Archive | May, 2014

New CVS Caremark Offering – Specialty Connect

First CVS Caremark began offering mail order (90-day Rxs at lower cost) at retail stores (aka Maintenance Choice), and now with Specialty Connect, they are doing the same thing in specialty pharmacy.  

Specialty Connect was a pilot program that won the PBMI Innovation Award this year.  What it does is to allow consumers the choice of getting their specialty medications at either the CVS Caremark specialty pharmacy or picking them up at a local store.  This is a change since: (1) many pharmacies don’t typically stock specialty medications; (2) many PBMs require use of a specialty pharmacy (i.e., mail); and (3) specialty medications typically require some addition handling and counseling which may be difficult to do at a local store level.

But, this is a very consumer friendly solution, and it has had some positive initial success.  Here’s a quote and some data from their press release: (some additional data in the original PBMI document)

“Specialty Connect helps specialty patients with these critical therapies by helping to eliminate common challenges they had often faced and by offering them flexibility and choice,” said Alan Lotvin, M.D., Executive Vice President of Specialty Pharmacy for CVS Caremark. “The program makes it easier and more convenient for patients to submit and receive their specialty prescriptions either through CVS/pharmacy or by mail. What’s more, it increases medication adherence, improves outcomes and lowers overall health care costs for specialty patients and payors.”


Specialty Connect has demonstrated high levels of patient satisfaction as well as improved adherence for specialty pharmacy patients. In fact, pilot program results demonstrated a 13 percentage point increase (from 66 to 79 percent) in patients who were optimally adherent to their medication. Early program results also show that the program is improving upon the patient experience and reducing traditional barriers to getting started on medication, with 97 percent of patients successfully starting on therapy after only their first interaction at a CVS/pharmacy store. In addition, more than half of patients, many of whom were existing mail service pharmacy customers, chose to pick up their specialty medications at CVS/pharmacy.

Hopefully, this and many of the other CVS Caremark successes will make people wonder why they ever wanted to break the company up into different business units.  As I’ve said for years on the blog, in the press, and to many Wall Street analysts, the integration of the business units can offer huge value once the synergies are realized and the consumer experience is integrated.  

The other interesting things that I thought about when reading about Specialty Connect were:

  • It’s great to offer a centralized call center to support specialty but will that be enough at the local store level?  Will patients want some type of higher touch local presence?  Can that be achieved through a telemedicine or kiosk type solution?  
  • I remember about 5 years ago when most specialty people thought they had to treat patients with specialty diseases differently.  I kept trying to argue that they are just like other consumers.  You should think about the experience across channels and at the patient not just condition level.  This seems to signal a movement towards this.  They are using SMS (text messages) and other channels to communicate with them which was a foreign concept a few years ago.

Top 25 Wikipedia Health Topics

The IMS Institute for Healthcare Informatics published a report in January called “Engaging Patients Through Social Media“.

One of the things it highlighted is the incredible use of Wikipedia for healthcare information.  People are typically going to Google and looking for a disease.  Based on Wikipedia’s page rankings, this often leads them there.



Now, what makes this more interesting is the article in the BBC News which says that 90% of wikipedia articles on health contain errors.

Of course, the trick in reading the article closely is that it says they found that “90% of the entries made statements that contradicted latest medical research”.  What’s the difference?  Well, we know that it takes years for evidence-based medicine to become adopted within healthcare.  So, how long does it take the latest medical research to get updated on all the sites?  What I would love to see is a comparison of Wikipedia to WebMD, Ebix, and Healthwise.  That would be telling.

Great #BigData JAMA Image Missing Some Data Sources

JAMA image data

When I saw this article and image in JAMA, I was really excited.  It’s a good collection of structured and unstructured data sources.  It reminded me of Dr. Harry Greenspun’s tweet from earlier today which points out why this new thinking is important.


But, it also made me think about this image and what was missing.  The chart shows all the obvious data sources:

  • Pharmacy
  • Medical
  • Lab
  • Demographic
  • EMR / PHR

It even points out some of the newer sources of data:

  • Facebook
  • Twitter
  • Online communities
  • Genetics

But, I think they missed several that I think are important and relevant:

  1. Structured assessments like the PHQ-9 for depression screening or the Patient Activation Measure.
  2. Communications data like:
    • How often do they call the call center?
    • What types of questions do they have?
    • Do they respond to calls, e-mails, SMS, letters, etc?
    • Have they identified any barriers to adherence or other actions (e.g., vaccines)?  Is that stored at the pharmacy, call center, MD notes?
  3. Browser / Internet data:
    • This could be mobile data from my phone.
    • What searches I’ve done to find health information.  What have I read?  Was it a reliable source?
  4. Device data (e.g., FitBit):
    • What’s my sleep pattern?
    • What am I eating?
    • How many steps do I walk a day?
  5. Income information or even credit score type data

These things seem more relevant to me than fitness club memberships (which doesn’t actually mean you go to the fitness club) or data which isn’t very personalized (to the best of my knowledge).

In some cases, just simply understanding how consumers are using the healthcare system might be revealing and provide a perspective on their health literacy.

  • Do they call the Nurseline?
  • Do they go to the ER?
  • Do they have a PCP?
  • Do they use the EAP?

We’d like to think this was all coordinated (and sometimes scared into believing that it is), but the reality is that these data silos exist with limited ability to track a patient longitudinally and be sure that the patient is the same across data sources without a common, unique identifier.

Novartis And Curing Cancer

The 5/26/14 edition of Forbes has a great article on Novartis called “Will This Man Cure Cancer?”.  It’s an interesting article and Novartis has really ramped up their focus on Oncology with their purchase of Glaxo’s Cancer drugs.  And, they recently got FDA approval for a lung cancer drug of theirs.  

The article talks about Joseph Jimenez’s leadership at Novartis and highlights several interesting things:

  • A focus on speed to stop having to turn patients away from a possible cure.
  • Cancer drugs already represent $11.2B of Novartis’ $58B in sales.
  • Novartis has a 33% stake in Roche which has $31B in oncology sales.
  • Gleevec was it’s big breakthrough oncology drug that Jimenez’s predecessor believed in and has been so successful that it’s a $4.6B drug where they’ve been able to quadruple the price.
  • It talks about transforming the campus working with architects like Frank Gehry and moving research to Cambridge, MA.

There is some discussion on a new therapy that they’re working on based on some initial trials which uses CARTs (Chimeric Antigen Receptor T-Cells) to attach cancer.  At the same time, Juno Therapeutics is on the same trail and raised $175M in their first round to research it.    

I really liked one quote from Jimenez in the article that seems to imply a focus on the end goal not necessarily whether they win.  

“You look at a company like Celgene, and you know they’re going to figure it out.  And they should figure it out.  It will be good for patients.  We want to beat the competition, but we’re really using the competition to trigger us to get to the patient.”

He goes on to talk about the issue of pricing especially around oncology drugs (but also applicable to specialty drugs in general).  He calls it “a new brutal world” because costs will go up with the aging population and new medicines which will cause more backlash against price.  He talks about looking at how to be innovative about pricing which could be interesting.  

EMD Serono Specialty Digest 10th Edition – A Few Highlights

This is definitely worth a read.  They have it nicely packaged up with a slide deck also once you register.  Here’s a few highlights.

Look at the gap between perceived value and satisfaction with clinical programs offered by specialty pharmacies.




Look at the huge jump in plans to educate physicians.  


Look at the different adherence management strategies.  I’m amazed at the low percentage using an outside vendor but the huge perceived effectiveness.  


Look at some of the benefit strategies that companies are planning to use.



This is an interesting one that shows that companies are really going to focus on controlling specialty benefits in the exchange world in the future.  


This shows the variation in terms of coverage (medical versus pharmacy) for different categories of drugs.


There’s more in the deck and report, but these should be enough to tease you to read more.  




Continued Discussion On Specialty Care Coordination

“Payers are primarily dissatisfied with their specialty pharmacy’s ability to document the interventions they say they are performing. As pharmacies compete on price and service, they will need to be able to efficiently document the services they perform in order to differentiate themselves in the marketplace.”

— Debbie Stern, R.Ph., president of Rxperts, Inc., an Anaheim-based consulting firm, told AIS’s Drug Benefit News for a story on the new EMD Serono Specialty Digest.

I like this quote from Debbie.  It reminds me of my post from the other day “Care Is Coming To Your PBM” and is very much in line with the article I tweeted yesterday – Pharmacy Chains Continue To Blur The Line.

The point is that complex conditions like oncology are a lot more than simply filling the drug.  To be truly patient-centric, you need to be able to answer all these questions:

  1. Were they diagnosed correctly?
  2. Were they staged correctly?
  3. Did the provider follow evidence-based care?  From NCCN?  From a particular pathway?
  4. Did they get all the genetic tests done?  
  5. Did they get too many tests?
  6. Are they prescribed the right drug?  Will that drug limit any future options for care?
  7. Is the drug covered on formulary?  If not, are there other ways to reduce the out-of-pocket costs to the member?
  8. Is it a limited distribution drug?  
  9. Do they understand the side effects of the drug and/or treatment?
  10. What does the patient want?  What do they know?
  11. Do they have a caregiver?  How are they involved?
  12. Are they getting the drug at the right site-of-care?
  13. Are they working with a case manager?  How is their care being coordinated?  
  14. What’s the survival rate?
  15. Are there implications for ongoing care as a cancer survivor?  How will they be coordinated?
  16. If they need palliative care, what are their wishes?  Does the family, patient, and provider all agree?

Cancer is a great example of where everything comes together from a care coordination, testing, diagnosis, delivery, and pharmacy perspective.  At the same time, we know that patients still see multiple doctors who don’t coordinate their care.  We know they get mis-diagnosed.  We know that don’t stay adherent with their medications.  We know they don’t always articulate their wishes.  And, we know the amount of care spent in the last months of life is disproportionate (IMHO) to the minor life extension which they get (often in less than optimal conditions).  

Here’s a good summary of some key data from the EMD Serono report:


Humana – Most Improved In Customer Service Report

I always enjoy Bruce Temkin’s reports and analysis.  He just came out with his latest report on customer service.  

It’s not a healthcare focused report so you have to gleam a few things from his summaries although you can buy the report to see the details by company.  Without doing that, I thought I’d point out a few things from his charts.

1. Humana was the most improved (of all companies) in terms of customer service.  Great job.  Coventry (which was bought by Aetna) had the biggest drop (of all companies) in terms of customer service.  [Perhaps not a big surprise as integrations can always be tough.]


2. As it has in past years, healthcare continues to be at low end of the spectrum in terms of customer service.  While you can divide up the market into pharmacies, physicians, hospitals, PBMs, and insurance companies (with many other players out there), one of the biggest groups which is covered in the survey is health insurance companies.  They fall below airlines and way below other types of insurance companies – i.e., auto / home.


3. Five of the bottom 20 companies he highlights on his blog are all health insurance companies.  [But, you’ll have to click through to see who!]

Seems like a great opportunity for someone to help those and the entire industry to think differently about customer service and consumer engagement.  

Who Is Hubbub Health?

“Hubbub is a technology-driven online playground and mobile wellness solution that uses social circles and gamification to motivate and engage people in healthy behaviors.”


Several people have suggested I take a look at what Hubbub Health is doing so I did.  At first glance, there were several things that caught my attention (beyond the interesting teaser description of the company):

  • Lots of unconventional language in how they talk (reminds me of the Wellpoint Tonik Healthcare business from years ago)
  • A direct to consumer model where you can download the app and use their tool AND a $3 PMPM (per member per month) model for employers which includes additional services like health coaching (most people aren’t in both markets)

Of course the question is whether this is just another one of many mobile companies making a play in healthcare or whether they’ll actually survive for a few years and get traction.  

But, Hubbub isn’t just another one of the many wellness vendors out there.  They’re part of Cambia Health.  You’ve probably still never heard of them, but Cambia is Regence which is a BCBS plan operating in Oregon, Idaho, Utah, and some counties in Washington.  Additionally, they own and/or invest in lots of companies – e.g., HealthSparq, GNS Healthcare, OmedaRx, and Wellero (plus Hubbub).

So, this gives them some instant credibility.  And, it’s an interesting time in the market.  The Population Health Alliance (which used to be the Care Continuum Alliance) recently put out a post looking for contributions around “Return on Value” or VOI (Value on Investment) which is the focus these days in Population Health Management. 

This sounds a lot like what you see in the presentation and white paper by Hubbub.


What was more interesting was some of the foundational elements upon which Hubbub was built like:

Cognitive Evaluation Theory (CET) concerns intrinsic motivation, motivation that is based on the satisfactions of behaving “for its own sake.”  Prototypes of intrinsic motivation are children’s exploration and play, but intrinsic motivation is a lifelong creative wellspring. CET specifically addresses the effects of social contexts on intrinsic motivation, or how factors such as rewards, interpersonal controls, and ego-involvements impact intrinsic motivation and interest. CET highlights the critical roles played by competence and autonomy supports in fostering intrinsic motivation, which is critical in education, arts, sport, and many other domains. (source)


Self-Determination Theory (SDT) represents a broad framework for the study of human motivation and personality. SDT articulates a meta-theory for framing motivational studies, a formal theory that defines intrinsic and varied extrinsic sources of motivation, and a description of the respective roles of intrinsic and types of extrinsic motivation in cognitive and social development and in individual differences. Perhaps more importantly SDT propositions also focus on how social and cultural factors facilitate or undermine people’s sense of volition and initiative, in addition to their well-being and the quality of their performance.  Conditions supporting the individual’s experience of autonomy, competence, and relatedness are argued to foster the most volitional and high quality forms of motivation and engagement for activities, including enhanced performance, persistence, and creativity. In addition SDT proposes that the degree to which any of these three psychological needs is unsupported or thwarted within a social context will have a robust detrimental impact on wellness in that setting. (source)

Those are foundational for a lot of the work in healthcare, and I liked this graphic about motivation. 


Whether the app works and captures my attention is still TBD.  I did download it and register, but I didn’t really get engaged upon registration.  And, the website seemed better than the mobile app, but it still had a few issues in terms of how the large top image dominated most of my screen on my laptop.  

At the end of the day, their key role like anyone in this space is to figure out how to engage the consumer (or patient or member or individual) as validated in a study they use.


A Great Health Add-on To Your HVAC System

In the spirit of the Internet of Things and the Smart Home, I was intrigued by a short article I read about Menssana Research which can identify 2,000 chemical compounds from our breadth…including signs of cancer and radiation exposure.  Pretty cool!


I guess this explains how dogs can detect diseases in humans. 

Of course, my mind jumped to the idea of how you could use existing devices (like Nest) which would be tied into our HVAC system and could monitor the overall air in an entire house and look for risks based on the air.  (like my idea of the smart toilet)  Maybe that’s a little too scary like why an underwriter wants your cell phone data or too much like the Snapshot from Progressive.  And, while on the one hand it’s cool, I’m not always sure we’re ready to know things too much in advance so the question would really be how early is the device identifying people and how accurate is it.  

Innovative Ideas For A Weight Loss Company

As I’m enjoying my time thinking about what’s next, one of the things that I’ve thought a lot about key problem areas in our healthcare system.  Obviously obesity is one of them.  And, you have lots of companies trying to figure out what to do here.  

So, I was thinking about what I would do if I were at a Weight Watchers or Jenny Craig or Vree Health

  1. Build an assessment tool (like Milliman or InterQual) which could be used for assessing patients and creating an evidence-based care plan.
  2. Work with KitchenAid or others to create a branded line of smart devices which used the Internet of Things to do things like re-order healthy foods and suggest menus.
  3. Work with Jiff’s assessment tool or with Newtopia to study the ability to take data and create personalized diet plans.
  4. Work with FitBit or other device company and a gamification company to create a kid’s device linked to a game where the key player got fat tied to their activity level and where they opened up new levels tied to their behavior (e.g., eating healthy).
  5. Create online communities for people to share stories and experiences (like PatientsLikeMe but moderated).
  6. Move from physical locations to a virtual site using American Well technology blended with Withings scales.
  7. Incorporate stress management and sleep management into the overall program.
  8. Work with Healthways and the Blue Zones effort to create a family centric option tied into the schools and focused on getting everyone healthy across generations.
  9. Create a mobile coach using embodied conversational agents (similar to avatars) to drive behavior change and create a location-based prompts (i.e., as I pull into McDonalds).
  10. Work with manufacturers to create a “beyond the pill” approach to obesity drugs that incorporates coaching and behavior change with the pill being the final mile which should drive greater formulary coverage.
  11. Create a detailed patient journey map based on ethnographic research for weight loss with different triggers and create a “Coach certification” that can be used with coaches to certify that they are following best practices.
  12. Work with biometrics companies (e.g., LabCorp, Quest) or clinics (e.g., MinuteClinic) to create an early identification process for obesity and/or metabolic syndrome with a process for them to “prescribe” a specific program.
  13. Research and design ethnic specific obesity related programs for sub-populations within the US.  For example, partner with the large Hispanic groups to create a Spanish (language, experience, culturally relevant) programs.
  14. Partner with the ADA and NKF to jointly address metabolic syndrome together.
  15. Work with the AMA and medical schools to teach MDs how to treat and talk with obese patients (something they don’t do well today).
  16. Work with a grocery store or food company to create an augmented reality process for smart phones or Google Glass that would highlight healthy foods on the shelf and help people shop better.
  17. Work with Medicaid to create a process by which people earned cell phone minutes or lower copays based on activity and participation.  

Just some ideas that I thought I’d share.  

Reconciling Legal Marijuana With Drug Prevention

As the parent of kids, I’m obviously concerned about what they do as they grow up.  On the one hand you want them to learn to make decisions.  On the other hand, you don’t want to endanger them.  That requires helping them to understand right from wrong.  That requires helping them to make smart decisions and understand the long-term implications of them.

This is where I struggle with the modern attitude towards the legalization of marijuana.  While it may not be a “gateway drug” according to science, it is certainly highly correlated with future drug use, and it has a negative impact on health.  Additionally, it’s addictive for about 10% of people and more addictive when you’re younger.

As someone who has watched people throw away their life on drugs and the son of someone who worked in drug and gang rehabilitation centers, I personally see it as a slippery path.  I agree that alcohol may be the gateway “drug” when not used appropriately and can be very dangerous for kids and for many adults who can’t control themselves.  You can find lots of research on alcohol related deaths due to increased disease burden or simply drunk driving.

So, like many health related topics, the information out there is very confusing for our kids.  On the one hand, we point out what your brain looks like on drugs (if you remember the PSA from the 80s and 90s).


On the other hand, we talk about medical marijuana, and we have states where it’s now legal to buy marijuana like Colorado.  But, the idea of walking down the street and seeing cannabis stores is crazy to me.


Perhaps a sad sign of this issue is the spike in travel to Colorado especially around Spring Break.  They’ve also seen an enormous jump in applications to go to college in Colorado.  (I think I’ll bet on causality not just correlation here.)

At the end of the day, I think we want to keep our kids safe and help them avoid anything addictive – tobacco, drugs, and alcohol.  (And, yes…you could take this further to look at caffeine or sugars or other things that impact their health.)  At a minimum, we want to help them understand the facts and make sure they know the risks and determine if they fit the addictive profile or not.  They already have a hard time navigating childhood and adolescence…let’s be careful not to make it too easy for them to fall off track.   Unfortunately, decisions like this  have broader implications on our next generation even if they don’t actually use marijuana.

Of course years ago, we used opium, cocaine, and herion as medicine also…but we outgrew that phase of “modern healthcare” so maybe this too will pass.

As Demand For Healthcare Services Goes Up, Satisfaction Goes Down

This statement alone should scare anyone as you think about all the new consumers coming into the healthcare system.  That will only stress the system more leading me to believe we’ll see bigger drops in satisfaction in the years to come.  

This data is from the latest American Customer Satisfaction Index (ACSI).  You can see a blurb on them below along with the full ranking of different industries.  Not surprising, healthcare isn’t at the top, but let me highlight a few of the categories:

  • Ambulatory Care = 79
  • Health and Personal Care Stores = 79
  • Hospitals = 76
  • Health Insurance = 73

In general, I found the industries to be very tightly clustered.  I’m going to reach out to them to see how to interpret that.  


About ACSI

The American Customer Satisfaction Index (ACSI) is a national economic indicator of customer evaluations of the quality of products and services available to household consumers in the United States. The ACSI uses data from interviews with roughly 70,000 customers annually as inputs to an econometric model for analyzing customer satisfaction with more than 230 companies in 43 industries and 10 economic sectors, as well as over 100 services, programs, and websites of federal government agencies.

ACSI results are released throughout the year, with all measures reported on a scale of 0 to 100. ACSI data have proven to be strongly related to a number of essential indicators of micro and macroeconomic performance. For example, firms with higher levels of customer satisfaction tend to have higher earnings and stock returns relative to competitors. Stock portfolios based on companies that show strong performance in ACSI deliver excess returns in up markets as well as down markets. And, at the macro level, customer satisfaction has been shown to be predictive of both consumer spending and GDP growth.


The Similarities Between Consultants And Entrepreneurs

I’ve been thinking a lot about the excitement of being an entrepreneur or an innovator and how that compares with being a consultant.  While I could find a few articles out there comparing these two career paths, I thought I would share my observations.  

I think the two have some of the same fundamentals:

  1. Self-motivator – In both cases, you have to able to drive yourself.  You’re responsible for your career and your success.  You’re always under pressure to perform, and you’re typically part of a small, core team.  It’s important that you can motivate yourself to push past the finish line.  I think of both like running a marathon.  
  2. Quick learner – Your role in both types of organizations is constantly changing.  You’re adapting with the business and the market.  This requires the ability to understand and see trends.  It requires the ability to connect with clients and monitor the market.  It requires the ability to learn new things and to have a desire to learn new things.  
  3. Able to pivot quickly – Change is a constant in almost any role in business today, but the pace of change in the start-up world is amazing.  You need to understand this pace of change and how to be a change agent in both these roles.  How do you help people with the organizational change that’s required to make your project a success.  
  4. PPTS – No…this isn’t being an expert at PowerPoint although that may be an important skills.  PPTS stands for People, Process, Technology, and Strategy.  You need to understand all four of these areas of the business.  You don’t have to code to be a great consultant or entrepreneur, but you need to understand technology and its impact on business.  
  5. Think and do – While there are a few opportunities to just develop strategy and move on or to simply operate an outsourced project, I think you need to understand how to take ideas from concept through implementation.  This means that you understand how to work with the CEO and how to work with the call center agent.  
  6. Motivational – Most entrepreneurs and consultants are somewhat evangelistic and they’re always involved in the selling process (in any role).  They are selling and building ahead of the curve which means they have to compel people to act.  They are also working with multiple vendors and cross-functional teams that don’t report to them.  Success is dependent on their people skills and the ability to motivate these different groups.  

Agree?  Disagree?  Thoughts?


Getting Back Into The Pharmacy Industry

After working at Express Scripts for almost 5 years and then selling into the PBM industry for almost 5 years, I’ve had the chance to lead and work on a ton of very interesting projects:

  • Electronic prescribing
  • Generic sampling
  • Generic promotion – DTC, plan design, utilization management
  • Formulary support programs
  • Mail order promotion – mandatory mail, retail-to-mail, 90-day
  • Prilosec and Claritin going from Rx to OTC
  • Adherence
  • Pill splitting
  • $0 copay / VBID

I’ve found that I love business development (working with clients and vendors).  I enjoy bringing ideas from concept through pilots and then determining how to scale them.  I love doing research and presenting.  I enjoy working cross functionally.  I enjoy leading teams and pushing the envelope to get people to think different.  Ultimately, I enjoy solving problems.  I like being the person who’s brought in with a business challenge and can then figure out the solution – do the research, evaluate the options, create a plan, implement the plan, and create a process of continuous improvement.

So, after spending 2 years working in the care management side of healthcare and learning about case management, disease management, claims code editing, and other solutions to manage complex patients with cancer or chronic kidney disease, I’m ready to jump back into the pharmacy industry (specialty, PBM, retail, pharma, payers or related companies).  (And, I’ll be bringing a lot of lessons learned with me.)

I think the industry is going through another inflection point which is what Mark Merritt from PCMA pointed out a few years ago is the core skill – adaptability.  If you think about the trends, I think there are several key things that make this an interesting time to be in the industry.  And, everyone is fighting commoditization by trying to differentiate themselves.

And, the fundamentals are good for the industry.

  1. The PBMs are big and need to grow so they’ll have to do some creative things.
  2. People continue to get older and take more medications.
  3. Health reform is forecasted to grow the market by over $200B in the next 10 years.  (from recent CatamaranRx presentation on their investor website)Image

Of course the question is what to do…

All of these things sound interesting, but here’s what I’m going to focus on:

  • A company with an entrepreneurial (or intrapreneurial culture).
  • A role working directly with clients (no Ivory Tower role).
  • A mission driven organization which wants to change the world and improve outcomes.
  • A passionate leader and team that I can learn from.
  • A leadership role where I can help a PBM or payer (or a group of them as a consultant) help make this transformation.  Some of the roles that would interest me would be:
    • MD strategy
      • Adherence
      • ACOs
      • Shared risk
      • Evidence-based care
    • Consumer experience
      • Journey mapping
      • Consumer advocate
      • Incentives
      • Gamification
      • Plain language
      • Patient Activation
    • Consumer engagement
      • Multi-channel coordination (print, web, IVR, mobile, SMS, F2F, telehealth)
      • Big data
      • Segmentation
      • A-B testing
      • Social media
    • mHealth / Care coordination
      • Risk and segmentation algorithms
      • Coordination with caregivers and providers
      • Remote monitoring
      • Working with clinics and telehealth
    • Beyond The Pill
      • Obesity
      • Chronic Kidney Disease
      • Oncology
      • Diabetes
    • Innovation and business development

(If you know of something interesting, let me know.)

Care Is Coming To Your PBM

The creation of the “softer, gentler” PBM is one of my predictions driven by the rise in specialty pharmacy. While generic fill rates and mail order penetration still matter to earnings, the focus across the industry is on specialty. 

  • What can we expect in terms of pipeline?
  • How and when will genetic tests be required? (i.e., companion diagnostics)
  • How can we treat the patient not just fill the drug?

This will bring back a focus on how pharma and the PBMs work together which has had a bumpy past. Initially the two were very close. Then, with the rise of generics and more trend programs like prior authorization and step therapy, the PBMs and pharma butted heads frequently.

Of course, the situation for pharma has changed also. They are trying to figure out how to go “beyond the pill” and create new consumer relationship and make money. (Here’s a good article about pharma and digital from the other day.)

In case you missed them, here’s a few other things that are relevant:

And, I think this screenshot from the Barclays Global Healthcare Conference Presentation given by Express Scripts shows that they are focused on this care and delivery intersection by continuing to show the success from the Therapeutic Resource Centers.


So, what do you think?  Will the PBMs become more care management focused?  Will they integrate with the other care providers?  Will this be the beginning of their focus on working with ACOs and PCMHs?  Will this change their approach?  Will we see PBMs differentiating around key, chronic diseases like the specialty pharmacies have done?  Will this create an opportunity for integrated PBMs (i.e., Humana, Cigna, Aetna) to differentiate?  

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