Enabling Healthy Decisions

TPAs are Third Party Administrators. You can see their definition in Wikipedia, but essentially they are companies that process claims, help manage risk, and often provide other functions in areas such as Flexible Spending Accounts for self-funded employers.

The key to TA success has always been. That TPAs provide intimate, personalized services to client-employers and plans. This means lots of hand-holding and assistance in understanding and gearing up for new laws, requirements and concepts as they will best fit for that particular employer or workforce.

. (Fred Hunt, past president, Society of Professional Benefit Administrators, Employee Benefit News, Feb 2012)

In general, the complexity of the regulated healthcare industry is good for the TPAs that specialized in helping their clients navigate this maze and create a customized plan that meets their needs. Of course, in this like other industries, TPAs are focused on using technology and other differentiators to demonstrate value for their clients.

I was reading the IBM executive summary called “From social media to Social CRM“, and I thought I would share some of my takeaways. (Note that CRM = Customer Relationship Management)

Social CRM “recognizes the role of business today is to facilitate collaborative experiences and dialogue that customers value.” Exciting! This seems like what many healthcare companies should be doing.

Some of their findings include:

• Nearly 80% of the online customers surveyed have at least one account on a social networking site
• Almost 50% have accounts on media-sharing sites
• Only 5% say they nearly always respond to others comments or post original content [creating a world of voyagers]
• Only 45% use social media to interact with brands…but the majority of those say they need to feel a company is communicating honestly before they will interact

There was a huge gap between why companies use social media and what customers want businesses to use social media for (as shown below):

Additional data points:

• Consumers who engage with a company via social media already have an affinity for the company or brand [key point…self-selection bias and identification of advocates]
• 70% of companies think social media will increase customer advocacy while only 38% of consumers agree
• Less than ½ of companies monitor their brand online
• Only 53% of companies offer social media training to their employees
• Only 27% of companies say they share social media insights across functional areas

As I read on into the details of the study, they share the Best Buy case study which showed $5M in reduced call center calls based on their social media strategy. They also point out that social CRM is about engagement not management which is another key point relevant to a lot of the healthcare discussions today.

Where are you on your social CRM strategy?

In preparation for my presentation on copay cards at the PCMA event on Wednesday, I read Mason Tenaglia’s article in Pharmaceutical Executive called “Letting the Facts Get in the Way“. I think it’s a good article from the manufacturer perspective to discuss copay cards. (You can see comments from Adam Fein here.) Perhaps if Mason and Visante could get together and share data we might actually have a full perspective of the marketplace.

Mason’s article is a frontal attack on the Visante paper on the topic that talks about copay cards increasing costs by $32B over the next 10 years (which by the way is less than $1 per Rx over that time period). But, I’m not sure it really clears up the debate for me. Let me discuss a few points.

• He talks about the APLD (Anonymous Patient Longitudinal Data) from Wolters Kluwer which can identify secondary payers. And, it can tell you if they were new to therapy, changed therapy, or simply were continuing therapy when they used the cards. This sounds great since everyone I’ve ever talked to said they can’t get to this data.
• He proposes that the Lipitor $4 program to extend the brand after a chemically equivalent generic is available is more an anomaly than a standard program. Perhaps. While I agree that the focus of many cards is in specialty (51% according to his estimate), if the Lipitor program works (still TBD), why wouldn’t others jump on board (which would likely increase costs to payers).
• He proposes that copay cards be used for Medicare Part D members (which most people tells me already happens). He also says that they’re the least adherent which is probably true based on total number of prescriptions which has been shown to correlate with lower adherence (not really their insurance).
• He states that most copay cards are used for Tier 2 (formulary) medications. It makes me wonder why the manufacturers pay rebates and use copay cards…which he alludes to in his article.
• He states that formulary access is attributed to marketshare which I think is true in a world of “me-too” products, but if products have new clinical value and better outcomes, they can get placed on a formulary without marketshare.
• He states that copay cards won’t drive up costs in Part D because over ½ of the utilization of brand drugs is by low-income patients where they won’t need a copay card for their $6.60 average copay. I personally disagree. I think that’s a red herring as this group is very price sensitive.
• Without giving away too much of my presentation for Wednesday (which I’ll post the slides and summary that day), he makes a key point but without the key data. “Combined medical and pharmacy costs in Medicare for oncology, rheumatology, and MS might actually be lower as a result of compliant patients.” The key word here is might. While I (like many) believe this to be true, I don’t think there are studies to support this. I agree that IF copay cards could demonstrate improved adherence AND that adherence could demonstrate lower medical costs and better outcomes THEN we would be having a different discussion.

It’s an interesting area. I’ll share a lot more thoughts on Wednesday, but I think Mason’s article is a good one for discussion on the topic.