latest studies by Kaiser to be really important.  They used both claims data and patient reported data to evaluate inpatient admission rates and costs.  And, as explained below, this data increased the predictive power of their model. 

The research determined that self-reported information about being in poorer health was a key determinant in predicting higher inpatient admissions and for being in the top tier for costs. Higher admission rates and costs were associated with patients who self-reported:

  • Lower score for general self-rated health
  • Yes to “do you need help with one or more activities of daily living?”
  • Yes to “do you have a bothersome health condition?”

The addition of this self-reported information to a claims history model explained an additional 2.8 percent of variance in admissions and 4 percent in cost.

Should You Be An “Imovator”?

Innovation has been a hot buzz word for the past few years.  The question is always whether to be on the bleeding edge (i.e., an innovator) or a fast follower.  I like the word “imovator” from a July 10th, 2010 Time article on the two business books – Different versus Copycats. 

Many people will tell you that we’ve tried that before or list all the reasons why something won’t work.  It’s never easy to be innovative.  At the same time, you don’t want to be innovative without a purpose.  There has to be a business value to justify the time and investment. 

One easy way to do this is to monitor your competition and simply make what they do better and less expensive.  This fast follower strategy has worked for many people.  They let the competition come up with an idea than execute on it better without having all the upfront investment. 

One of the examples in the article was Walmart.  Sam Walton didn’t invent the discount store, but he certainly figured out how to do it better and scale it.  So, as you think about 2012, what are your strategies for innovation and imovation? 

I personally find focusing on the whitespace between different products to create opportunities.  Look at how consumers use your products.  Look at the choices in the market.  There are often niches which can be grown to create opportunities.  The key is identifying those and creating something that is sustainable in terms of differentiation.

Good Health Is More Than Skin Deep

In the July 11th Time Magazine, there was a small article which I think made a great point – you can be lean and still be at risk for heart disease and diabetes due to fat.  What you can’t tell by weight and appearance is the person’s genetics.  Apparently, international researchers have found a specific variant of a gene that regulates where and how fat is stored.  People with the “lean gene” were storing fat deeper in the body around organs and in tissues.  This visceral fat is more dangerous and can impair bodily functions. 

So…the key point is that even healthy looking people need to monitor their cholesterol and glucose levels.  (I guess those advertisements for high cholesterol drugs were right!)

Does Duration Of Team Matter In Business As In Sports?

One thing that I often think about is the amount of change in the teams within rapidly growing companies (e.g., many PBMs). Does this have an effect on internal knowledge, productivity, and therefore success? It’s a great question. With that in mind, I found the infographic below very interesting.

At the same time, I looked back a few years to see how much change there has been in the management teams at each of the largest PBMs (Medco, Express Scripts, and CVS Caremark).  [Honestly, it was less change than I had expected, and I didn’t look at average age since I’m not sure that’s a great proxy in business while it may be in sports.]

  • At Express Scripts, 7 of the 10 people listed on the website have been there that entire time.  Most of them in their current roles. 
  • At CVS Caremark, 6 of the 10 people listed on the website have been there that entire time althought there has been more movement across roles. 
  • At Medco, 14 of the 16 people listed on the website have been with Medco that entire time and the two others might have also but their start date wasn’t listed in their bio. 

So maybe more change is needed?  Certainly with the changes in the market dynamics, there is always a need for bringing in a fresh perspective…at the same time, the PBM industry is complex and continuity given long-term contracts is important. 


by visually via


Infographic: New Year’s Resolutions

I’m not a big New Year’s Eve fan.  I much rather start the new year refreshed and beginning to think about my goals for the next year.  While I used to do a very rigorous 1, 3, 5, and 10-year plan every New Year’s Day, I’ve been a little slack lately.  I’m going to try to be better this week and at least get some 1 and 5-year personal and professional goals captured. 

With that being said, I liked this infographic from  It’s relevant if you think in terms of prescription adherence. 

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