Archive | February, 2013

A Web Strategy Is NOT A Digital Strategy

February 26, 2013 by George Van Antwerp 0 Comments

I was monitoring a pharma conference over in Europe this morning.  I found a few of the dialogues really interesting.  One of them was about a company creating all these websites to allow consumers to engage with them.  There was then some debate.

On the on hand, I can agree that you can do some creative things with the channel, and therefore, I should be too down on someone who is very web centric.  (i.e., focus on the strategy)  On the other hand, digital is much bigger than web.

I’m sure there’s a lot of views here, but let me share mine in terms of what to consider from a digital strategy:

  • A website or series of sites along with a mobile web optimization for devices
  • Search engine optimization
  • Social (e.g., Facebook, Google+)
  • Communities
  • Video
  • Mobile apps
  • Device integration (e.g., BodyMedia)
  • Software integration (e.g., EMRs, PHRs)
  • Blogging
  • Twitter
  • Gamification
  • Telehealth
  • Remote monitoring
  • Big Data
  • Predictive algorithms
  • Location based services (e.g., FourSquare)
  • Use of SMS

While there are a lot of complicated images out there trying to show everything around digital strategy, I found this one pretty simple and concise.

Digital Strategy

Healthcare, Innovation, Leadership, Marketing / Communications, mHealth, Social Media, Technology
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Is Healthcare An Investment Or A Cost?

February 26, 2013 by George Van Antwerp 0 Comments

As I’ve been looking at the employer view of healthcare, it strikes me that there are two different fundamental approaches.

  1. Healthcare expenses are a cost.  We want to drive down the costs as much as possible.
  2. Healthcare is an investment in our human capital.  We want to optimize our spend with the best outcomes.

Unfortunately, this likely means that the most vulnerable population is disadvantaged in this model (i.e., the hourly worker who is in a job where they are easily interchanged with another employee).

But, for companies where their biggest asset is their people (e.g., Microsoft), it seems clear that they would want to focus on healthcare as an investment.

This might drive you to make different decisions.

  • What if you looked at your formulary (for medications) based on side effects not necessarily costs?
  • What if you were willing to pay more for drugs with a clear impact on productivity (e.g., no drowsiness)?
  • Would you pay more for facilities that were better able to get people back to work?
  • Would you really push people into high deductible plans when this forces them to spend more time figuring out the system and navigating it?
  • Would you provide them all with devices to help them manage their healthcare?
  • Would you hire health advocates to help them navigate the system?
  • Would you provide them all with second opinions for major diseases (e.g., cancer) at no additional out-of-pocket costs?
  • Would you make sure to implement a telehealth solution so they weren’t away from the office as much?
  • Would you provide them with an onsite gym?
  • Would you provide them with healthy food onsite?

It seems like you would look at these types of decisions differently.  It wouldn’t be about the lowest healthcare premium.  It wouldn’t be about pushing them to a limited network.  It wouldn’t be about limiting their choice.  It wouldn’t be about shifting costs.  It would be about guiding them to make choices that kept them happy, productive, and engaged so that they could do the best work for you.

This would involve addressing stress.  It would involve addressing sleep patterns.  It would involve helping them create a work-life balance.

General Thoughts, Healthcare, Leadership, Value Propositions

Body Peace Treaty As Mentioned On Biggest Loser

February 24, 2013 by George Van Antwerp 0 Comments

I was finally catching up on my Biggest Loser shows yesterday.  They talked about the Body Peace Treaty from Seventeen magazine. Not something I read, but there are some good points in the treaty.  Here are a few for you.

  • Do the little things that will keep my body healthy, like walking instead of hanging on the couch, or drinking water rather than something sugary.
  • Appreciate what makes my body different from anyone else’s. I love that I’m unique on the inside, I will try to feel that way about the outside too!
  • Support my friends, who just like me, have their own body issues. Hey, we’re all in this together!
  • Remember that the sun will still rise tomorrow even if I had one too many slices of pizza or an extra scoop of ice cream tonight.
  • Quit judging a person solely by how his or her body looks — even if it seems harmless — because I’d never want anyone to do that to me.
  • Remind myself that what you see isn’t always what you get on TV and in ads — it takes a lot of airbrushing, dieting, money, and work to look like that.
  • Respect my body by feeding it well, working up a sweat when it needs it, and knowing when to give it a break.
  • Realize that the mirror can reflect only what’s on the surface of me, not who I am inside.
  • Not let my size define me. It’s far better to focus on how awesome I look in my jeans than the number on the tag.
  • Surround myself with positive people. True friends are there to lift me up when I’m feeling low and won’t bring me down with criticism, body bashing, or gossip.

So, while some of the things on the list may be more biased towards young women, the fundamentals are the same for all of us.

Books / Articles, exercise, Healthcare
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10 Lessons Learned From Losing Weight

February 22, 2013 by George Van Antwerp 0 Comments

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This is the 3rd time in my life that I’ve lost over 10% of my body weight.  I’ve tried it with all exercise.  I’ve tried it with all diet changes.  And, this time, I think I’ve gotten smarter and am doing it with a combination of both thanks to technology which is helping me to track calories in and out.  I try to work towards a 500 calorie deficit every day.

With that in mind, here’s a few lessons learned.

  1. It doesn’t ever really get easier, but it can become a habit (e.g., running) and the norm (e.g., eating better).  It’s a lifestyle not an event.
  2. You eat more calories than you think.  It’s all about Eat This Not That.  (e.g., the blueberry bagel I ate the other day had more calories than a Dunkin Donuts donut.)  A lot of this happens with bread and rolls and to share a quote I heard the other day – “The whiter the bread, the sooner you’re dead.”
  3. Food is tied up in all our holidays and celebrations.  (e.g., celebrating with cake and ice cream, neighborhood BBQ, holiday dinner)  You need to learn to take part in these and then burn some extra calories or enjoy in moderation.  You will be very frustrated if everything is about denial and not having access to these foods.  As I heard a clinician address this question earlier this week, it’s better to be good 360 days a year than to feel like you’ve failed when you participate in these holiday events.
  4. Losing weight isn’t just about food and exercise…it’s mental about your attitude.  (e.g., do you stress eat and what will you do in the future?)
  5. It’s worth it, but it’s hard work.  I look back at my time doing the Insanity workout and their advertisements.  I think they make the point that you have to work hard to get results.  (and it’s one of the hardest workouts that I’ve ever tried…and couldn’t finish.)
  6. You can’t change if everyone around you isn’t changing.  Weight is tied into your social circle as many examples have shown.
  7. It takes a while for people to recognize your weight loss so keep yourself motivated with an end goal.  And, make sure to set reasonable goals (e.g., 1-2 lbs a week).  Unless you’re on the Biggest Loser and can work out 3 hours+ a day with a controlled diet, you’re not necessarily going to make huge drops each week.
  8. Technology can help whether it’s BodyMedia, FitBit, Nike Fuel, or one of the many other solutions that are out there.  I’d also add both the idea of a device with a tool for tracking calories (food diary).
  9. Weight loss is tied in with sleep so make sure you get your sleep on a regular basis or you’ll mess up all your efforts.
  10. Travel with healthy snacks since you’ll end up somewhere hungry and be stuck going to fast food or grabbing the candy bar if you don’t have something with you.

 

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exercise, Healthcare

2013 PBMI Presentation On Pharmacy Need To Shift To Value Focus

February 19, 2013 by George Van Antwerp 0 Comments

Today, I’m giving my presentation at the PBMI conference in Las Vegas.  This year, I choose to focus on the idea of shifting from fee-for-service to value-based contracting.  People talk about this relative to ACOs (Accountable Care Organizations) and PCMHs (Patient Centered Medical Homes) from a provider perspective.  There have been several groups such as the Center For Health Value Innovation and others thinking about this for year, but in general, this is mostly a concept.  That being said, I think it’s time for the industry to grab the bull by the horns and force change.

If the PBM industry doesn’t disintermediate itself (to be extreme) then someone will come in and do it for them but per an older post, this ability to adapt is key for the industry.  While the industry may feel “too big to fail”, I’m not sure I agree.  If you listened the to the Walgreens / Boots investor call last week or saw some of things that captive PBMs and other data companies are trying to do, there are lots of bites at the apple.  That being said, I’m not selling my PBM stocks yet.

So, today I’m giving the attached presentation to facilitate this discussion.  I’ve also pre-scheduled some of my tweets to highlight key points (see summary below).

 

Planned PBMI Tweets

Books / Articles, Care Management, Healthcare, inVentiv Health, Marketing / Communications, mHealth, PBM / Pharmacy, Technology, Value Propositions
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59% Of MDs Want To Know About Employer Care Mgmt Efforts

February 12, 2013 by George Van Antwerp 0 Comments

I just came across this survey data from January of 2010 where the Midwest Business Group on Health (MBGH) did a survey of physicians. I found it really interesting. Let me pull out a few points with some comments…

  • 72% of physicians agree that employers should have a role in improving and maintaining the health of their employees with chronic disease. [Since they ultimately are the one paying the bill, this seems like a reasonable expectation in today’s world.]
  • 59% believe that they should be informed about employer efforts to help their patients manage chronic conditions. [This is increasingly becoming important as we move from a Fee-For-Service (FFS) world to a value-based or outcomes-based healthcare environment.]
  • 46% agree that employers should have a role in helping employees adhere to their medication and treatment regimes. [Since MDs generally don’t view this as their task, if it’s not someone acting on behalf of the employer, I wonder who they think should be doing this.]
  • 32% agree that employers should play no role in the health of patients. [With healthcare impacting productivity and global competitiveness, I think this is an unreasonable expectation.]
  • 61% want the employer to provide physicians with information on what is available to patients so they can counsel them on the value of participation. [How would they want this information and what would they do with it?]
  • 49% would like to receive workplace clinical screening results to reduce redundancies in testing. [Do the other 51% want duplicative testing?]
  • 48% want to receive actionable reports (e.g., screening results, health coaching reports) to support them in treating patients. [I would hope so. If the employer (or really their proxy) is managing the patient in a chronic program, why wouldn’t the physician want this data?]
The study went on to say that physician’s want employers to provide support around weight loss, smoking cessation, flu shots, and other broad programs. They also want the employer to focus on lifestyle change and health improvement not the chronic disease itself. This makes sense, but in general employees are more focused on trusted information coming from their physician not their employer so there’s a clear gap here. (See graph from Aon Hewitt’s 2011 Health Care Survey, New Paths. New Approaches.)
Books / Articles, Care Management, Healthcare, Leadership, Managed Care, Marketing / Communications, Research, Technology
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Only 50% Of Healthcare Companies Respond To Twitter Messages – Test Results

February 11, 2013 by George Van Antwerp 1 Comment

12 Of 23 Companies

As I mentioned a few weeks ago (2/2/13), I wanted to test and see if healthcare companies would respond to consumers via Twitter. To test this, I posted a fairly general question or message on Twitter to see the response (see below). Of the 23 companies that I sent a message to, only 12 of them ever responded even after 6 of them received a 2nd message. Those results are shared below. What I also wanted to look at was the average time to respond along with which group was more likely to respond.

  • PBMs – All of the 3 PBMs that I reached out to responded. (This could be biased by my involvement in this space since two of them e-mailed me directly once I posted a comment.)
  • Pharmacies – Only 2 of the 4 retail pharmacies that I reached out to responded.
  • Disease Management Companies – Only 1 of the 3 that I reached out to responded. (I was surprised since Alere often thanks me for RT (re-tweeting) them, but didn’t respond to my inquiry.)
  • Managed Care – 5 of the 7 companies that I reached out to responded. (For Kaiser, they responded once I changed from @KPNewscenter to @KPThrive.)
  • Health Apps or Devices – Only 1 of the 5 companies that I reached out to responded. (This continues to surprise me. I’ve mentioned @FitBit on my blog and in Twitter numerous times without any response or comment.)
  • Pharmaceutical Manufacturers – Only 1 of the 3 companies that I reached out to responded. (This doesn’t surprise me since they are very careful about social media. @SanofiUS seems to be part of the team that has been pushing the envelope, and they were the ones to respond. I thought about Tweeting the brands thinking that those might be monitored more closely, but I didn’t.)

I will admit to being surprised. I’m sure all of these companies monitor social media so I’m not sure what leads to the lack of response. [I guess I could give them the out that I clearly indicated it was a test and provided a link to my blog so they could have chosen not to respond.]

Regardless, I learned several things:

  1. Some companies have a different Twitter handle for managing customer service.
    1. @ExpressRxHelp
    2. @AetnaHelp
    3. @KPMemberService
  2. Some companies ask you to e-mail them and provide an e-mail.
  3. Some companies tell you to DM (direct message) them to start a dialogue.

From a time perspective, I have to give kudos to the Prime Therapeutics team that responded in a record 2 minutes. Otherwise, here’s a breakout of the times by company with clusters in the first day and approximately 2 days later.

Company

Response Time (Hrs:Min)
Prime Therapeutics

0:02
Aetna

1:12
LoseIt

1:19
Healthways

2:07
Walmart

3:01
Express Scripts

8:35
Kaiser

29:22
BCBSIL

47:32
OptumRx

47:39
BCBSLA

48:18
Sanofi

53:30

I guess one could ask the question of whether to engage consumers via Twitter or simply use the channel more as a push messaging strategy. The reality is that consumers want to engage where they are, and there are a lot of people using Twitter. While it might not be the best way to have a personal discussion around PHI (Protected Health Information) given HIPAA, it certainly seems like a channel that you want to monitor and respond to. It gives you a way to route people to a particular phone number, e-mail, or support process.

As Dave Chase said in his Forbes article “Patient engagement is the blockbuster drug of the century”, this is critical for healthcare companies to figure out.

The CVS Caremark team told me that they actively monitor these channels and engage with people directly. I also talked with one of the people on the Express Scripts social monitoring team who told me that they primarily use social media to disseminate thought leadership and research, but that they actively try to engage with any member who has an actionable complaint. They want to be where the audience is and to quickly take the discussion offline.

If you want to see the questions I asked along with the responses, I’ve posted them below…

Consumerism, Healthcare, Managed Care, Marketing / Communications, Methodology, mHealth, PBM / Pharmacy, Research, Social Media, Technology
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The Prescribing Apps ERA – Will Clinicians Be Ready? #mHealth

February 7, 2013 by George Van Antwerp 1 Comment

Dr. Kraft (@daniel_kraft) recently spoke at FutureMed and talked about the prescribing apps era.  I’ve talked about this concept many times, and I agree that we are rapidly moving in that direction.  And, there’s lots of buzz about whether apps will change behavior and how soon we’ll see “clinical trials” or published data to prove this.

From this site, you can get a recap, but here are the key points that he made:

1) Mobile Phones (quantified self) are becoming constant monitoring devices that create feedback loops which help individuals lead a healthy lifestyle.  Examples include; monitoring glucose levels, blood pressure levels, stress levels, temperature, calories burned, heart rate, arrythmias. Gathering all this information can potentially help the patient make lifestyle changes to avoid a complication, decrease progression of a particular disease, and have quality information regarding his physical emotional state for their physician to tailor his treatment in a more efficient manner.

2) The App prescription ERA:  Just as we prescribe medications prescribing apps to patients will be the future. The reason why this is important is that apps created for particular cases can help the patients understand their disease better and empower them to take better control.

3) Gamification: using games in order to change lifestyle, habits, have been mentioned before. A very interesting concept was that created in the Hope Labs of Stanford. The labs created a game in which children would receive points after there therapeutic regiment, once points were optioned they could shoot and attack the tumor. Helping with the compliance rate of the treatments

4) Lab on a chip and point of care testing

5) Artificial Intelligence like Watson and its application in medicine.

6) Procedure Simulation: Several procedures done by medical professionals follow (not 100%) a see one, do one teach one scenario.  Probably very few people agree with this concept and that is why simulation has great potential. In this case residents, fellows in training can see one, simulate many and then when comfortable do one.

7) Social Networks and Augmented Reality

At the same time, a recent ePocrates study hammered home the point that while this is taking off physicians don’t have a mechanism for which ones to recommend and why.

According to the Epocrates survey, more than 40 percent of physicians are recommending apps to their patients. In terms of the apps being recommended, 72 percent are for patient education, 57 percent are lifestyle change tools, 37 percent are for drug information, 37 percent are for chronic disease management, 24 percent are for medical adherence and 11 percent are to connect the patient to an electronic health record portal.

Physicians also have several different sources for identifying which apps to recommend to their patients. According to the survey, 41 percent get advice from a friend or colleague, while 38 percent use an app store, another 38 percent use an Internet search engine, 23 percent learn of an app from another patient or patients, and 21 percent use the app themselves.

That said, the survey also notes that more than half of the physicians contacted said they don’t know which apps are “good to share.”

As I’ve discussed before, this is somewhat of the Wild West.  Patients are buying and downloading apps based on what they learn about.  They’d love for physicians, nurses, pharmacists, and other trusted sources to help them.  But, those clinicians are often not technology savvy (or at least many of the ones who are actively practicing).  There are exceptions to the norm and those are the ones in the news and speaking at conferences.

IMHO…consumers want to know the following:

  1. Which apps make sense for me based on my condition?
  2. Will that app be relevant as I move from newly diagnosed to maintenance?
  3. Should I pay for an app or stick with the free version?
  4. Is my data secure?
  5. Will this app allow me to share data with my caregiver or case manager?
  6. Will this app have an open API for integration with my other apps or devices?
  7. Is it intuitive to use?
  8. Will this company be around or will I be able to port my data to another app if the company goes away?
  9. Is the information clinically sound?
  10. Is the content consumer friendly?
  11. Is it easy to use?
  12. Is there an escalation path if I need help with clinical information?
  13. Will my employer or health plan pay for it for me?
  14. Is my data secure?

And, employers and payers also have lots of questions (on top of many of the ones above):

  1. Is this tool effective in changing behavior?
  2. Should I promote any apps to my members?
  3. Should I pay for the apps?
  4. How should I integrate them into my care system?
  5. Do my staff need to have them, use them, and be able to discuss them with the patient?  (Do they do that today with their member portal?)

mhealth_infographic_large

Books / Articles, Business Tools, Consumerism, Healthcare, Infographic, Innovation, Leadership, Managed Care, Marketing / Communications, mHealth, Research, Social Media, Software, Technology, Value Propositions
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Less Than 1/3rd Of Health Insurers Very Confident In Their Big Data Value To Consumers

February 6, 2013 by George Van Antwerp 0 Comments

With all the discussions these days on Big Data and how to use information to create insights and wisdom, I was really shocked when I looked back at this PWC survey from 2011.  In it, less than 1/3rd of health insurers were very confident in their use of informatics to add value around case management, disease management, wellness, and consumer health tools.  WHAT???

This seems crazy to me.  In this interconnected world where everyone is talking about connected devices, mHealth, and ENGAGEMENT, health insurers are in the optimal position to leverage their data to provide insights, to provide transparency, to create algorithms, to be preventative in their actions, etc.  Maybe their technology platforms are too old?  Maybe they’re too silo’d?  I’m not sure.  But, I find this an interesting arbitrage opportunity.

With a system that integrates data from claims, labs, patient reported sources, HRAs, and biometrics, you can add value by creating a personalized patient experience that adapts with their needs.

Clinical Informations for Care Mgmt

Care Management, Healthcare, Marketing / Communications, Methodology, Research
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Two Examples Of How Healthcare Is Going Local

February 6, 2013 by George Van Antwerp 3 Comments

I remember when I first started working in the healthcare industry in 1998, people kept reinforcing for me that “Healthcare is Local”.  As we move into a national effort to transform healthcare, the question is how will healthcare transform to gain scale efficiencies while still taking advantage of this simple reality.

With that in mind, I found a WSJ article today about hospitals trying house calls very interesting.  It talks about how insurers and health systems are using the old fashion model of house calls to engage patients to reduce re-admissions and improve outcomes…while lowering costs.  Since healthcare costs are massively concentrated with 1% of patients driving 22% of healthcare costs, this becomes possible.  Additionally, as you focus .  on people at high risk based on some model like the Johns Hopkins ACG model or people who have been recently discharged or people with multiple co-morbidities and other risk factors, you have a chance to make a difference.  It will be interesting to see how this takes off.

Another example of how healthcare is going local is the use of health apps.  I saw a number earlier today where someone was saying there’s now 50,000 health apps.  I usually talk about 16,000, but it’s obviously going up all the time.  Employee Benefit News recently had an article about how health apps were changing the engagement rates for wellness programs.  Obviously, the phone is the ultimate in local allowing the creation of an app that’s with us all the time and can be real-time in terms of interactivity.

Books / Articles, Healthcare, Research

Wellness In The Workplace – Optum Research

February 6, 2013 by George Van Antwerp 0 Comments

I found a summary of this Optum Study – Wellness In The Workplace in the January 2013 Employee Benefit News:

  • 56% of companies (surveyed) have a formal, written strategic plan for wellness
  • 28% of companies have an onsite clinic
  • 49% of eligible employees participate in company wellness programs (seems really high to me)
  • 90% of companies with 3,000+ employees say wellness solutions are an important part of their benefits (compared with 79% of employers with 2-99 employees)
  • 83% of companies use coaching to address weigh management
  • The top barriers to employee participation are:
    • Lack of time / energy
    • Lack of interest
    • Effective communications
  • 52% of companies offer wellness programs to employee’s family members
  • Onsite clinics are offering:
    • 77% flu shots
    • 56% wellness communications
    • 43% fitness challenges
    • 42% preventative care
    • 41% health risk assessments

wellness participation

Books / Articles, Healthcare, Marketing / Communications, Research

Would A Robot Therapist Solve Your Problem?

February 5, 2013 by George Van Antwerp 0 Comments

Wired had an article recently about how robots are replacing people over time.  The article talked about TUG which is a robot used in hospitals.  It also mentioned MindMentor.com which it called the site of the world’s first robot therapist.  Interestingly, it says that after a 1-2 hour session, that 47% of patients said that their problems were solved.  From the 2008 article, it sounds like there’s some opportunities for improvement in terms of NLP, avatars, and other technologies.

That seems high.  I would think it would take more sessions.  Additionally, I would think that people don’t get their problems solved that easily.

While this solution is on sabatical (due to lack of funding), the article went on to talk about USC’s Bandit robot for kids with autism.

Healthcare, Innovation, Research, Technology

Healthcare Companies On The 100 Best Companies To Work For

February 5, 2013 by George Van Antwerp 0 Comments

Here’s a list of the Healthcare companies that were on the 2013 “100 Best Companies To Work For” list by Fortune.

  • #3 – CHG Healthcare Services
  • #17 – REI (although more of a retail company from the traditional view)
  • #20 – Millennium
  • #21 – W.L. Gore
  • #32 – JM Family Enterprises
  • #36 – Genentech
  • #39 – Meridian Health
  • #41 – Mayo Clinic
  • #43 – Scripps Health
  • #46 – Children’s Healthcare of Atlanta
  • #48 – Novo Nordisk
  • #49 – Atlantic Health System
  • #52 – St. Jude Children’s Research Hospital
  • #58 – The Everett Clinic
  • #61 – Stryker
  • #67 – The Methodist Hospital System
  • #69 – OhioHealth
  • #76 – Baptist Health South Florida
  • #89 – Roche Diagnostics

Given how much healthcare companies should know about the importance of workplace satisfaction and it’s correlation with overall health (less stress), healthcare costs, and overall presenteeism and absenteeism, I personally would expect more on the list.

Books / Articles, Healthcare

Guest Post: The Reality Of Health Insurance Exchanges

February 4, 2013 by George Van Antwerp 0 Comments

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The legislation has passed and the legal challenges are, for all intents and purposes, exhausted. It’s time for American businesses and individuals to start dealing with the reality that the Patient Protection and Affordable Care Act, also known as ObamaCare, is now the law of the land.

Health Insurance Exchanges

One of the most important provisions of the PPACA created state and federal health insurance exchanges, online marketplaces that will offer people and businesses the opportunity to shop for health insurance plans on the Internet and choose the plan and premiums that fit their needs. They will be able to start buying insurance on Oct. 1, 2013, but the plans won’t go into effect until Jan. 1, 2014. And, if all goes according to White House predictions, the exchanges will help individuals and small businesses shop for insurance coverage and get a better deal than they’ve been able to garner in the past.

In fact, the federal government will subsidize health insurance premiums for many Americans. For instance, Washington will pay for part of your premiums if your annual income is between $15,302 and $46,021 for an individual and from $31,155 to $93,700 for a family of four. Those who earn less than $15,302 probably qualify for Medicaid, which is not available through the health insurance exchanges. At the same time, if you currently have high-end coverage, holding on to it may cost you big time in the form of taxes.

Depending on your point of view, the health insurance exchanges will either fuel competition among insurance companies and increase the size of the insurance pool, which will in turn make insurance more affordable and more accessible, or the exchanges will burden American taxpayers and the country’s economy as a whole with ever-increasing health care costs.

Financial Sense

If you own a business, you’ll have to decide what makes more financial sense: providing your employees with some type of health insurance plan or letting them purchase their own insurance through the newly-established health insurance exchanges.

Businesses and individuals will be able to buy one of three levels of health insurance from the exchanges. The most expensive plans will have lower deductibles, while those insured under the least expensive plans will have higher out-of-pocket costs. Deductibles will be no more than $5,950 a year for individuals and $11,900 for families. According to the White House, an estimated 23 million Americans will buy their health insurance through the exchanges.

Health Plans Will Cover…

All plans sold under the health insurance exchanges will cover:

  • Emergency services;
  • Hospitalization;
  • Maternity and newborn care;
  • Mental health and substance abuse services, including behavioral health treatment;
  • Prescription drugs;
  • Rehabilitative services and devices;
  • Preventive and wellness services, as well as chronic disease management;
  • Pediatric services, including oral and vision care.

Probably the most controversial parts of the PPACA are provisions that (1) prohibit insurance companies from denying coverage based on pre-existing conditions, and (2) permit individuals to get around the rule that they must have health insurance by paying a fine that is less costly than the insurance itself. This could mean that some people will pay the fine ñ a tax, actually, according to the Supreme Court ñ until they get sick, at which point, they will buy health insurance.

In the past, insurance companies have refused to pay for necessary health care because of pre-existing conditions. According to a study by the House Committee on Energy and Commerce, between 2007 and 2009, the nation’s four largest insurers ñ Aetna, Humana, UnitedHealth Group and WellPoint ñ rejected 212,800 claims for this reason. This will no longer be an option for insurers.

In addition, the PPACA will get rid of lifetime and annual limits on plans purchased through health insurance exchanges. This will eliminate the possibility of financial ruin for individuals ñ and the employers who insure them ñ with long-term and unusually expensive medical issues.

Who Will Run The Exchanges?

The states now have until Feb. 15, 2013 to decide whether they will set up their own health insurance exchanges. Unsure of the ultimate cost of doing so, many states have chosen to let the federal government handle that job.

As of the end of 2012, 18 states, mostly in the far West and the Northeast, had chosen to establish their own health insurance exchanges. Twenty-five states, many of them in the South and the Midwest, had decided to let the federal government operate the exchanges, while another seven states had opted for a partnership with Washington.

Regardless of who is operating the health insurance exchange in your state, the way you purchase insurance is going to change. You probably won’t know for sure who the winners and losers will be in the new world of health care until all the provisions of the Patient Protection and Affordable Care Act are implemented.

How will these new rules affect you and your family? Do you see the centralization as a good thing or a bad thing?

This post was provided by John Egan is managing editor of Insurance Quotes, a popular insurance website that provides online services to consumers seeking Auto Insurance knowledge and savings on their car insurance policies.

Guest Post, Healthcare

How Quickly Do Healthcare Companies Respond To Twitter Comments? (Test)

February 2, 2013 by George Van Antwerp 0 Comments

I was intrigued by this test done over in the UK to look at how quickly retailers responded to comments via Twitter (you can see an infographic about similar US data below).  Obviously, more and more consumers are using social media.  And, we know that comments can go viral quickly especially when they’re negative.

“A recent Spherion Staffing Services survey shows that when consumers have a good customer service experience, 47 percent are likely to tell a company representative; 17 percent will express their opinions via social media; and 15 percent will write a review. The same survey from 2010 showed that only 40 percent of consumers were likely to share a great experience with a company representative—proving that consumers are becoming more vocal with companies they interact with. If consumers have a poor experience, 36 percent are willing to write a complaint directly to the company, and one in four will express their opinions on social media. Nineteen percent, the same statistic as last year, will choose to write a review online.” (December 2011 Study)

Of course, some people actively monitor their social media feeds while others view them more as a PR channel.  It also depends on whether the feed management is outsourced or insource and whether it’s monitored by marketing, operations, customer service, sales, or some combined team.

Here’s a good post on measuring response and activity within Twitter accounts.

So, what I’ve decided to do is a Twitter test similar to the one above.  I’m going to post the following to different categories of healthcare companies and see how quickly they respond.

  1. To retail pharmacies:  Are you using social media to handle customer service?
  2. To PBMs:  Are you using social media to handle customer service?
  3. To Managed Care: Where’s the best place to find out about your Medicare products?
  4. To mHealth companies:  Can you share examples of how employers are promoting your products?
  5. To pharma:  Are you doing any value-based contracting with PBMs?
  6. To device companies:  Can you share examples of how employers are promoting your products?

Who do you think will be the fastest to respond?  Will the bigger companies simply have more resources to monitor and staff their teams or with more digital companies be more in tune with social media?

KeepingUpWithTwitter_2

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