Archive | June, 2013

Should You Care That Obesity Is Now A Disease?

The AMA has opened an interesting discussion in the past few days with their decision to recognize obesity as a disease.  On the one hand, we all know obesity is a problem that’s impacting our overall health and productivity across the world.  On the flip side, will this actually change anything?

Key discussion points:

  • What is a disease?
  • Is BMI a good metric to use?  If not, what should be used to measure obesity – waist?
  • How do you treat it?

Here’s a few quotes from some articles:

“Right now, physicians will treat high blood pressure, diabetes, give patients medications and say, ‘Oh you also need to lose weight,’” Khaitan told FoxNews.com. “I think (this) gives the physicians a little more credibility in pushing patients to address obesity and become healthier. It’s recognized as a disease…not just something that (because) you have poor lifestyle habits, this is your problem.”  (Fox News)

Obesity is not just a health risk but a disease. Estimates of the genetic contribution to weight gain in susceptible families range from 25—40% with a greater heritability for abdominal fat distribution of 50%1>2.  Obviously there is a major environmental effect but this genetic susceptibility alone removes this condition from a social stigma to the disease category.  (British Medical Bulletin 1997)

“The American Medical Association’s recognition that obesity is a disease carries a lot of clout,” says Samuel Klein, director of the Center for Human Nutrition at Washington University School of Medicine in St. Louis. “The most important aspect of the AMA decision is that the AMA is a respected representative of American medicine. Their opinion can influence policy makers who are in a position to do more to support interventions and research to prevent and treat obesity.”  (USA Today)

Telling all obese people that they have a disease could end up reducing their sense of control over their ability to change their diet and exercise patterns. As experience with addictions has shown, giving people the sense that they suffer from a disease that is out of their control can become self-defeating. So the disease label should be used sparingly: just as not all drinking is alcoholism, not all overeating is pathological. (Time)

Here’s a few facts from the Obesity Action Coalition:

  • In the United States, it is estimated that 93 million Americans are affected by obesity.
  • Individuals affected by obesity are at a higher risk for impaired mobility and experience a negative social stigma commonly associated with obesity.
  • Socioeconomic status plays a significant role in obesity. Low-income minority populations tend to experience obesity at higher rate and are more likely to be overweight.
  • In 2001, the states with the top five percentages for obesity were Mississippi, West Virginia, Michigan, Kentucky and Indiana.
  • Almost 112,000 annual deaths are attributable to obesity.
  • In the United States, 40 percent of adults do not participate in any leisure-time physical activity.

Here’s also a few things you might not realize about obesity from Yale:

  • Finding 1: Obesity can raise some cancer risks
  • Finding 2: Obesity is tied to heart attacks in younger adults
  • Finding 3: Obesity can ruin your day
  • Finding 4: Obesity speeds up girls’ puberty
  • Finding 5: Obesity is a cause of diabetes in kids
  • Finding 6: Obesity in middle age increases risk for dementia

Let me give my hypotheses on why this might matter:

  1. In theory, this is supposed to increase the likelihood that physician’s talk about obesity with their patients.  This would be great, but I think most research shows physician’s aren’t prepared or comfortable with this discussion.  Will the fact that it’s a disease make this easier?  Maybe.
  2. This may be a boon for the obesity Rx market (assuming any of them work and have minimal side effects).  Physician’s may be much more likely to write an Rx for a disease than a lifestyle issue.
  3. This may help get obesity Rxs and bariatric surgery to be covered by health insurance.  The downside of this is that more people may not actually change behavior (diet, exercise, sleep) but instead look for a “quick” fix through drugs and surgery.

In my mind, there is a best case scenario here:

  • Calling it a disease drives awareness among the healthcare community.
  • This increases investment in resources to treat obesity.
  • Treatment is viewed more like mental health to include drugs and behavioral therapy.
  • Physician’s get trained on the disease.
  • Pharma details physicians on the disease and creates CME programs.
  • Patients start to take this more seriously.
  • Plans cover obesity – insurers, employers, CMS.
  • Obesity becomes a broad program including diet, exercise, coaching, Rx, and bariatric surgery following a progressive approach to treatment tied to your starting point.
  • Companies link incentives to managing weight.
  • New metrics are designed that are better than obesity.

Of course, one of the more recent articles which was depressing on this topic was that exercising regularly may not overcome the impact of sitting the rest of the day.  That makes it very hard to increase caloric burn while having a job that requires lots of desk, computer, and meeting time.

Costs Of Obesity In America

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Presentation – 2nd Annual Bio/Pharma Retail Summit – Discount

I’m excited to be presenting in the Fall with Adam Fein and lots of other great speakers at the 2nd Bio/Pharma Retail Strategy Summit to be held September 18-19 in Philadelphia, PA.  

I get to talk about one of my favorite topics which is how health reform is driving change in the industry and enabling new opportunities for the pharmacy / pharmacist.  

You get to listen to me for 90-minutes so I’m hoping to find some great examples, data, and insights to get you thinking hard about your business and the white space here.  I hope to see some of you there.  If interested, I’m passing on a discount code they offered to me as faculty.

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Why The Cigna PBM Deal With Catamaran Is Relevant?

Not a big shock to anyone, but Cigna announced yesterday that they were signing a 10-year deal with Catamaran (formerly SXC) to outsource the operations of their pharmacy (PBM) business.  (see WSJ article or the story on Adam Fein’s blog)

This PBM industry has been full of change over the past 5 years as I’ve discussed many times.  So, the question is why is this deal relevant or just another yawner.

Let me give a few reasons:

  1. This is the 3rd big managed care company (Aetna, Wellpoint, Cigna) to decide to create this type of long term relationship with one of the big PBMs.  They each picked a different one.  (Aetna/CVS, Wellpoint/Express, Cigna/Catamaran)  United brought their business in-house from Medco, and Humana has continued to expand their pharmacy business.  
  2. Eric Elliott (former head of Cigna’s PBM and now head of Prime Therapeutics PBM) and Dan Haron (current head of Cigna’s PBM) are both very smart executives who I believe saw lots of value in the integrated PBM story.

So, if I read between the lines here, I come to a few quick thoughts:

  1. Are they all structuring long term deals that get them through this reform period and minimize risk, but give them the chance to bring this back in house after this settles down?  
  2. Could this symbolize a further repositioning and commoditizing of the PBM industry that all of these companies want to retain marketing, engagement, strategy, and formulary but outsource call center, operations, contracting, network management, and other tasks?  Would this further accelerate a “race to the bottom” on price that I’ve talked about before?
  3. Does this have implications to specialty pharmacy?  Will that become split into two different businesses – operations versus clinical care?  (more on that later)
  4. I don’t know the bidding here, but scale used to matter a lot.  If CVS and Express Scripts didn’t aggressively bid for this contract, that might imply a point of diminishing returns in terms of scale.  (which I clearly believe exists)
  5. Under what circumstances does the integrated model work (i.e., what does Humana, United, and Kaiser see differently) or will all the payers look to outsource certain tasks to the big PBMs?

The interesting times in the industry continue.  It’s a head scratcher of what comes next!

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Pharmacy Non-Adherence Infographic

While I’ve moved most of the infographics I find to my Pinterest account, I wanted to capture and share this one from Stephen Wilkin’s blog since it hits so many of the points that I try to make with people.

patient-non-compliance-infographic3

The Role Of Healthcare Technology Curator

When I worked as an IT consultant, you had two clear choices – an enterprise system (e.g., SAP) or a best-of-breed (BOB) strategy.  People liked the simplicity of an enterprise system, but you may have sub-optimized reporting or some flexibility in your solution.  On the other hand, the BOB strategy required more maintenance, effort, and coordination to pull it off in a coordinated fashion.

In today’s healthcare world, I look at and meet with a ton of technology companies.  The struggle is how to keep up with all the change in the industry and be nimble enough to engage the new start-up, but flexible enough to evolve with the market without impacting the consumer experience.

Maybe it draws on my training as an architect, but I was describing my technology vision as one of a general contractor.  The buyer (client) wants a BOB solution.  They want everything optimized – data, reporting, workflow, content, mobile, clinical algorithms, etc.  At the same time, they often underestimate what it takes to manage all of these vendors, integrate the data on the backend, and create an integrated consumer experience across multiple vendors and technology platforms.

That’s where I see some real value add as a “technology curator”.  I see one of my roles in helping manage an evolving ecosystem of healthcare companies and working with a flexible technology platform that can quickly plug and play with different solutions.  This also allows me to have pre-built integrations with certain solutions, but I can also offer consumers the ability to choose their device (for example) and with the right API set up just be device agnostic in my solution.

Over time, this offers clients a lot of flexibility.  The get the BOB approach within an enterprise system environment.  They don’t have to keep issuing RFPs and evaluating vendors (since we’re doing that).  They don’t have to stitch together multiple data sets to create the integrated, longitudinal view of the consumer (since we’re doing that).  They don’t have to pretend that they’re offering a cohesive consumer experience (since we’re doing that).  And, most importantly, they are flexible over time to jump from solution to solution within the architecture without disrupting everyone since it’s behind the “presentation layer” that the consumer experiences.

MTM is like Population Health Management

I saw this quote of the day in Drug Benefit News, and it made me think about all the discussions I’ve been having around population health management and the need for a longitudinal patient record and integrated member experience.

Medication therapy management (MTM) at its core is viewing “the member in its entirety and not as individual activities…and looking at all of those things around medications for that patient. You can have the best programs in the world but if the patient is not engaged, they are a waste of time and energy, and that’s why an integrated activity like MTM has the opportunity to be so significantly effective.”

– Jan Berger, M.D., chief medical officer at Silverlink Communications, Inc.

 

Click here to read the DRUG BENEFIT NEWS article in which this quote appeared.

The #QuantifiedSelf and “Walking Interview”

If you haven’t heard, “sitting is the new smoking” in terms of health status.  And, unfortunately, you can’t just get up and exercise for an hour and then go sit all day.  That brief spurt of exercise doesn’t change the fact that we sit for 9+ hours a day.

If you think about our shift in work from a very manual work environment to a service and technology work environment, we’ve made activity during the day harder and harder to achieve.  Between e-mail and meetings, most of us are stagnant to accomplish our work.

That got me thinking about the #QuantifiedSelf movement and all of the activity trackers (e.g., FitBit, BodyMedia).  We know companies definitely look online to see people’s social media activity as part of the interview process.  Will they begin to ask about their activity data as a proxy for health?

On the flipside, perhaps the person interviewing should really be asking to see their potential boss’ activity data.  I’d be as interested in knowing what happens during the day.  It would provide a lot of insight into what happens in terms of meetings, face-t0-face activity, and be a good proxy for the real work experience.

Of course, the other option would be to introduce “walking interviews”.  People talk about walking meetings.  I’ve even done a running meeting going for a jog with a potential partner to discuss how we work together.  (It was the only time we could find to meet at a conference.)

Walking interviews would tell you a lot about someone’s health.  You could go up some stairs.  You could walk a few miles in an hour.

Since we know that health, happiness, and wealth are all correlated, this type of insight for the interviewer and interviewee seems very valuable.

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