Archive | January, 2014

Dossia: Not Just a Personal Health Record Anymore

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I had a chance to see a product demo of Dossia the other day.  I was really impressed which I don’t easily say.  I was expecting to hear a pitch on Personal Health Records (PHRs) and why they were different.  Instead, I got to see a robust patient engagement portal which did some really interesting things. (see image above from the Health 2.0 demo they gave)

From their website, here’s the “about” description which lists some very influential players…

Dossia is an organization dedicated to improving health and healthcare in America by empowering individuals to make good health decisions and become more discerning healthcare consumers. Backed by some of the largest, most respected brands in the world – Applied Materials, AT&T, BP, Cardinal Health, Intel, Pitney Bowes, Vanguard Health Systems, NantWorks and Walmart – Dossia’s founding member companies have united under the common vision of changing healthcare.

Having these companies involved over the past 6 years has been really important for them to accomplish what they’ve done.  As someone that’s worked on a lot of the same population health challenges, they’ve accomplished things that not even Google Health could do.

So what were the features and functions that really impressed me:

  1. They’ve built integration to health plans, PBMs, pharmacies, lab companies, and even EMR companies.  This creates a data rich longitudinal view of the patient for the patient.  (I like the expression on their website where they say “Dossia is the connective tissue that powers healthy change.”)
  2. They’ve incorporated health content which by itself isn’t impressive, but the content is tailored to the individual based on their medical data.  Not hard, but not something that many people do well.
  3. They’ve built out a series of partnerships and integrations with over 50 apps where you can navigate that turn them on as widgets within the portal.  This is very similar to some of the cool things that CarePass is doing.
  4. They’ve built the system out using open APIs (application programming interfaces) which allows other companies to easily integrate with them.
  5. And, probably one of the cooler things from my consumer engagement lens was their ability to do WYSIWYG rules creation to trigger outbound communications based on clinical data.  The idea of a rules engine isn’t difficult, but the ease of their solution with the integrated data makes it very powerful.

And, they’ve expanded their reporting.  They’ve pulled in ways to manage those family members for which you’re a caregiver.  They’re doing lots of interesting things.  They are definitely worth talking to if you haven’t seen them in a few years.

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Why Healthcare Needs A “Google Health”

Most people know that Google tried to jump into the healthcare space with Google Health a few years ago.  Google Health was (from Wikipedia):

Google Health was a personal health information centralization service (sometimes known as personal health record services) by Google introduced in 2008 and cancelled in 2011.  The service allowed Google users to volunteer their health records – either manually or by logging into their accounts at partnered health services providers – into the Google Health system, thereby merging potentially separate health records into one centralized Google Health profile.

Personally, if they wanted to build that, they should just go buy Dossia, and they would be there.  Looking backwards, you can read the announcement to cancel Google Health here, and there’s lots of articles out there about why it failed.

While they haven’t had a dedicated health team officially, they continue to have several health related projects:

  1. Helpouts is a video service that is HIPAA compliant meaning it could eventually compete with Teladoc, MDLive, and American Well.
  2. Calico is a newer company focused on aging which has lots of people wondering as they add well known executives to the core team.  
  3. They just came out with their smart contact lens to help diabetics test their blood sugar.
  4. Google has an app called My Tracks and an API to tap into some of the sensors in the phone that could be used for fitness apps.  
  5. Google X staff recently met with the FDA leading to some speculation.  
  6. Of course, there is also lots of discussion about how Google Glass could be used in healthcare.  (I personally think about the Checklist Manifesto as a perfect opportunity.)
  7. And, I would also point to the intelligent home (per their acquisition of Nest) as a venture which will lead them down the path of health at some point.

You could also look at the companies that Google Ventures is investing in from the health space:

I could have easily seen them investing in something like Theranos which stands to change the biometrics space.  

So…it’s not like they’re ignoring the space which isn’t unusual for many companies outside of healthcare.  Healthcare is hard.  Healthcare has lots of regulatory constraints.  In general, many companies want to avoid having to deal with some of those issues which can constrain the rest of their businesses.

But, let’s look at the critical and hot topics in healthcare right now:

  • BigData – how to use data; how to build predictive models
  • Engagement – how to personalize communications and engage consumers to take action from mass customization to segmentation to even gamification
  • Mobile and devices – how to use technology to track your steps, monitor your health, and collect data (see post about why your underwriter wants your mobile data)
  • Social – how to use social pressures and peers to create better health
  • Connectivity – how to connect devices, caregivers, pharmacies, providers, and others into a shared platform for care
  • Security – how to securely manage data
  • Transparency – collecting and aggregating pricing data to help consumers make intelligent decisions
  • User experience – creating user journeys and user interfaces to improve the overall consumer experience (perhaps changing the model like Uber (a Google Ventures investment))

Do those things sound like the competencies of any one company?  To me, they all sound like things that Google is good maybe even great at.  Additionally, the founders of Google have the big, picture and long-term vision that’s critical in healthcare.  Driving change in healthcare isn’t about meeting specific quarterly numbers.  It’s about seeing the world in a new light where you want to drive change and improve things like childhood obesity.  It doesn’t happen overnight.  

I wish I knew more about Google.  Someday, I’d love to work with them on some of these opportunities.  If so, I could see this being a perfect fit in the Google X world.  I could see them making a change as a core focus, as investors, or simply by creating enabling tools.  But, at the end of the day, this is why I think health needs Google to have a focus here.  It’s almost 20% of our GDP and something that impacts most people on a daily basis.  

Listing of Medication Adherence Solutions

It’s been a few years since I’ve worked on medication adherence solutions.  It seems to have become a big focus again in the industry both with the Medicare Star Ratings program and with all the emphasis on waste.

As I started thinking about adherence, I thought it would be good to create a list of solutions and vendors.  I couldn’t find one anywhere on the web.  So, here’s my initial list of almost 100 companies.

I’ll make this a dynamic list so please comment or send me suggestions to add.

Here’s some old posts on adherence that I think are still relevant here:

I’ve divided the list of solutions and vendors into the following:

Devices

  • Adherence Solutions LLC – develop programs to create alliances between different players, sell Dose-Alert which is a smart pill bottle cap, and provide a mobile tool
  • AdhereTech – smart pill bottles
  • Automated Security Alert – medication dispensers to complement their medical alert system
  • Biodose – electronic tray for monitoring time and day of use
  • CleverCap – smart cap for pill bottle
  • Didit – manual tracking device that attaches to a pill bottle
  • DoseCue – smart pill bottle
  • eCap – electronic compliance monitor
  • ePill – medication reminder devices
  • eTect – biocompatible tag on the pill with connectivity and a mobile solution focused on clinical trial adherence
  • iRemember – smart pill bottle cap with voice reminder and smart phone synching
  • MedCenter – monthly organizer and reminder system
  • Med-E-Lert – automated pill dispenser
  • MedMinder – automated pill dispenser
  • MedVantx – medication sampling at the physician’s office
  • Proteus – smart pill technology
  • Quand Medical – uses Near Field Communications and mobile to do medication management and reminders
  • SMRxT – smart pill bottle
  • TalkingRx – audio device attached to pill bottle
  • uBox – smart pillbox
  • Vitality GlowCap – smart pill bottle with communication programs

Mobile / Digital

  • 2Comply – patient portal with web coaching
  • ActualMeds – online medication management for consumers, caregivers, and providers
  • AI Cure Technologies – digital health solution
  • AssistMed – web and mobile based adherence solutions
  • Ayogo – social games and apps to improve engagement and adherence
  • CareSpeak – mobile solution
  • Care4Today – two-way messaging platform, app, and website
  • CellepathicRx – mobile solution
  • CloudMetRx – cloud based solution to help caregivers with medication management
  • Dosecast – mobile medication management and pill reminder
  • GenieMD – mobile medication management and reminders as part of broader solution
  • iPharmacy – mobile pill identifier, medication guide, and reminder app
  • Mango Health – mobile medication management with gamification and incentives
  • Medacheck – mobile reminder system that incorporates caregivers
  • MedCoach – mobile medication management and pill reminder
  • MedHelper – medication compliance and tracking app
  • mHealthCoach – reminder based solution creating a digital support system
  • Mscripts – mobile solution
  • MyMeds – mobile and web medication management and pill reminder solution
  • MyMedSchedule – mobile Rx management tool with reminder service
  • Nightingale – mobile solutions for reminders, engaging your physician, and notifying your caregivers
  • PillBoxie – mobile medication management and reminder app
  • PillManager – mobile medication management and pill reminder
  • PillMonitor – mobile medication reminders and logs
  • PillPhone – mobile phone solution with biometric authentication
  • Prescribe Wellness – automated, digital interventions
  • RightScript – platform to manage prescriptions through mobile reminders that connect patients, caretakers, practitioners, and health plans
  • RxCase Minder – mobile medication management
  • RxNetwork – mobile medication management and reminders with rewards
  • Quintiles – building digitally, connected communities
  • Virtusa – multi-dimensional interventions across the patient’s journey

Platform

  • Adheris – adherence suite and advanced analytics (just acquired Catalina Health) [note: they are owned by inVentiv Health who I work for]
  • Avanter – an adherence program for pharmacies in Argentina
  • Capzule – pill reminders as part of PHR
  • Dr. First – embedded tools into EHR
  • HealthPrize – platform with gamification, incentives, education, and communications
  • LDM Group – suite of compliance products
  • McKesson – sampling, coaching, coupons, and messaging
  • MediSafe – mobile medication management app and adherence platform
  • MedPal Health Solutions – platform for medication adherence solutions
  • MedSimple – medication management, pill reminders, coupons, and PAP programs
  • mHealthCoach – care collaboration platform using machine learning to personalize communications
  • Tavie – virtual nurse for improving adherence focused on several conditions

Communications

  • Ateb – multi-channel communication programs for pharmacies
  • Atlantis Healthcare – custom adherence solutions
  • Eliza – multi-channel communication programs
  • Intelecare – multi-channel adherence communications
  • MemoText – messaging platform
  • Patient Empowerment Program – medication adherence program for pharmacies
  • Pleio – adherence solutions for the first 100-days (when most people stop taking medications)
  • Silverlink – multi-channel communication programs [note: this is the company that I used to work for and still use]
  • Varolii (now Nuance) – multi-channel communication programs
  • Voxiva – web and text messaging solution
  • West – multi-channel communication programs

Big Data

Tools / Enablers

  • 5th Finger – assessment and personalization tools
  • GNS Healthcare – using data and predictive models to identify targets and fuel intervention programs
  • HumanCare Systems – creating patient and caregiver support solutions
  • Insignia (PAM) – measure of patient activation for segmentation and scoring
  • MedMonk – help pharmacists obtain funding for patients who can’t afford their out-of-pocket pharmaceutical expenses
  • MedSked – low tech, high impact labeling solution
  • Merck Adherence Estimator – screening tool available as a widget or online at Merck Engage
  • NaviNet – communications network to enable adherence
  • NCPA – toolkit and ROI calculator for pharmacies
  • ScriptYourFuture – tools and text reminders
  • Walgreens API – an application programming interface for developers to use to connect their adherence solutions to Walgreens

Medicare focused

  • Dovetail – pharmacist led programs including MTM, in-home visits, and telephonic coaching (focused on Star Ratings)
  • Mirixa – incorporated into the MTM program
  • Outcomes – data and tools as part of their MTM solution
  • Pharm MD – Medicare STARS program

Condition specific

  • GeckoCap – adherence offering for kids with asthma
  • MyRefillRx – mobile adherence app focused on high blood pressure

Packaging

Pharma

  • 90Ten Healthcare – providing adherence programs in 23 countries
  • TrialCard – voucher and co-pay programs for consumers to stop Rx abandonment
  • Triplefin – customized programs for pharma brand managers
  • Adherence Engagement Platform – a Pfizer program of adherence materials and tools (I couldn’t find it online only in hard copy)
  • RS Associate – a company working with manufacturers in India
  • Rx.com – MTM, pre-edit messaging at the POS, and print-on-demand messaging at the pharmacy

International (recommendations send to me without English sites)

What other companies am I missing?  Send them to me directly or add them in the comments section here.  Thanks.

How Do The Big PBMs Grow?

By now, the idea of a PBM and who they are is much more of a household item than it was a decade ago.  We’ve seen massive consolidation in the industry.  We’ve seen PBMs grow in the specialty PBM space.  The question I often ponder is what’s next.  Here’s some of my thoughts.

  1. Do Nothing.  Obviously, there’s a lot to be said for ongoing momentum.  The PBMs have shown growth for many years.  While the generic opportunity and the mail opportunity has slowed down, there are still opportunities in the specialty space.  
  2. Distribution. This seems like an obvious possibility.  Why not buy Cardinal, AmerisourceBergen, or someone else?  Procurement and distribution are core competencies so I think this makes some sense.  But, will that create issues in the current client list and retail pharmacies and PBMs haven’t always had the best relationships.  (E.g., Express Scripts GPO with Kroger)
  3. Pharma.  This has been debated by a few PBMs, but getting into the R&D space is risky and doesn’t build on their core competencies.  What could be more interesting would be them getting into the services space by acquiring a company like IMS or Quintiles.  
  4. International.  Several PBMs have tried this model.  In general, it hasn’t gone anywhere.  I think the international collaboration of Walgreens and Boots is really interesting and other retailers have gone international.  I don’t see this happening anytime soon with any material impact.  
  5. Physician.  Having a greater impact in the prescribing process could make a lot of sense.  I could see some interesting targets in terms of Allscripts, Cerner, or athenahealth.  This has been a challenge for years with a few ventures into the space.  (e.g., CVS Caremark and iScribe)
  6. Technology.  At the end of the day, the PBMs are large technology companies.  Could they see their way into the mHealth space?  This space is growing like crazy, and you’re seeing established players get into the remote patient monitoring space (e.g., AT&T and Qualcomm).  I could see an acquisition in this area of a telehealth company (e.g., Teladoc) or a device company (e.g., Welldoc).  Or, they could build something more organically.  On the flipside, they could look at technology platforms to open doors to care management or ACOs (e.g., Lumeris).  Alternative, I could see SoloHealth as a really interesting asset.    
  7. Retail.  With a few exceptions, I think this strategy is off the table.  I’ve loved the CVS Caremark integration for years, and I think it’s showing dividends.  Rite-Aid is probably the only big acquisition target out there.  In this space, you probably have to look at it the other way.  Would any retailers (e.g., Walmart, Walgreens, Target) buy a PBM?  Walgreens got rid of their PBM, and Walmart has said they don’t want to be in that market so I’m not sure that would go anywhere.  
  8. Insurer.  I think this one has some interesting opportunities from a Medicare perspective and from a commercial perspective.  Could PBMs create an underwritten product and take on risk?  I think yes, BUT I think that could impact their need for reserves and the way the market sees them.  That makes me think this is less likely, but possible.  
  9. Device Benefit Management.  I think several ex-PBM executives have gone out to try to build the “benefit management” concept into the healthcare marketplace in other areas (e.g., IPG).  Could an existing PBM do it and cross-sell into their base?  Perhaps.  But, a stretch.  They’re getting big so they want to buy meaningful revenue, create synergies, and then grow it.  
  10. Navigation.  The most used benefit is pharmacy.  Today, consumers touch the healthcare system most frequently through retail and their daily prescriptions.  With the ongoing complication of the health benefits, there is a huge need for navigators (and not just in the healthcare.gov use of the term).  Think about companies like Health Advocate or Accolade.
  11. Data.  With the RxAnte acquisition, it has to make you wonder about PBMs and their data assets.  How can they use them differently?  Can they create apps?  Can they create algorithms to license?  What would this look like?  What about companies like Proteus?  Perhaps, a PBM could consolidate several unique assets along the device, smart bottle, data path.
  12. Condition specific.  I could see some PBMs going deep on particular areas like oncology to really build out an oncology practice that did everything from second opinions to case management to end-of-life counseling.  Those could all wrap around the drugs.  Or, imagine them going into the chronic kidney care space by acquiring a company like DaVita.  
  13. Providers.  While there could be some interesting synergies here with a large hospital group (e.g., HCA) or some ACO/PCMH players, I see that more of a managed care play for rolling up companies.  The ROIC (Return on Invested Capital) is too different in these physical operations that I see that being a struggle.  And, I think there’s lots of concerns about the hospital needs over time.  

Which path plays out…I don’t know, but I think it’s getting close to time that you’ll see another shift in the market as they try to secure their next 10 years of growth by expanding into something that builds on their core competencies.  

I think the other question would be if they focus on differentiation by really showing material differences in outcomes and engagement rates and look at how they show an overall health ROI not just Rx specific.  That would be where I would place my bets and look at which of these options support that.  Maybe we’ll see a PBM X (like Google X) doing some strategic long-term deals to change the overall healthcare roadmap.  

Conscious Home Mash-Up – More Likely Post Google – Nest?

In case you didn’t see it, Google acquired Nest the other day.  There’s lots of interesting articles out there about how this will fit in.

It was fascinating timing as I had just written about why Google should be in this space on Saturday.  

It got me thinking about other mash-ups to get into this space.

What about Pulte Homes working with BCBS of MI, the UAW, Ford, and the Henry Ford Health System to create a long-term retirement community built around an ACO with Medicare included?  This could be a great offset for the UAW and Ford to their healthcare liabilities.  It could create new provider models for Henry Ford.  It would create new building opportunities for Pulte, and it would provide new underwriting opportunities for BCBS.  

The other question that this brings up is who else will they acquire…or will others in this space get acquired by Cisco or AT&T or others that want to create this.  

I’ve reached out to the Nest founder and some people at Google and Google X.  (I don’t know any of them.)  This seems really exciting and similar to some of my thoughts.  I’d love to learn more.  

And, perhaps with the news that some of the Google X people met with the FDA, maybe Google is figuring out a way to get back into healthcare.  Hopefully, they don’t overlook the opportunity for patient remote monitoring in the smart home.  

Why Google Should Build The Next Seaside

In 1998, I wrote my first business plan which was about technology and architecture.  At the time, I had graduated from Architecture school and was working with Sprint on a data warehousing implementation.  It got me thinking about how to create a series of connected devices and link them to an enterprise system to manage that data for a smart home.  At the time, I think people thought I was crazy.

Jump forward 15 years and it all seems to make more sense.  For example:

Now, this type of connectivity is called the Internet of Things (#IoT) which based on Wikipedia is:

“The Internet of Things (or IoT for short) refers to uniquely identifiable objects and their virtual representations in an Internet-like structure. The term Internet of Things was proposed by Kevin Ashton in 2009.[1] The concept of the Internet of Things first became popular through the Auto-ID Center at MIT and related market analysis publications.[2] Radio-frequency identification (RFID) was seen as a prerequisite for the Internet of Things in the early days. If all objects and people in daily life were equipped with identifiers, they could be managed and inventoried by computers.[3][4] Besides using RFID, the tagging of things may be achieved through such technologies as near field communication, barcodes, QR codes and digital watermarking.[5][6]

 

Equipping all objects in the world with minuscule identifying devices or machine-readable identifiers could transform daily life.[7][8] For instance, business may no longer run out of stock or generate waste products, as involved parties would know which products are required and consumed.[8] A person’s ability to interact with objects could be altered remotely based on immediate or present needs, in accordance with existing end-user agreements.[3]

According to Gartner there will be nearly 26 billion devices on the Internet of Things by 2020.[9] According to ABI Research more than 30 billion devices will be wirelessly connected to the Internet of Things (Internet of Everything) by 2020.[10] Cisco created a dynamic “connections counter” to track the estimated number of connected things from July 2013 until July 2020 (methodology included).[11] This concept, where devices connect to the internet/web via low power radio is the most active research area in IoT.”

Or, if you prefer McKinsey to Wikipedia, here’s their article about the Internet of Things:

“More objects are becoming embedded with sensors and gaining the ability to communicate. The resulting information networks promise to create new business models, improve business processes, and reduce costs and risks.”

With all the buzz about Google’s buses and catamaran’s to ship their workers to the GooglePlex, it got me thinking about them creating a smart city.  They could have their smart cars running around.  They could even create a scalable version of smart roads that re-charge the electric cars eliminating the need for charging stations.  Or maybe, this would be something for Elan Musk who has his HyperLoop vision and Tesla Motors.  This could even play into the Green (or Sustainable) Architecture effort.  I could one day imagine a home recycling station that turned your used plastic into materials that could be used in your 3D printers. 

Of course, the key is a core infrastructure that manages all of this data and starts to create algorithms for how to use it.  Image being able to log in and get information about your house, your kids, your community, and your health.  Some things are already out there and being developed.

  • Mother is a technology that summarizes all of this data and pulls it together for people to use and monitor. 
  • Twine monitors your home and provides you with information such as your garage door is left open. 
  • Ninja Sphere is another solution for controlling your home devices.
  • Thing Worx is another solution focused on this connected house.
  • Cisco has a section dedicated to the Internet of Things.
  • Qualcomm and Verizon and others are getting into the health space, and you have companies like ADT or Time Warner that are already in the home and could expand into the health space. 

The other thing that all this data drives is the need for insights.  It’s no good to have data without the ability to turn it into knowledge.  This is again something that Google knows a lot about.  Imagine having a connected team of physicians that monitor your health based on your sleep patterns, your adherence, your exercise, and other key metrics such as blood pressure.  Imagine a dietician that monitored your food and gave you ideas about how to eat better.  There are lots of ways for the data to be used in an obviously Big Brother way, but if that could be turned on and off, then we could gain the insights without having to give up all our privacy. 

But, in general, many people are willing to trade privacy for insights.  That’s what we do every day. 

This idea of the Smart Home or Connected Home or Intelligent Home got me thinking over the holidays.  I even emailed Pulte Homes and Lennar Homes to see if they were doing anything in this space.  (They didn’t respond.)  I did stumble upon Home For Life Solutions which seems to be thinking about some of this and was talking about this back in 2009 in an article about Smart Homes and Aging in Place.    I was talking to a friend on Friday, and he shared with me some very cool things that The Villages in Florida is doing to incorporate health into their community. 

I can see so many opportunities here especially around the concept of Aging in Place.  Imagine all the Baby Boomers getting older and wanting to stay in their homes.  I’m not sure what Calico is going to do, but this could be an opportunity for them.

In a recent issue of TIME, Page discussed how Calico will treat aging and related diseases. He didn’t reveal much about the methodology, but stressed that Calico’s team will “shoot for the things that are really, really important.” The goal for Calico’s research according to Page, is to help prevent many diseases and have a greater impact on public health than drugs that target individual diseases. (from MedCity News)

Of course, this is why the concept of Seaside came to me.  A small, planned community where you live, work, and play.  There is also research by the CDC on healthy sustainable communities.  And, of course, there’s the efforts to create Blue Zones as communities

Imagine if this community existed.  You would be able to create your own insurance company.  You could offer discounts.  You could do the same with life insurance.  It could be like the Snapshot from Progressive

And, there is so much more opportunity:

  • When you drive into your driveway, why can’t your garage door recognize you.  Why do you have to press a button to open the garage?
  • Why can’t my purchases at the store be tracked online so I always know what I have and what I need?
  • Why can’t a smart cookbook recommend a recipe for tonight based on what food is at home, what food’s about to expire, and what I ate for lunch to create a balanced menu and caloric mix?
  • Why can’t my devices order my prescriptions for me when I’m low?
  • Why can’t my calendar automatically reschedule my doctor’s appointment when something else comes up?
  • Why can’t my running shoes automatically order a new pair of shoes when the cushioning gets low due to too many miles? 

One day, this will all happen where our house will be smart.  It will understand what I like in terms of lighting, shows, and music.  It will tap into my devices.  And, I’ll be able to get monitored and insights that improve my life.  And, best of all, this will be done in a sustainable way that improves the environment and our quality of life. 

So…maybe I can get Google or someone else excited about this idea!  It will take someone with a big vision to change the world, but I think it’s a huge opportunity!

Design Thinking Is Critical For The Healthcare User Experience (UX)

I was watching this video of Tim Brown (CEO of IDEO) earlier this morning, and it immediately clicked with me.  The idea of design thinking is very similar to the architecture training that I had.  Perhaps that is why I’m so fascinated by the opportunity to use technology and data driven insights to improve the consumer experience in healthcare.  

I like this definition of design thinking from an HBR article on it.

“it is a discipline that uses the designer’s sensibility and methods to match people’s needs with what is technologically feasible and what a viable business strategy can convert into customer value and market opportunity.”

This graphic from the Design Thinking for Educators site (from IDEO) is another good summary.

Image

But, one of the key reasons that I want to talk about this is IDEO’s frameworks are critical for healthcare.  If you look at David Kelley from IDEO, one of his key points is that “empathy” is essential to design.  That is so true in healthcare.  It reminds me of my interview with Michael Graves on this topic.  (BTW – IDEO is the group that worked with Walgreens on their new store design.)

In general, the user experience in healthcare is horrible.  People don’t understand the system.  They don’t understand their benefits.  Data is only now beginning to be transparent (but it’s still confusing).  People can’t read and understand the information.  Their providers don’t speak in plain language.  

It’s frustrating because all of us know this is a problem, but it’s so massive to change.  I always use the Triple Aim framework to make the point that the consumer experience is critical.  Think about evaluating prescription drugs or chemotherapy.  Quality of life is really important but often overlooked.  This leads to patients getting too much care as physicians try to cure them only to perhaps make their life miserable in their last few weeks of life.  

I’m going to have to continue to learn more about design thinking and reflect on how to use it more systemically in my approach to problem solving.  

 

Interview With David Tripi – Janssen Healthcare Innovation

A few weeks ago, as a follow-up to my discussion with Aetna about CarePass, I had a chance to talk with David Tripi from Janssen Healthcare Innovation about their new solution.

David is a founding partner at Janssen Healthcare Innovation where he is part of a multi-disciplinary group working toward the goal of propelling the company to become the leader in the healthcare solution business. Prior to the launch of the JHI team, David was with Johnson & Johnson for over 15 years.

“Janssen Healthcare Innovation (JHI), an entrepreneurial group within Janssen Research & Development, LLC, develops cutting-edge health solutions designed to modernize healthcare delivery, improve patient outcomes, and create a healthier world.”  This is a 3-year old effort by Johnson & Johnson focused on integrated care businesses and enabling technologies.  To support those, medication adherence and mobile are key areas.

One thing that David stressed is that they are platform agnostic and that their Care4Today Mobile Health Manager works as both an app and via SMS.  Therefore, the 50% of the US that doesn’t have a smartphone can still use it.  Additionally, it’s not a product or drug specific solution.  You can use this even if you don’t use a J&J product.

Care4Today Care4Family

Adherence is a huge challenge that everyone is aligned around, and everyone is trying to find solutions – plan design, incentives, apps, consumer engagement, framing, behavioral economics, and smart pill bottles (to name a few).  So, what’s part of the Care4Today solution?

  • It has reminders for Rx and OTC products.
  • It has a refill reminder process which they hope to automate in the future.
  • It has a two way secure messaging platform.
  • It has images of over 20,000 pills.
  • And, they also included a caregiver strategy and an incentive option.

The idea of social health is important.  We’ve talked about this for weight loss and smoking.  But, with the expanded role of caregivers, can they play a key role in improving adherence?  For example, if you respond that you didn’t take your pill and the response goes to your caregiver, will they call you?  Will that follow-up motivate you?  (Care4Family)  Some prior research says yes.

A broader question might be about how to pick a caregiver or how to define it.  Should it just be your family?  Should it include your physician?  What if you don’t have a support system?  Could the healthcare companies or advocacy companies give you a “professional caregiver”?  What about an avatar as a caregiver?

I asked about the incentive program that they included (Care4Charity).  David pointed out that using apps isn’t fun (at least for most people) so they wanted to give a slight motivation.  I questioned him on why $0.05 (which is the daily donation if you check in and take your meds).  They did lots of research which showed that the amount didn’t really matter.  So, this is an experiment to see if this extra feature of the program will nudge people to be more adherent.  Or ultimately, it would be great to segment the population to understand who it was motivating for and for whom it didn’t matter.

One of the things I wondered about was how they were going to promote the app.  Obviously, relationships with companies like Aetna and their CarePass program are one way, but with the tens of thousands of apps out there, how will people find it?  David told me that they were going to initially focus on social media – Facebook, Twitter, and mommy blogs – to drive awareness.  Next, they’re going to use pharma reps to discuss the app with physicians and pilot this strategy in HIV.

At the time, they’d had over 55,000 consumer downloads, and they’ve already gotten some initial feedback from physicians that like the fact that they’re offering solutions that aren’t branded to a specific pharmaceutical product.  Some of those physicians are already offering it to patients.  They expect this will be a big driver.  They are now starting to talk with retail pharmacies about how to encourage consumer use.  While my initial reaction was that this would be “competitive” with the Walgreens and CVS Caremark mobile solutions, they see collaboration opportunities especially with Walgreens and their open API.

Of course, I wondered about how the app was being used, but they don’t collect PII (personally identifiable information).  In the future, they plan to offer an option for patients to opt-in to share information and create a clinic dashboard for physicians to see which patients are using it and providing them with data.  And, with a new collaboration with HealthNet, consumers will be logging into the app with their HealthNet ID which will allow them to link up PII and PHI (protected health information).

So, what’s next…

  • They’ve launched in the US and France.  They’re expanding into the UK and other countries next.
  • They’re adding Spanish in Q1-2014.
  • They’ve just completed some human factor testing which will drive some UI and UX changes.
  • They’re going to do some testing and look at results with whatever data is available.
  • They’re going to try to partner with as many people as possible.

Will it move the needle around adherence?  It’s still too early to tell.  But, it’s great to see pharma testing new strategies and working in new ways with payers to try to address this challenge.

CarePass Updates – Medication Adherence and Stress

A few weeks ago, I had a chance to follow-up with Martha Wofford, the VP of CarePass about their latest press release.  This was a quick follow-up interview to our original discussion.  As a reminder, CarePass is Aetna’s consumer facing solution (not just for individuals who they insure) which integrates mHealth tools and data to help consumers improve their engagement and ultimately health outcomes.

“Many Americans have a lower quality of life and experience preventable health issues, adding billions of dollars to the health care system, because people do not take their prescribed medications. There are a myriad of reasons why medication adherence is low and we believe removing barriers and making it easier for consumers to take their medications is important,” said Martha L. Wofford, vice president and head of CarePass from Aetna. “As we continue to add new areas to CarePass around medication adherence and stress, we seek to provide people tools to manage their whole health and hopefully help people shift from thinking about health care to taking care of their health.”   (from press release)

As part of this update, we talked about one of my favorite topics – medication adherence.  Obviously, this is a global problem with lots of people trying to move the needle.  In this case, they’ve included the Care4Today app from Janssen.  This tool does include some functionality for the caregiver which is important.  It also links in charitable contributions as a form of motivation.  We talked about the reality that adherence is really complex, and people are different.  This may work for some, but adherence can vary by individual, by condition, and by medication.  But, they hope that this is a tool that may work to nudge some people.

I was also glad to see them taking on the issue of stress by adding the meQ app.  This is a key struggle, and Martha pointed out to me that 1/4 of adults are either stressed or highly stressed.

“When people are under chronic stress, they tend to smoke, drink, use drugs and overeat to help cope.  These behaviors trigger a biological cascade that helps prevent depression, but they also contribute to a host of physical problems that eventually contribute to early death…” – Rick Nauert, PhD for National Institute of Mental Health, 5/2010

She mentioned that they’ve gotten a great reception to this program, but they have a lot more to learn.  They’re still in the early period of getting insights and interconnecting all of their efforts.  We also talked about some of the upcoming opportunities with the caregivers (or the sandwhich generation).  I personally think the opportunity to improve aging in place through a smart home strategy with remote monitoring is going to be huge of the next 10 years.

I did interview the Janssen people as a follow-up which I’ll post separately, but I also thought I’d include this video interview of Martha that I found.

Should Photos Replace Texting For Healthcare

I’ll admit that several people have asked me about this over the years.  If a picture is really worth a thousand words, would it be better to send someone a picture than a text message.  Perhaps a picture of me in my skinny jeans if I’m trying to lose weight.  Perhaps a picture of my grandkid if I’m trying to get healthy to run around the yard with them.  Perhaps a picture of my favorite vacation location to motivate me to stick with a health goal.  It’s an interesting question.

So, let’s start with tex messaging in healthcare.  When I think of using SMS (or texting) in healthcare, my first example is always Text4Baby which was a unique coalition of companies that worked with Voxiva to get this launched.

Text4baby_522f5f55154ee_w1500

Of course, Voxiva has since expanded to offer other programs:

Voxiva

And, I think there are some business cases out there around using SMS to interact and change behavior in healthcare.  The Center For Connected Health in Boston with Dr. Joseph Kvedar has been studying this in several settings.  Here’s one poster from them on a pilot.  Here’s a good summary of what had happened as of 2012 from MobiHealth News.

Here’s a few other studies:

I could go on, but I think you get the point.  Lots of people have tried using text messaging as a low-cost but potentially effective way to get messages to consumers about a specific health behavior.  Especially in other countries, this can be the preferred method.

But, we always talk about the fact that people remember pictures better than words.  And, culturally, we’ve become a society that takes pictures of everything.  We share those pictures on Facebook and Pinterest and Twitter and other social media tools.  And, in many cases, we’re obsessed with infographics as a means of delivering information.  So, why not use them more in healthcare communications?

There is some research out there to support this topic:

I was thinking about my interview with Aetna about CarePass and what CarePass was doing, and it seemed to create a good example.  Would I rather a text that reminded me about my goal or the picture on the right?

whats your healthy ad2

Additionally, I know in discussions with Vic Strecher, co-founder of HealthMedia, that we’re talked about the value of customizing imagery on letters to personalize and engage consumers.  I just can’t find anything published by them right now to show that they studied that.

So, as we think about motivating people and sending them reminders, I think it would be really interesting to see the results of a picture driven process versus a written communication.  Is it the same effect?  Does it vary?  By age, gender, type of action?  Of course, the one thing I would recommend is letting the consumer upload and pick their picture not picking from some general list of canned photos.


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