Archive | October, 2012

Are You Part Of The Quantified Self “Movement”?

I’m not sure whether to call it a movement or a trend or some other term, but I think it’s very interesting.  This idea of capturing and tracking data manually and through devices fits very well with the idea of “Know Your Numbers” in healthcare.

Here’s the descriptionof Quantified Self from Wikipedia:

The Quantified Self is a movement to incorporate technology into data acquisition on aspects of a person’s daily life in terms of inputs (e.g. food consumed, quality of surrounding air), states (e.g. mood, arousal, blood oxygen levels), and performance (mental and physical).

The movement was started by Wired Magazine editors Gary Wolf and Kevin Kelly in 2007as “a collaboration of users and tool makers who share[d] an interest in self knowledge through self-tracking”. In 2010, Wolf spoke about the movement at TED, and in May 2011 the first international conference was held in Mountain View, California.

Quantified Self is also known as self-tracking, body data and life-hacking. It is described in articles such as this one in the Economist and this in Forbes.

With an increasing amount of devices on the market that can be integrated (e.g, FitBit), we will see a huge rise in remote patient monitoring where the patient takes a greater role in this effort.  Even know you are seeing more efforts to integrate devices into the “smart home” with a focus on older patients, but I think this smart home concept will continue to grow. 

This Slideshare presentation is a nice summary…

 

 

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Stand Up To Cancer At World Series

If you were like me, you were surprised and impressed to see all the Stand Up To Cancer signs at last night’s World Series game in San Francisco. It was impressive, but it made me wonder who this company was. Here’s some text from one of their press releases.

Stand Up To Cancer (SU2C) — a program of the Entertainment Industry Foundation (EIF), a 501(c)3 charitable organization — raises funds to hasten the pace of groundbreaking translational research that can get new therapies to patients quickly and save lives. In the fall of 2007, a group of women whose lives have all been affected by cancer in profound ways began working together to marshal the resources of the media and entertainment industries in the fight against this disease.

SU2C’s “Dream Team” approach to funding translational cancer research enables scientists from different disciplines at research centers across the country and internationally to collaborate on projects geared toward getting new, less toxic treatments to patients as quickly as possible. Monies also support innovative cancer research projects that are often deemed “too risky” by conventional funding sources. Sixty-five institutions are currently involved. As SU2C’s scientific collaborator, the American Association for Cancer Research, led by a prestigious SU2C Scientific Advisory Committee, provides scientific oversight, expert review of the research projects and grants administration.

I also grabbed a screenshot of some of the factoids from their website:

Less Than 20% Trust A Pharmacist To Help Them Make Healthcare Decisions – Surprising?

Whenever you go to the pharmacy, they always ask you if you have questions and make you sign off that you were offered counseling.  It begs the question of whether anyone actually does.  I just got this survey data e-mailed to me, and I wanted to share it since it was surprising to me and from RxAlly

I also found it surprising that people don’t think their pharmacist can help them make healthcare decisions.  This is certainly relevant in the Medicare world where AARP and others have partnered with pharmacists traditionally.  Additionally, I think it limits some of the longer term opportunities for pharmacy, pharmacists, and PBMs.  I’ve always thought that given their frequency of patient intervention that there would be lots of opportunities to leverage the pharmacist at the POS to close care gaps and be very engaged in the overall care and driving health outcomes. 

Only 15 percent of U.S. adults have ever discussed a medication maintenance regimen with a pharmacist and only 49 percent have discussed any new medication with a pharmacist. Less than 20 percent (18%) of U.S. adults trust a pharmacist most to help guide and inform healthcare decisions for themselves and their families. A majority of people trust their doctor most (72%), followed by friends and family (36%), spouses or significant others (36%) and the internet (22%).

Source: RxAlly
http://rxally.com/rxally-news.html

Familiarity vs Importance Provider Gap Around Population Health Management

The ideas around Population Health are certainly critical both to us as a country to eliminate the waste in our healthcare system, but they are also foundational in a move from a fee-for-service (FFS) environment to an outcomes-based payment model. Interesting, if you look at a study that was just released, it continues to show a disconnect within the provider community. (Study is Population Health Management In Physician Practice: A Call To Action.)

I believe some of this stems from the costs associated with the build out, integration, and use of these technologies in today’s environment. But, I think some of this stems from a broken connection between national policy, localized implementation, and payer coordination around key healthcare issues such as obesity.

The following paragraph from the same document is also very telling.

“With 72% of respondents reporting that they had either already adopted or were in the process of adoption a patient-centered model of care, it was interesting that only 19% of practices self-reported as Patient-Centered Medical Home (PCMH) and only 10% as an Accountable Care Organization (ACO). Considering the critical role that population health management will play in both types of practice models, the data suggest that while they are undertaking population health management initiatives, many practices may not yet be at a level of transformation to warrant presenting as PCMH or ACO at this point in time. Also interesting is that of the 11 practices that did self-report as ACO, only 5 of the 11 also reported as PCMH – showing again perhaps another disconnect or struggle with implementation and understanding. PCMH, after all, has been described as “foundational” to Accountable Care Organizations.”

A lot of this change won’t be done by physicians, but it was promising to hear in the same report that:

  • 96% of large provider practices employed Nurse Practitioners;
  • 70% employed Physician Assistants; and
  • 91% employed Care Coordinators.

So, how are those resources being used today? And, how do these resources get integrated into an overall care strategy for the patient? Are notes shared with external care managers? How do we find the right point person? How does an external payer team for MM coordinator with the local resources for something like discharge planning?

What Is Population Health Management? Or Medical Management? Or Disease Management?

This is one of those terms that is thrown around a lot just like Medical Management or Disease Management.

I thought it would be helpful to define the 3.

Population Health Management (PHM) is…

“Programs targeted to a defined population that use a variety of individual, organizational, and societal interventions to improve health outcomes” (Mathematica Policy Research Issue Brief, August 2011)

Medical Management (MM) is…

“The general term often applied to the practices of utilization management (UM), case management (CM), and disease management (DM), alone or in combination with each other.” (Trends and Practices in Medical Management: 2001 Industry Profile)

Disease Management (DM) is…

“An approach to healthcare that teaches patients how to manage a chronic disease.” (Disease Management on About.com)

Is that clear as mud?

In today’s world, everything is patient-centric so that doesn’t differ between the three. Obviously, DM is a part of MM, but I rarely hear people talk about MM as a part of PHM which it seems to be to me. But, I don’t think of most MM type programs taking on the macro level change that PHM implies to me. PHM implies things like public health or broad programs like BlueZones. It implies looking at things like plan design, incentives, social trends, workplace culture, and other aspects of change that are necessary to create change and sustain change.

Here’s the Care Continuum Alliance’s full description of PHM (or as they call it here – population health improvement):

Key components of the population health improvement model include:

  • Population identification strategies and processes;
  • Comprehensive needs assessments that assess physical, psychological, economic, and environmental needs;
  • Proactive health promotion programs that increase awareness of the health risks associated with certain personal behaviors and lifestyles;
  • Patient-centric health management goals and education which may include primary prevention, behavior modification programs, and support for concordance between the patient and the primary care provider;
  • Self-management interventions aimed at influencing the targeted population to make behavioral changes;
  • Routine reporting and feedback loops which may include communications with patient, physicians, health plan and ancillary providers;
  • Evaluation of clinical, humanistic, and economic outcomes on an ongoing basis with the goal of improving overall population health.

The population health improvement model:

  • Encourages patients to have a provider relationship where they receive ongoing primary care in addition to specialty care;
  • Complements the physician/practitioner and patient relationship and plan of care across all stages, including wellness, prevention, chronic, acute and end-of-life care;
  • Assists unpaid caregivers, such as family and friends, by providing relevant information and care coordination;
  • Offers physicians additional resources to address gaps in patient health care literacy, knowledge of the health care system, and timeliness of treatment;
  • Assists physicians in collecting, coordinating and analyzing patient specific information and data from multiple members of the health care team including the patients themselves;
  • Assists physicians in analyzing data across entire patient populations;
  • Addresses cultural sensitivities and preferences of individuals from disparate backgrounds;
  • Promotes complementary care settings and techniques such as group visits, remote patient monitoring, telemedicine, telehealth, and behavior modification and motivation techniques for appropriate patient populations.

And, if you read articles about PHM, these macro issues don’t seem to be the focus. The focus seems to be mostly on the technology to accomplish PHM. There are obvious challenges and key success factors there. (Recent commentary on PHM.)

Only 66% Of Medicare Beneficiaries Used Their Free Preventative Care In 2011

Medicare offers people free preventative care which includes a variety of things:

(This list is from http://www.medicare.gov/coverage/preventive-and-screening-services.html.)

Now, while HHS says that over 32M people used these services in 2011, this is only 66% of Medicare beneficiaries. This varies by state with 48.1% of people in Wyoming taking advantage of this benefit while 71.1% of people in Delaware take advantage of the benefit.

I’m not sure of the root cause, but I suspect a lot of it has to do with education. Beneficiaries don’t understand what’s free. They don’t understand how to take advantage of the benefit, and physicians aren’t reinforcing this.

Different Ways To Represent The Same Data

I was just watching the Verizon advertisement where they show data in a few ways. While their charts are all basically the same, it made me think about different ways of representing the same data. We all know that this is an important thing as we evaluate the effectiveness of different programs.

Let me highlight four different ways of representing two data elements. In this case, I’m comparing two programs. The first program (A) had a yield of 20% and the second program (B) had a yield of 23%.

  • I could say that Program B was 3 percentage points better than Program A.
  • I could say that Program B was 15% better than Program A.

I could show the data in two different charts where I simply change the y-axis.

The Real Bears YouTube Video – Creative Attack On The Soda Industry

This video is a little slower going than I had imagined, but it makes a series of tough points about the soda industry and its impact on our healthcare.  See http://therealbears.org for more information.

What’s Possible With Healthcare Technology – Infographic and Health 2.0

I love where the future of healthcare technology is going.  If you missed the Health 2.0 Conference this week, you can see a lot of the presentations now online for FREE!  It’s very cool.

At the same time, I think this infographic from the Institute of Medicine reinforces some of the key points.

Infographic: Your Health In One Drop From WellnessRx

I saw a mention of WellnessRx from Health 2.0 and went to look at them.  I found this infographic which I think is interesting and reinforcing of the value of biometrics in population health management.

Big Bird Comment From Romney Is Relevant To Healthcare

I keep seeing buzz about the Big Bird comment about PBS from the Presidential Debate from last week. As always, I interpret things differently. To me, this shows Romney’s willingness to make tough and perhaps unpopular decisions (like raising taxes for the Middle Class). At some point, these things may be critical.

Sure…the PBS budget may be small, but at some point, we as a country need to focus on how we cut costs to reduce our deficit. (See US debt clock.)

This reminds me a lot of the discussions we used to have to have as a PBM with employers or labor unions about their benefits. It goes back to the basic framework of “you can’t have your cake and eat it too”. Everyone wants to have a broad network of providers. Everyone wants to have an open formulary. Everyone wants to have the broadest benefits at the lowest cost without increasing their contribution every year.

Just by cutting a drug or a provider from your benefit may seem small, but the savings add up. (Like Big Bird or PBS.)

But, this is the problem we have in healthcare. How do we make enough small decisions to add up to real savings? How do we do this without upsetting everyone and impacting satisfaction (or is that simply life)?

The Future Of Population Health Is Mobile

The statistic that I like to point out is that more people have access to mobile devices than people who have access to toothbrushes. I know that sounds crazy to us Americans, but that’s apparently a global reality (in so much as statistics don’t lie). And, people seem lost without their smartphones so they have them within a few feet of them almost 24 hours a day.

Combine that with several trends, and you can begin to understand why Qualcomm Life predicts that by 2020 there will be 160 million Americans who will be monitored and treated for medical conditions remotely.

  1. There will be a shortage of doctors (at least in certain geographies).
  2. Technology continues to be more and more ubiquitous. (Just look at this amazing video)
  3. Telemedicine is becoming more normal.
  4. Big data continues to be a huge focus with lower data costs, greater integration, and ultimately more and more predictive models to interpret real-time data.

So, as I pointed out the other day about the value of the mobile data for a healthcare underwriter, that same data can be used to create a systemic intervention system for monitoring and intervening with consumers to drive behavior change. AND, since the data and delivery method is mobile, the interventions can be highly personalized based on when, how, what channel, etc. to improve engagement rates. I can even know who influences your behavior change and how to get them to encourage you to change behavior (peer pressure) or who you monitor and can influence you based on their recommendations.

I’m not sure I’m ready to go as far as Dr. Ron Loeppke from US Preventative Medicine who said

“These mobile apps that are emerging are going to be a predominant part of how health care is delivered going forward.” (Smartphones Take Wellness Engagement To New Levels by Elizabeth Galentine)

BUT, I do believe that over time that this will become the increasingly dominant channel for interventions and behavior change. Ultimately, your mobile phone number may be a more valued data point than your Social Security number.

New Drug Epidemic Causing 3x Deaths Of Cocaine Epidemic

There are so many attention grabbing ways of beginning this post…

  • Millions of parents deal drugs to their kids
  • 44% of teens have friends who abuse drugs
  • An increase in free drugs
  • Kids are stealing their parents drugs stashes
  • 200M pounds of drugs left in the open for kids to find
  • 10 deaths per 100,000 people from drugs

Would you have guessed that all of these are talking about prescription drugs?

The Medicine Abuse Project (at www.drugfree.org) is trying to get this word out and find a way to change this. The basic points of their messaging:

  1. Safeguard your medications…lock them up and throw extra ones away.
  2. Talk to your kids about drugs and the risk of abusing legal and illegal drugs.

Infographic: Laughter As Medicine (And Equals Working Out)

I think we’ve all heard this at some point or another although I was surprised by the comparisons to the health values of sleep and working out.  I wonder how hard I have to laugh to accomplish that.

Go Patch Adams!

Laughter Infographic

 

Will You Be Charged More For Not Participating In Wellness Programs?

Thus, the major factors that insurance companies traditionally use to charge higher premiums – such as health status, the use of health services, and gender – will no longer be allowed under the ACA. However, the ACA does permit employment-based health plans to charge employees up to 30 percent more on their premiums (and potentially up to 50 percent more) if they fail to participate in a wellness program or meet specified health goals.  [From Kaiser document]

Traditionally, health plans and employers have rewarded consumers for taking some basic action (e.g., $100 for completing an HRA)…although some companies prefer penalties versus incentives.

At that same time, there is some evolution happening here with companies moving from simply paying for an action to requiring participation in a program (e.g., disease management).  The next step that a few companies are engaging in is actually incenting or penalizing consumers based on health outcomes.  This will certainly open some doors for legal challenges where people will argue that they are genetically pre-disposed to some factor that limits their ability to lose weight or lower their cholesterol or some other measure of health.

But, in one of the first legal challenges in FL, the court recently upheld the idea of rewarding (or penalizing) consumers based on taking a specific action (like completing a biometric screening).  With that, I expect companies will be more empowered to take advantage of the fact that under health reform they can charge consumers up to 30% more for their healthcare for either not participating or not achieving a specific health outcome.

With an average monthly premium of $468 per month of single person coverage and consumers paying an average of 21% of their healthcare costs (or $97 per month), this means that a consumer could pay an additional $29 per month (or $349 per year).  [If I interpret all of this correctly…if it’s 30% of the total health premium (not just the consumer’s share), then this jumps up dramatically.]

Not surprisingly, employees aren’t real excited about this.  In a survey by the National Business Group on Health, 62% oppose charging employees more for health coverage if they do not participate in wellness programs.  And, 68% oppose requiring employees to participate in a wellness program in order to qualify for health insurance.

And, according to the survey, the most effective cost control tactic was believed to be Consumer Driven Health Plans by 43% and wellness programs by 19% while 60% of employers plan to increase the premium paid by employees (i.e., cost shifting).

But, if companies throw out a life preserver (i.e., wellness program) to a drowing individual (i.e., unhealthy individual), why isn’t it a reasonable expectation that the individual has to grab it (i.e., participate in the program)?

Do Women Make 80% Of Healthcare Decisions? And Are They More Adherent?

Despite all the articles about the changing gender roles, there is still the common belief that 80% of healthcare decisions are made by women. I guess I would assume that men would be more involved in their healthcare which either points out a major engagement issue or something more systemic (or just a self-perpetuating myth).

The She-Conomy site reinforces this fact, and I also saw it in a PharmaVOICE article (9/12) recently which highlighted the report – Seven Lenses for Marketing Health to Women.

That article had several interesting facts in it. One which caught my attention was the following…

“30% of Facebook users in this study said receiving brand messages from a pharmaceutical company via Facebook would be a good way to communicate with them.” (That seems really high to me.)

On the flipside, I tend to believe the data point that 78% of respondents would feel more in control of their health with a mobile app to provide information…making the case for Happtique even more important.

I found the following in a Kaiser Family Foundation report. (KFF often being a source of truth for me.)

Women are the health care leaders for their families. Women take charge of the vast majority of routine health care decisions and responsibilities for their children, and on top of their everyday family obligations, over one in 10 women care for a sick or aging relative. Meeting these multiple obligations is demanding and leaves many women concerned about meeting all their family and work commitments as well as managing their own health.

  • Eight in 10 mothers/guardians say they take on chief responsibility for choosing their children’s doctors (79%), taking them to appointments (84%), and ensuring they receive follow-up care (78%). Mothers are also primarily responsible for decisions about their children’s health insurance (57%).
  • Similar to men, one in four women feel a lot of stress from career (24%) and financial concerns (23%). Women are significantly more likely than men to be very stressed about managing their own health needs and those of their parents.
  • One in 10 women (12%), compared to 8% of men, cares for a sick or aging relative, often an ill parent. The majority of caregivers report that they perform a range of tasks, including housework (91%), transportation (83%), and various financial decisions (66%). Many also assist with medical and physical care, such as administering medicines or shots (58%), as well as routine activities such as bathing and dressing (42%).
  • Caregivers themselves contend with a host of health challenges. Four in 10 are low-income, nearly half (46%) have a chronic health condition of their own, and one in five non-elderly caregivers are uninsured.
  • A sizable share (29%) of caregivers provide assistance full-time, spending more than 40 hours per week as a caregiver. This is even more common among low-income caregivers, 44% of whom report assisting their relative for over 40 hours weekly.

Interestingly, this ties into a discussion I was having the other night about whether men or women are more adherent to their medications and whether that is a relevant segmentation factor in designing an intervention strategy. The data I’ve seen says women are less likely to be adherent than men, but the company I was talking to believed their data pointed the other way. Here’s a few articles on the topic:

And from the CVS Caremark 2008 Trends Rx Report

72M Uninsured Under Romney Plan…That Would Be A Problem

I know lots of people are skeptical or against healthcare reform.

A report that just came out says that Romney’s plan would lead to 72M uninsured by 2022. I have no idea if that’s a reasonable analysis, but any more uninsured should be a problem for us as a country. They wait to get care leading to bigger long term issues under Medicaid and Medicare. They over-utilize the emergency room. And, as a first world country, we should want to have everyone getting a basic level of preventative care to prevent long-term issues and higher costs and improve out quality of life.

I’ll admit that I was initially a skeptic of healthcare reform, but I think it’s a reasonable solution. Not perfect. As I’ve argued for a while, it only focused on quality and access but not cost. I would have started with access first. But there are several very positive parts of healthcare reform regardless of what some people believe.

  • Support for technology
  • Support for preventative care
  • Accountable Care Organizations
  • No lifetime limits
  • No denial of coverage due to pre-existing conditions
  • Pharma reimbursement during the donut hole
  • At least 85% of what you pay for healthcare must be spent on medical costs (not administrative)
  • No single payer

Infographic: Inactivity Pandemic

I always love a good infographic with good data elements on a topic I care about.

Inactivity Infographic

Would MDs Recommend SMS Based Adherence Programs? 87% Would…

WorldOne Interactive has some interesting data from provider surveys on their website. This one jumped out at me.

  • 87% of MDs polled would recommend a text message based adherence solution to their patients

At the same time, I also thought this one was really important since the question is always whether the physicians want to know adherence data or not. Based on my old post, I didn’t think that MDs would want this type of data since they generally don’t seem to value PBM interventions.

  • 80% of MDs polled would find it useful to get periodic e-mail reports about their patients therapy compliance.

How Many Patients Does A Physician See Per Day? And Other MD Factoids

I thought this was an interesting factoid which I got today and is from The Physician’s Foundation report.

Here are a few other findings…

  • In the next one to three years, over 50 percent of physicians plan to cut back on patients, work part-time, switch to concierge medicine, retire or take other steps that would reduce patient access to their services.
  • Over 59 percent of physicians indicate passage of the Patient Protection and Affordable Care Act (i.e., “health reform”) has made them less positive about the future of healthcare in America.
  • Over 82 percent of physicians believe doctors have little ability to change the healthcare system.
  • Close to 92 percent of physicians are unsure where the health system will be or how they will fit into it three to five years from now.
  • Over 62 percent of physicians said Accountable Care Organizations (ACOs) are either unlikely to increase healthcare quality and decrease costs or that that any quality/cost gains will not be worth the effort.
  • Physicians are divided on the efficacy of medical homes, and many (37.9 percent) remain uncertain about their structure and purpose.
  • Over 47 percent have significant concerns that EMR poses a risk to patient privacy

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