Enabling Healthy Decisions

The topic of innovation labs in healthcare is an interesting one (see other post). The other day, I had the chance to go and visit the Express Script’s Lab here in St. Louis.

This is a newer facility built back in November 2010 and has 26 scientists working there. It’s where some of the research team that I worked with years ago still is, but it now has a big focus as both a showcase facility and a hub for managing pilots.

There are a few key things in the facility:

1. An open floor plan for collaboration with a giant whiteboard and chalkboard and several meeting rooms.
2. The large screen you can see above which shows different metrics and can have any section expanded to drill down on current pilots or other activities.
3. An interactive board in one area for a more intimate client discussion looking at their data.

There are now some people on the research team from Franklin Lakes (i.e., Medco). It will be interesting to see how they incorporate some of their research studies. Someone had recently told me about some cool work they had done using technology on the bottle (similar to my augmented reality idea).

A big focus of the team is on predictive modeling drawing from work in the financial services industry. They are looking at things like fraud and abuse, re-admissions, and adherence.

Like the team has always done, they use a champion / challenger approach to evaluating pilots. I thought the example they showed me on the big screen was interesting. It looked at both linguistics changes (i.e., words) and graphical changes on the web to evaluate consumer behavior. They carve out 10% of the population to randomly get these different scenarios and compare their success to the “champion” which is the existing strategy.

I had a chance to then see the interactive client board which focused a lot on network, generics, mail, and predicting adherence. They have some very cool mapping software to break all this data down to the block level and let you see how things compare. For example, they showed me claims based adherence on the map versus predicted adherence. This is important to think about where you focus resources especially when you understand that a majority of non-adherence (according to their studies) is due to procrastination. They are thinking about and treating adherence like you would a disease. How can you act preventively?

Right now, their ScreenRx^SM solution is focused on 9 different conditions and uses their model to identify and trigger tailored interventions based on patient identified barriers or obstacles. As I’ve talked about before, while most people think it’s cost…it’s only about 16% (according to their research). Therefore, you can focus your more expensive interventions on the patients with cost and clinical barriers versus simply waiving copays for everyone (for example).

This past week, Aetna announced their innovation lab (see press release). This adds to several other labs out there including the Express Scripts lab, the Humana Innovation lab, and the two Kaiser facilities (Garfield and the Center For Total Health). I’m sure there are more.

It made me think about this as a tool for driving innovation. Based on my limited experience visiting 3 of these 4, it seems like they fall into a few types:

1. An operational prototype for showing how innovation can affect process and experience.
2. A showcase for demonstrating technology and new ideas.
3. A demonstration center for showcasing research and the pilot process.

This makes me think of visiting the Domino’s Pizza facility years ago where they had different pizzas being served and tried there to see how employees reacted. In other cases, you see companies like Walgreens rollout new locations and test the consumer response as a type of living lab.

Let me highlight a few of the things from this annual list by Beloit College. It’s put together to help highlight the mindset of incoming college freshman. Generally, in healthcare, these are the healthy people that don’t get much focus, but increasingly, it will be important to understand them for preventative services, caregiver engagement, and exchanges. (Note: numbering below reflects original numbers from the list)

Ultimately, this will change the way we support and provide healthcare information.

2. They have always lived in cyberspace, addicted to a new generation of “electronic narcotics.”

4. Michael Jackson’s family, not the Kennedys, constitutes “American Royalty.”

7. Robert De Niro is thought of as Greg Focker’s long-suffering father-in-law, not as Vito Corleone or Jimmy Conway.

8. Bill Clinton is a senior statesman of whose presidency they have little knowledge.

9. They have never seen an airplane “ticket.”

14. There has always been football in Jacksonville but never in Los Angeles.

15. While still fans of music on radio, they often listen to it on their laptops or replace it with music downloaded onto their MP3s and IPods.

21. A significant percentage of them will enter college already displaying some hearing loss.

23. Women have always piloted war planes and space shuttles.

27. Outdated icons with images of floppy discs for “save,” a telephone for “phone,” and a snail mail envelope for “mail” have oddly decorated their tablets and smart phone screens.

28. Star Wars has always been just a film, not a defense strategy.

32. Newt Gingrich has always been a key figure in politics, trying to change the way America thinks about everything.

34. Billy Graham is as familiar to them as Otto Graham was to their parents.

35. Probably the most tribal generation in history, they despise being separated from contact with their similar-aged friends.

47. Before they purchase an assigned textbook, they will investigate whether it is available for rent or purchase as an e-book.

49. There has always been a World Trade Organization.

67. Chronic Fatigue Syndrome has always been officially recognized with clinical guidelines.

68. They watch television everywhere but on a television.

74. Genomes of living things have always been sequenced.

Human Resources professionals, consultants, and healthcare companies spend a lot of time trying to figure out what benefits packages to offer, how to frame those out to employees, and then how to get them to choose the right package for them. The key question is whether this works and whether employees care?

A recent survey from the Aflac WorkForces Report would indicate that the answer is no.

• 56% estimate that they waste up to $750 a year because they make mistakes with their health benefits.
• Only 16% are confident about their decisions on healthcare benefits.
• 52% say that their company doesn’t communicate with them at all about open-enrollment.
• 89% say they simply elect the same options every year.
• 47% say they rarely or never exceed their deductibles.
• 16% contribute the right amounts to their flexible spending accounts.

All of this while benefits are getting more complicated and consumers are being expected to pay more of the bill.

I found this study on health exams interesting. It was done by KRC Research for Bausch & Lomb. According to their data, only 52% of adults surveyed have been to the dentist in the past 12 months. That by itself isn’t that surprising, but the fact that it was fourth on a list of five exams was very surprising to me.

(Note: This data was from a graphic that appeared in the USA Today this past week. I could not find the original source in a Google search.)

I’m sticking with my theme this week of sharing presentations.  Here’s one from Pew on the Rise of the e-Patient.

Have you looked at RockHealth at all.  They are a seed money accelerator for digital health startups.

I found a few of the their decks in Slideshare which I thought I would share.  They make some great slides.

I thought I would share this presentation I found.

The FDA recently approved the Proteus system for creating digital medicines.  What does this mean?  It means that in the future the pill you swallow could have a digital tracker that confirms that you really did take your medication.

This is a fascinating development especially as adherence continues to be a focus in quality metrics.  And, with the recent study by CVS Caremark, you now have two critical reasons that adherence should be a part of any health intervention program:

1. Adherence is proven in several conditions to directly lower overall medical costs; and

2. Adherence is shown to improve absenteeism.

BUT, does that justify a device in your pills.  Not alone, but if you look at the recent Express Scripts’ study (that was unfortunately buried in their drug trend report), you’ll see that there’s a material gap between how adherent patients think they are and their real adherence.  That might justify a device.

The big questions will be:

1. What will the cost of the device be?
2. How easy will it be to use?  (Right now, you’ll need patches and connectivity to a mobile device.)
3. How easy will it be to manufacturer it into the pill?  (Right now, you take a second pill with the device.)
4. Will integrated manufacturing change the pill or the production line requiring any capital investments by the manufacturer?
5. How many drugs will this be cost justified by?
6. Will we really want to be monitored that closely or will this seem too big brotherish?

This story (and others like it) will continue to come out.  It’s an interesting one.