Archive | November, 2012

Can Sushi Be Delivered As A Custom Food Chain? – How Do You Roll


Until a few months ago, I would eat sushi once a month (at the most).  Now, I’ve been lucky that our Charlotte office is right across the street from How Do You Roll which allows you to come in a build your own sushi roll (ala Subway).  This is a franchise model which has been around for a few years. 

My quick summary is:

  • Good choices of fresh meat
  • Good fresh vegetables
  • Lots of options for creating unique sushi rolls
  • Quick
  • Good service
  • Reasonably priced (e.g., combo of roll with edamame and drink for <$10)

FitBit One Goes To The Gym – Last Challenge

I’ve shared a few tests with you about my FitBit One which included comparisons against my Garmin and versus a pedometer. Today, I got to take it to the gym with me and tested it for distance and calorie count relative to several pieces of equipment from LifeFitness – treadmill, stationary bike, and elliptical. For the treadmill, I also looked it two ways: (1) running at an 8 minute mile pace and (2) walking at a 15 minute mile pace at a 15% slope.

As you can see before, the FitBit was much better aligned on distance with the treadmill, but it was not as aligned on calorie count. I’m have no hypothesis here. I will say that I was surprised that the uphill walking didn’t somehow register as steps. I say that because I went on an outside run the other day up and down hills, and the FitBit did a great job of tracking my uphill runs and translating that into floors climbed.

As a side note, I think this does a nice job (if you believe the equipment calorie count) on showing how a slow walk up a steep slope can burn lots of calories compared to a fast run.

Stay Moving Avoid Sitting Disease

A clinician was talking to me he other day about “sitting disease“. They said that our increasingly sedentary lifestyles are causing all kinds of problems – not least of them being obesity.

With that in mind, I thought I’d share this article and Infographic…

Office workers can exercise at their desk to get into better shape

Stuck working in an office with no time to hit the gym on a regular basis? There are ways to burn off a few calories during office hours, says Selen Razon, a physical education professor at Ball State.

“Studies have shown that long periods of inactivity — including sitting at your desk — increase the risk of cardiovascular disease and cancer,” she says. “I suggest that people do a few simple exercises to get their bodies moving and then stretching and toning at your desk. Moving a little goes a long way.”

Razon suggests:
• Start exercising before arriving at your desk by first parking your car as far away from the building as possible and then walking.
• Take the stairs whenever possible.
• Do exercises at your desk, including flexing arms, legs and abs on 30-second intervals.
• Get rid of a chair and sit on a medicine/fitness ball while working. Sitting on a ball will tone and strengthen your abs.
• Stand up and/or take short walks every 20 minutes at desk. Studies show even simple frequent standing breaks significantly decrease your chances of getting diabetes.
• Exchange the typical desk for one that allows you to stand, which burns more calories.
• Bring gadgets to the office. Hand grippers and stretch cords are relatively cheap and can provide great outlets for keeping active while you look at your screen.

FitBit vs Garmin – Test #2

As I mentioned, I got my new FitBit One the other day. I’ve been experimenting with it each day. Yesterday, I showed how it performed versus a pedometer. Today, I focused on how it performed versus my Garmin Forerunner watch that I use to track my distance and speed when running outside. While the data relative to the pedometer was pretty similar, there was a 15-16% discrepancy between the FitBit and my Garmin.

According to the Garmin, the FitBit was underestimating my distance traveled. To validate the distance, I also used to calculate the distance (which they estimated to be 0.82 miles).

At the same time, I also wanted to see if there was a difference between just having it sitting in the bottom of my pocket versus putting it on my belt loop. Location didn’t seem to matter.


(Note: This chart shows distance in miles.)

FitBit vs. Pedometer – Test One

I’ve been enjoying the FitBit One for a few days now.  I decided there were a few tests that I’d like to do.  The first one was to compare it to the step count from a pedometer that I’ve had. 

It hasn’t been a highly active day (as I’ve been working from my home office), but there doesn’t seem to be much of a difference. 

Kroger Expansion – Digital, Physical, Strategic, and Specialty Pharma … Oh My!

Since one of my first jobs was at Kroger, I’ve always been intrigued to see what happens with them. (I can even still go back almost 30 years later and still have some of the General Managers at my old store come out and remember me.) So, I was initially intrigued a few weeks ago when the story came out in Drug Store News about their expansion plans.

“Over the course of a day-long investor conference Tuesday, Kroger outlined its future growth strategy. Across its physical store base, Kroger plans to enter one or two as-yet-to-be-named new markets along with boosting presence in existing markets. But Kroger also has significant designs on the multichannel consumer, and outlined for analysts the grocer’s plan to grow its marketshare across the digital landscape as well.”

Kroger has several interesting assets to leverage:

Now, with today’s announcement, they’ve made a jump into the Specialty Pharmacy Space with their acquisition of Axium. It begs the question of what they want to be – a grocer with a pharmacy, a pharmacy with groceries, a health destination, or something new.

Looking at some JD Powers data from 2010, they are positioned in the middle of the pack from a pharmacy satisfaction perspective.

On the other hand, if I look at their positioning from Bruce Tempkin’s analysis, they score well.

I have to believe there’s some great opportunity here. I’m a big believer that the retail assets create large opportunities for them to play in the broader healthcare market.

  • They have broad hours (in some cases 24/7).
  • They are natural destinations for people.
  • They can host clinics.
  • They already have pharmacies.
  • They have food which is a critical part of addressing obesity and for certain conditions like hypertension and diabetes.
  • They have patient specific data around things like home monitoring tests, food products, OTCs, and other products.
  • They are generally located in easy access locations.
  • They have good brand equity.

For example, just look at this press release from Target from a few years ago. This is a broad vision (that I’ve never heard or seen in the market). On the flipside, we know that CVS, Walgreens, and WalMart are spending considerable efforts trying to really “own” this space with their teams. We also know that specialty pharmacy (and even pharma in general) is trying to see how it gets out of its box and become broader players in the health continuum looking beyond just drugs to actual outcomes. (This is why healthcare is so exciting right now!)

My Fitbit One Has Arrived – Challengers?

I’m a big believer in the idea of connected devices – Quantified Self movement.  While I’d love to track my data via manual input, that comes and goes.  So, over the summer, I began thinking about a device to use.  There are lots of them out there, but I’lll admit that it was hard to determine which one would be best (see one review):

For me, I decided there were several criteria:

  1. Able to track multiple activities – walking, running, biking, and steps.  (in terms of calories and raw numbers)
  2. Easy mobile and web interfaces with wireless integration.  (Mac and PC)
  3. APIs for connecting into other applications.
  4. Battery life.

I didn’t spend much time looking at the communities associated with each and how they work to motivate you to exercise.  I do think that’s important.

I also like the Striiv game idea where you earn points based on your activities (badges) to unlock more things in a virtual world.  For gamers and others, this plays into the “gamification” trends.


Did I pick right?  We’ll know soon, and I’ll give you an update.  But, I certainly welcome challengers.  (If you want me to try your device and compare it, let me know.)

1/3rd Of Diabetes Develop Chronic Kidney Disease #WorldDiabetesDay

With 347M diabetics worldwide and another 79M in the US alone with pre-diabetes, we hear a lot about this condition, and its cost impact. But, I’m always surprised that there’s not more focus on the fact that 1/3rd of diabetics will develop Chronic Kidney Disease (CKD). CKD is a progressive condition for most patients where they eventually end up on dialysis which is very expensive and has a significant impact on patient’s quality of life.

So what can diabetics do to avoid developing CKD:

  • Control your blood sugar level
  • Keep blood pressure under control
  • Check your blood pressure as often as your doctor recommends
  • Ask your doctor to test you for kidney disease at least once each year
  • Take medicines to help control your blood glucose, cholesterol, and blood pressure if your doctor orders them for you
  • Follow your diet for diabetes
  • Get regular exercise
  • Avoid alcohol
  • Do not smoke
  • See your doctor as often as you are told

Top Diabetic Bloggers And Infographic

I found this site listing some of the top diabetic bloggers and also found this infographic there.

Is War A Good Framework For Addressing Cancer?

A physician asked me this a few months ago, and I thought it was a great point.  We were discussing the fact that there are often times when we (the medical institution) may try too hard to “cure cancer” (see some of the points in my post about palliative care).  When it’s viewed as a war that has to be won, it may be that too much effort is spent to beat cancer into remission rather than thinking about the patient’s experience.  (see cartoon from below)

A friend game me this example…While his brother’s cancer was in remission, the toll of the chemo and the other treatments was so much that he was never able to work again.  The patient would have preferred to be able to work a few more years and die of cancer, but that discussion never happened. 

In general, I believe most physicians would consider this a failure.  They’re taught to “beat” the disease not to back off and let the disease “win”.  But, I often hear about the “war on cancer“. 

Even after 40 years, we still have a large amount of annual deaths from cancer. 

Infographic: Obesity

Unfortunately, I don’t think a lot of this will surprise many of you, but it’s scary to think about the impact of obesity across different industries.  For some of them this is big business.  And, while I don’t think employers have fully realized how to focus on this from a “wellness” or “disease management” perspective, I think that will change. 

What Is My Maximum Heart Rate?

If you’re like me, you get on the treadmill or other exercise equipment at the gym and see it talk about exercising at X% of your maximum heart rate. Or, you get a heart rate reading on the device and wonder what it means.

It appears that the simple answer is to take 220 minus your age. For example, if you’re 30, then your maximum heart rate would be 90.

Now, when I plugged my age into a Mayo Clinic site, it shows me all the caveats about this answer.

Is Your Specialty Pharmacy A Dispenser, An Advocate, Or An Innovator?

Specialty drugs are expected to represent 40% of total Rx spend by 2020 so guess what…they’re the focus. Generic Rxs represent 80% of the oral drugs dispensed today and are low cost. PBMs, pharmacies, and payors are and should be focusing on specialty drugs.

Of course, this is driving a shift towards price compression and medical management types of functions like PA, UM, ST, case management, and even disease management.

So…what should your specialty pharmacy be focused on?

  1. Integrating medical and pharmacy benefits and data (a lot easier said than done as many have tried and failed).
  2. Using technology to engage physicians including social media, iPad apps, and EMRs.
  3. Providing a holistic solution that enables patients to self-manage, understand their disease, and improve their adherence to minimize waste and improve outcomes.
  4. Work with providers to be part of the broader care team and subsequently the shift to P4P (pay-for-performance) from FFS (fee for service).

I think this is going to require a tighter coupling of population health companies with specialty pharmacies and potentially better leveraging pharma manufacturers as partners versus suppliers.

This is not just a cost challenge…this is about outcomes. I usually think of it in terms of “The Triple Aim” which is about cost, quality, and experience.

If you look at your specialty pharmacy partner, I think you could put them in 3 buckets:

  • Dispenser – Focused on operational metrics (TAT, ASA) and lowest cost dispensing.
  • Advocate – Focused on “hub” type services that address basic patient needs (mostly patient out-of-pocket costs) and look at pharmacy focused case management.
  • Innovator – Focused on using technology and data (medical, pharmacy, lab) to create differentiated outcomes through patient engagement, participating in the care team, and personalizing medicine.

9 Lessons From BlueZones

I got to see Dan Buettner, author of BlueZones, present a few times and love some of the insights from his research. The other day, there was a list of these nine lessons in USA Today:

  1. Move naturally
  2. Know your purpose
  3. Kick back
  4. Eat less
  5. Eat less meat
  6. Drink in moderation
  7. Have faith
  8. Power of love
  9. Stay social

It’s worth digging into his research if you’re looking at how to live longer.

Articles That Caught My Attention – mobile, mHealth, vaccines, gaming, social media

I’m getting a little backed up in terms of articles and ideas that caught my eye so I’m going to share a few of them here.

Using Gilligan To Drive Colonoscopies

While I do applaud the creative concept here, I wasn’t overly impressed with the creative itself.  At the end of the day, the question for me is results.  Did it pay for itself?  Did it get more people to get colonoscopies (in the target audience) than otherwise would have?  I’m unsure of that.

Here’s what I did find in a HealthLeaders article…At the end of the day, I’d want to compare that to a program we did at my last company for UHG in this area.

The campaign also netted 44 colonoscopy appointments. Of those 44 appointments, 13 were current Good Samaritan patients and 31 were new to the hospital. Forty-three of the 44 scheduled an appointment through the call center and one booked online. Of those who called, 27 cited the radio spot as how they found out about the service. More than half of the patients were in the target group of 50–59 year olds, with 24 female and 20 male.

Healthcare In 2020 – Best Book I’ve Read In A Long Time

Healthcare in 2020 by Steve Jacob is a great book. Lots of facts. Lots of relevant information. A quick read. Well referenced. If I could, I would send this to every client I’ve ever worked with to help them understand why changing healthcare is so important.

I’m going to share a handful of things from the book here. Even if I could provide you with a detailed summary, I wouldn’t. You need to read this book.

  • Estimated MD shortage by 2020 is >90,000 and nurse shortage is 600,000-1M.
  • A great quote from two bioethicists (Daniel Callahan and Sherwin Nuland):
    • The medical system’s “main achievements today consist of devising ways to marginally extend the lives of the very sick … for a relatively short period of time – at considerable expense and often causing serious suffering to (the patient)”.
  • Of the 30-year increase in US average life expectancy in the last century, only 5 years can be credited to advances in medical care. The rest is from public health measures.
  • The number of people 65+ will double to 1.3B globally by 2040 and the elderly will outnumber children <5 for the first time.
  • The percentage of people who work out 12 times a month dropped from 53% in 1988 to 43% (in 2009).
  • Doctors advise only about 1/3rd of their obese patients to lose weight.
  • The most frequently reported “moderate activities” by US adults are food and drink preparation and lawn and garden care. [Not particularly high on the calorie burning schedule.]
  • Nearly 3 out of 4 cancer deaths are attributable to smoking.
  • In a 2009 report, about 75% of adults 17-24 were ineligible for the military because they had:
    • Failed to graduate high school
    • Were physically unfit or
    • Had a criminal record
  • 1 of 3 homes in US metro areas have at least one problem that can harm health:
    • Water leaks
    • Peeling paint
    • Rodent infestations
  • Cancer screenings find lots of pseudo-disease – i.e., abnormalities that meet the criteria of being cancerous but will never grow to become harmful.
  • Surveys show a lack of participation in programs:
    • ½ hadn’t been screened for colon cancer.
    • Only 7% used nurse help lines
    • <5% of people eligible used smoking cessation or weight management programs
    • 3 of 4 people didn’t get a flu shot
  • Use of decision aids has reduced rates of major elective surgery by ¼ without affecting patient outcomes or satisfaction.
  • A physician would need to practice 18 hours a day to provide all the recommended preventative and chronic disease controls to their patients.
  • A 2005 study found that nonclinical staff does the most effective job of managing patients with diabetes.
  • Per the IOM 2005 report, 30-40% of healthcare spending represented “overuse, underuse, misuse, duplication, system failures, unnecessary repetition, poor communication, and inefficiency.”
  • The FBI estimates that 3-10% of healthcare spending is lost to fraud.
  • In a research study, parents with sick children saying they had Medicaid or CHIP coverage where turned down 2/3rds of times and had to wait 22 days longer for an appointment than those with private insurance.
  • About 40 US surgeries a week are performed on the wrong person or wrong body part.
  • 1/3rd of families lost most or all of their savings because of a terminal illness.

Some scary data points. This book was a great reinforcement of some of the projects I’ve been involved with trying to accomplish the Triple Aim – Quality, Cost, Experience.

10 Healthcare Trends To Monitor in 2013

I came across the chart below and thought I would post it with my perspective on trends for next year.

  1. “Accountable Care” in the form of CMS ACOs or Patient Centered Medical Homes will continue to expand.  I predict some companies will begin to provide the infrastructure such that providers don’t have to come up with the $2-4M in capital needed.
  2. Integrated “Big Data” looking at pharmacy, medical, lab, AND patient reported data AND physician EMR data will be the rage to mine and use in predictive models. 
  3. Consumer engagement around health will continue to be a huge focus.
  4. Obesity will continue to be an issue that people struggle with and employers begin to focus more actively on managing.
  5. mHealth in the form of mobile apps, connected devices, telemedicine, and remote monitoring will begin to move from the innovators to be a more standard component of the solutions with ROIs being more standard.
  6. The core components of health reform will remain (regardless of who wins) and the shift of people from underinsured and uninsured into the insured pool will finally be the tipping point for provider access and push growth in the clinics and telemedicine (video and phone) world. 
  7. Transparency will become something that consultants begin to mandate and try to get into contracts around pricing, claims auditing, and other services across the entire healthcare spectrum.
  8. Hospitals will continue to buy physicians and look at how they can play a more dominant regional role especially outside of the urban areas. 
  9. Consolidation will continue across all areas – providers, payers, pharmacy, pharma, technology.
  10. Investment in healthcare will continue to outpace other industries. 

Should NY Hold The Marathon This Weekend? (SuperStorm Sandy)

This seems like an interesting question, but one with perhaps a straightforward answer. With NY and NJ devastated by Superstorm Sandy and almost 4M still without power, should NY try to hold their marathon this weekend? Seems like a clear no to me.

I do understand the fact that this is a big revenue event for the city.  I do understand that you want to show your ability to recover from the storm.  BUT, it takes resources – volunteers, police, hotels, food, and other efforts to pull this off.  Wouldn’t those resources be better focused on the people that are still trying to dig out of their homes and get power?


Wired Health Survey

The same Wired article had some highlights from their Wired Health Survey. Here’s a few data points that caught my attention:

  1. How many caffeinated drinks do you consume a day?
    1. 0 = 16%
    2. 1-2 = 56%
    3. 3-4 = 22%
    4. 5-6 = 4%
    5. 6+ = 2%
  2. Most popular exercise types:
    1. Walking 62%
    2. Weight training 42%
    3. Running 37%
    4. Cycling 34%
    5. Yoga 21%
    6. Swimming 18%
  3. 73% of respondents take a supplement.
  4. On average, how many hours of sleep do you get each night?
    1. 3-4 = 2%
    2. 5-6 = 39%
    3. 7-8 = 55%
    4. 9-10 = 4%
  5. 78% of respondents say that tracking their personal health metrics has helped them reach their goals. (Quantified Self) Here’s what they track:
    1. Height or weight = 64%
    2. Fitness or activity level = 46%
    3. Blood pressure = 39%
    4. Cholesterol = 33%
    5. Heart rate = 28%
    6. Vision or hearing = 26%
    7. Sleep habits = 26%

The Wired Guide To Health

I was reading Wired Magazine (Oct 2012) last night, and I came across this article “Living By Numbers: The Wired Guide To Health”. It gives “18 data-driven ways to be happier, healthier, and even a little smarter.” In my words, it’s a nice cheat sheet of some basic things we should all know (and many of which I’ve blogged about over the years).

  1. Conserve your willpower: it runs out.
  2. Shorten your workouts. (high intensity interval training)
  3. Make a sport-specific playlist. Music is the ultimate motivator. Choose your workout tunes carefully.
  4. Learn to read a scientific report.
    1. Causation versus correlation
    2. True size of the effect
    3. Statistical power
    4. Conflicts of interest
  5. Don’t ignore data.
  6. Check your genome.
  7. Sleep or else.
  8. Know whether to caffeinate or nap.
  9. Be a discerning pill popper.
  10. Eat this meal. Load your plate for maximum nutrition not maximum taste. L
  11. Beware of food trends.
  12. Do the right things at the right time. (circadian rhythms affects sports)
  13. Heighten your senses with a call of duty. (gaming can make you quicker and more focused)
  14. Get to know your poop bugs.
  15. Dial in your happiness.
  16. Avoid unnecessary procedures.
  17. Get a standing desk.
  18. Learn to live longer. (Blue Zones)

%d bloggers like this: